Abstract
We investigated whether responses to as-needed intravitreal aflibercept injections (IAIs) for polypoidal choroidal vasculopathy (PCV) differed among patients based upon drusen characteristics in fellow eyes. 110 eyes from 110 patients with PCV received 3 monthly IAI and thereafter Pro re nata (PRN) IAI over 12 months. Patients were classified into 4 groups depending on fellow eye findings. Group 1 (n = 16): pachydrusen; Group 2 (n = 45): no drusen; Group 3 (n = 35): soft drusen; Group4 (n = 14) PCV/scarring. Best-corrected visual acuity improved at 12 months in all groups, but not significantly in Group 1 and Group 4; however, visual improvement was similar among the groups after adjusting baseline confounders. Group 1 had a significantly lower percentage of eyes needing retreatment (all p < 0.001; Group 1: 16.7%; Group 2: 50.8%; Group 3: 80%; Group 4: 85.7%). The mean number of retreatments was least in Group 1 among the groups (all p-value < 0.003; Group 1: 0.50 ± 1.32; Group 2: 1.73 ± 2.08; Group 3:2.71 ± 1.99; Group 3: 2.71 ± 2.16). Patients with pachydrusen in fellow eyes were less likely to require additional IAI following the loading dose and may be ideal candidates for aflibercept monotherapy in their first year.
Highlights
Polypoidal choroidal vasculopathy (PCV) is considered a variant of exudative age-related macular degeneration (AMD) characterized by clinical features including type 1 neovascularization with terminal aneurysmal dilation, seen on indocyanine green angiography (ICGA) [1]
Group 1 was youngest among the 4 groups. (p = 3.4×10-4) and subfoveal choroidal thickness in Group 1 was greatest among the 4 groups. (p = 2.2×10-3) T allele frequency was significantly lower in Group 1 compared with other groups. Pseudodrusen were not seen in this cohort
It is well known that Age-related maculopathy susceptibility2 (ARMS2) A69S and Complement factor H (CFH) I62V are major genetic variants susceptible to exudative AMD including PCV in Asians [9,22]
Summary
Polypoidal choroidal vasculopathy (PCV) is considered a variant of exudative age-related macular degeneration (AMD) characterized by clinical features including type 1 neovascularization (located between retinal pigment epithelium and Bruch’s membrane) with terminal aneurysmal dilation, seen on indocyanine green angiography (ICGA) [1]. In a Japanese clinic-based study, the prevalence of PCV was reported to be almost half of the patients with advanced AMD [2]. In 2005, genome wide association studies revealed that Complement factor H (CFH) Y402H and Age-related maculopathy susceptibility (ARMS2) A69S were strongly associated with AMD in Caucasians [5,6]. Subsequent studies confirmed that these genes were associated with neovascular. Unlike Caucasians, I62V at CFH gene was found to have the strongest association with AMD in Asians [9]
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