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Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab.

Yamashita M, Nishi T, Hasegawa T, Ogata N - Clin Ophthalmol (2014)

Bottom Line: A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED.The visual acuity in this eye decreased from 10/20 to 2/20.The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan.

ABSTRACT

Purpose: To report the effects of aflibercept on eyes with large retinal pigment epithelial detachment (PED) associted with polypoidal choroidal vasculopathy (PCV).

Methods: We reviewed the medical records of patients with PEDs associated with PCV that were treated with aflibercept after intravitreal ranibizumab had failed.

Results: Three eyes of patients aged 72, 79, and 80 years were studied. Reflective material was seen in the PED along the outer surface of the retinal pigment epithelium (RPE) by spectral-domain optical coherence tomography (SD-OCT). A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED. In addition, one eye developed a retinal hemorrhage and a recurrent PED just after the third injection of aflibercept. The visual acuity in this eye decreased from 10/20 to 2/20.

Conclusion: The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization. Intravitreal aflibercept could be considered for large PEDs in eyes with PCV but should be carefully applied.

No MeSH data available.


Related in: MedlinePlus

Findings from case 1, a 79-year-old Japanese man with a large PED in the left eye with PCV.Notes: (A) Fundus photograph of the left eye at the initial examination showing a large serous retinal PED. His BCVA was 2/20 OS. (B) FA image of the left eye at the initial visit showing late leakage at the base of the PED suggestive of occult CNV and pooling of dye within the serous PED. (C) IA images at the initial visit showing hyperfluorescent spots in the choroidal circulation at the base of the PED suggesting the presence of polyps and hypofluorescence in the serous PED lesion. (D) Fundus photograph taken after three monthly aflibercept injections. The large serous PED is not present. (E) SD-OCT images of the left eye at the initial examination showing a large serous PED with SRF. The PED appears to be optically empty. Reflective material beneath the RPE layer (white arrow) suggestive of an occult CNV was detected that corresponded to the lesion of late leakage by FA. (F) SD-OCT image 6 months after three monthly injections of ranibizumab. Three monthly injections of ranibizumab slightly flattened the PED and reduced the SRF. However 6 months later, recurrent SRF and PED were observed. Hyper-reflective materials (white arrowhead) beneath the outer surface of the RPE can be seen. (G) SD-OCT image showing near resolution of the PED with complete resolution of the SRF after three additional monthly injections of ranibizumab (total of six injections). Sub-RPE materials (white arrowhead) can be seen even though the PED is collapsed. (H) One month after the last injection of ranibizumab, a recurrent large PED can be seen. (I) Flattened PED 2 weeks after a single aflibercept injection. Sub-RPE materials (white arrowhead) can be seen. (J) A complete resolution of the PED after the second injection of aflibercept, although reflective materials (white arrowhead), suggesting fibrovascular tissue, can be seen within the PED beneath the RPE layer. (K) SD-OCT image of (D). After three monthly injections of aflibercept, complete resolution of PED had a fibrovascular PED. BCVA remained 2/20 OS.Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; FA, fluorescein angiography; IA, indocyanine green; OS, oculus sinister; PCV, polypoidal choroidal vasculopathy; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SD-OCT, spectral domain optical coherence tomographic; SRF, subretinal fluid.
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f1-opth-8-343: Findings from case 1, a 79-year-old Japanese man with a large PED in the left eye with PCV.Notes: (A) Fundus photograph of the left eye at the initial examination showing a large serous retinal PED. His BCVA was 2/20 OS. (B) FA image of the left eye at the initial visit showing late leakage at the base of the PED suggestive of occult CNV and pooling of dye within the serous PED. (C) IA images at the initial visit showing hyperfluorescent spots in the choroidal circulation at the base of the PED suggesting the presence of polyps and hypofluorescence in the serous PED lesion. (D) Fundus photograph taken after three monthly aflibercept injections. The large serous PED is not present. (E) SD-OCT images of the left eye at the initial examination showing a large serous PED with SRF. The PED appears to be optically empty. Reflective material beneath the RPE layer (white arrow) suggestive of an occult CNV was detected that corresponded to the lesion of late leakage by FA. (F) SD-OCT image 6 months after three monthly injections of ranibizumab. Three monthly injections of ranibizumab slightly flattened the PED and reduced the SRF. However 6 months later, recurrent SRF and PED were observed. Hyper-reflective materials (white arrowhead) beneath the outer surface of the RPE can be seen. (G) SD-OCT image showing near resolution of the PED with complete resolution of the SRF after three additional monthly injections of ranibizumab (total of six injections). Sub-RPE materials (white arrowhead) can be seen even though the PED is collapsed. (H) One month after the last injection of ranibizumab, a recurrent large PED can be seen. (I) Flattened PED 2 weeks after a single aflibercept injection. Sub-RPE materials (white arrowhead) can be seen. (J) A complete resolution of the PED after the second injection of aflibercept, although reflective materials (white arrowhead), suggesting fibrovascular tissue, can be seen within the PED beneath the RPE layer. (K) SD-OCT image of (D). After three monthly injections of aflibercept, complete resolution of PED had a fibrovascular PED. BCVA remained 2/20 OS.Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; FA, fluorescein angiography; IA, indocyanine green; OS, oculus sinister; PCV, polypoidal choroidal vasculopathy; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SD-OCT, spectral domain optical coherence tomographic; SRF, subretinal fluid.

Mentions: We switched to aflibercept and, after one intravitreal injection, the PED was slightly flattened; two additional injections of aflibercept were given, which flattened the PED over the hyper-reflective material observed by SD-OCT. The BCVA remained at 2/20 OS (Figure 1).


Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab.

Yamashita M, Nishi T, Hasegawa T, Ogata N - Clin Ophthalmol (2014)

Findings from case 1, a 79-year-old Japanese man with a large PED in the left eye with PCV.Notes: (A) Fundus photograph of the left eye at the initial examination showing a large serous retinal PED. His BCVA was 2/20 OS. (B) FA image of the left eye at the initial visit showing late leakage at the base of the PED suggestive of occult CNV and pooling of dye within the serous PED. (C) IA images at the initial visit showing hyperfluorescent spots in the choroidal circulation at the base of the PED suggesting the presence of polyps and hypofluorescence in the serous PED lesion. (D) Fundus photograph taken after three monthly aflibercept injections. The large serous PED is not present. (E) SD-OCT images of the left eye at the initial examination showing a large serous PED with SRF. The PED appears to be optically empty. Reflective material beneath the RPE layer (white arrow) suggestive of an occult CNV was detected that corresponded to the lesion of late leakage by FA. (F) SD-OCT image 6 months after three monthly injections of ranibizumab. Three monthly injections of ranibizumab slightly flattened the PED and reduced the SRF. However 6 months later, recurrent SRF and PED were observed. Hyper-reflective materials (white arrowhead) beneath the outer surface of the RPE can be seen. (G) SD-OCT image showing near resolution of the PED with complete resolution of the SRF after three additional monthly injections of ranibizumab (total of six injections). Sub-RPE materials (white arrowhead) can be seen even though the PED is collapsed. (H) One month after the last injection of ranibizumab, a recurrent large PED can be seen. (I) Flattened PED 2 weeks after a single aflibercept injection. Sub-RPE materials (white arrowhead) can be seen. (J) A complete resolution of the PED after the second injection of aflibercept, although reflective materials (white arrowhead), suggesting fibrovascular tissue, can be seen within the PED beneath the RPE layer. (K) SD-OCT image of (D). After three monthly injections of aflibercept, complete resolution of PED had a fibrovascular PED. BCVA remained 2/20 OS.Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; FA, fluorescein angiography; IA, indocyanine green; OS, oculus sinister; PCV, polypoidal choroidal vasculopathy; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SD-OCT, spectral domain optical coherence tomographic; SRF, subretinal fluid.
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f1-opth-8-343: Findings from case 1, a 79-year-old Japanese man with a large PED in the left eye with PCV.Notes: (A) Fundus photograph of the left eye at the initial examination showing a large serous retinal PED. His BCVA was 2/20 OS. (B) FA image of the left eye at the initial visit showing late leakage at the base of the PED suggestive of occult CNV and pooling of dye within the serous PED. (C) IA images at the initial visit showing hyperfluorescent spots in the choroidal circulation at the base of the PED suggesting the presence of polyps and hypofluorescence in the serous PED lesion. (D) Fundus photograph taken after three monthly aflibercept injections. The large serous PED is not present. (E) SD-OCT images of the left eye at the initial examination showing a large serous PED with SRF. The PED appears to be optically empty. Reflective material beneath the RPE layer (white arrow) suggestive of an occult CNV was detected that corresponded to the lesion of late leakage by FA. (F) SD-OCT image 6 months after three monthly injections of ranibizumab. Three monthly injections of ranibizumab slightly flattened the PED and reduced the SRF. However 6 months later, recurrent SRF and PED were observed. Hyper-reflective materials (white arrowhead) beneath the outer surface of the RPE can be seen. (G) SD-OCT image showing near resolution of the PED with complete resolution of the SRF after three additional monthly injections of ranibizumab (total of six injections). Sub-RPE materials (white arrowhead) can be seen even though the PED is collapsed. (H) One month after the last injection of ranibizumab, a recurrent large PED can be seen. (I) Flattened PED 2 weeks after a single aflibercept injection. Sub-RPE materials (white arrowhead) can be seen. (J) A complete resolution of the PED after the second injection of aflibercept, although reflective materials (white arrowhead), suggesting fibrovascular tissue, can be seen within the PED beneath the RPE layer. (K) SD-OCT image of (D). After three monthly injections of aflibercept, complete resolution of PED had a fibrovascular PED. BCVA remained 2/20 OS.Abbreviations: BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; FA, fluorescein angiography; IA, indocyanine green; OS, oculus sinister; PCV, polypoidal choroidal vasculopathy; PED, pigment epithelial detachment; RPE, retinal pigment epithelium; SD-OCT, spectral domain optical coherence tomographic; SRF, subretinal fluid.
Mentions: We switched to aflibercept and, after one intravitreal injection, the PED was slightly flattened; two additional injections of aflibercept were given, which flattened the PED over the hyper-reflective material observed by SD-OCT. The BCVA remained at 2/20 OS (Figure 1).

Bottom Line: A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED.The visual acuity in this eye decreased from 10/20 to 2/20.The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan.

ABSTRACT

Purpose: To report the effects of aflibercept on eyes with large retinal pigment epithelial detachment (PED) associted with polypoidal choroidal vasculopathy (PCV).

Methods: We reviewed the medical records of patients with PEDs associated with PCV that were treated with aflibercept after intravitreal ranibizumab had failed.

Results: Three eyes of patients aged 72, 79, and 80 years were studied. Reflective material was seen in the PED along the outer surface of the retinal pigment epithelium (RPE) by spectral-domain optical coherence tomography (SD-OCT). A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED. In addition, one eye developed a retinal hemorrhage and a recurrent PED just after the third injection of aflibercept. The visual acuity in this eye decreased from 10/20 to 2/20.

Conclusion: The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization. Intravitreal aflibercept could be considered for large PEDs in eyes with PCV but should be carefully applied.

No MeSH data available.


Related in: MedlinePlus