Original article
Factors Influencing the Treatment Response of Pigment Epithelium Detachment in Age-Related Macular Degeneration

https://doi.org/10.1016/j.ajo.2015.06.025Get rights and content

Purpose

To study the effect of various baseline factors, particularly the type of drug (ranibizumab vs aflibercept), on the functional and anatomic response of treatment-naïve pigment epithelial detachment (PED) associated with neovascular age-related macular degeneration (neovascular AMD), after 3 intravitreal injections.

Design

Retrospective consecutive case series.

Methods

This study included 102 patients (n = 115 eyes) with treatment-naïve neovascular AMD and PED (>150 μm), who were treated with either ranibizumab (n = 68 eyes) or aflibercept (n = 47 eyes). A multivariate analysis using stepwise linear regression was performed in order to assess factors influencing visual acuity improvement, as well as treatment response of PED height after 3 monthly injections.

Results

Multivariate analysis revealed that better visual improvement was associated with lower best-corrected visual acuity (BCVA) at baseline (P = .001), presence of subretinal fluid (P = .001), and retinal angiomatous proliferation (P = .001); PED reduction was associated with higher PED at baseline (P = .001), predominantly serous PED (P = .003), and the use of aflibercept (P = .022). Drug type was not associated with change in BCVA at 3 months.

Conclusion

Eyes with neovascular AMD and PED showed significant functional and anatomic response after 3 monthly intravitreal anti-VEGF injections. The functional response depended on baseline BCVA, presence of subretinal fluid, and retinal angiomatous proliferation, while anatomic response was influenced by baseline PED height, degree of vascularization, and drug type. Drug type was not associated with change in BCVA, but had a weak effect on anatomic response.

Section snippets

Methods

This is a retrospective consecutive case series that was performed in the Jules-Gonin University Eye Hospital in Lausanne, Switzerland. The study was approved by the Swiss Federal Department of Health for retrospective data analysis, and was performed in accordance with the ethical standards of the Declaration of Helsinki.

In this study, we identified a consecutive series of eyes with treatment-naïve active neovascular AMD with PED that were treated with intravitreal anti-VEGF injections between

Results

In this study we assessed 115 eyes of 102 patients. The mean age of the patients was 80 ± 7.8 years, and the male-to-female ratio was 0.44. The angiographic type of CNV at baseline was occult in 61.7% (71 of 115), minimally classic in 19.1% (22 of 115), classic in 4.3% (5 of 115), and retinal angiomatous proliferation (RAP) in 14.8% (17 of 115) of the eyes. At baseline, the mean size of CNV was 3.2 ± 1.5 DA, and the mean size of PED was 1.9 ± 1.1 DA. On ICGA, PEDs were predominantly serous in

Discussion

In this study, we showed that eyes with neovascular AMD with PED showed significant functional and anatomic response to anti-VEGF intravitreal injections of either ranibizumab or aflibercept at month 3. We assessed factors that influence the functional and structural response of PED in neovascular AMD, with a particular focus on the effect of drug type (ie, ranibizumab vs aflibercept). Multivariate analysis showed that change in BCVA was not influenced by drug type but rather by baseline BCVA,

Ali Dirani (MD, MPH, MSc) is currently a clinical retina fellow at Jules-Gonin Eye hospital (University of Lausanne, Switzerland). He is an ophthalmologist graduated from Saint-Joseph University (Beirut, Lebanon). He holds a master degree in public health and a master in biological sciences (genetics and biochemistry). He had published many clinical studies and had participated in many international meetings.

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    Ali Dirani (MD, MPH, MSc) is currently a clinical retina fellow at Jules-Gonin Eye hospital (University of Lausanne, Switzerland). He is an ophthalmologist graduated from Saint-Joseph University (Beirut, Lebanon). He holds a master degree in public health and a master in biological sciences (genetics and biochemistry). He had published many clinical studies and had participated in many international meetings.

    Irmela Mantel, MD is currently a medical retina consultant at the Jules Gonin Eye Hospital in Lausanne, Switzerland. She is actively involved in a number of research projects investigating retinal degenerative disorders and in particular age-related macular degeneration. Dr. Mantel received her medical degree from the University of Zurich, Switzerland. After an ophthalmologic residency in Switzerland (Lucerne and Lausanne), she was a medical retina fellow to Professor Alan Bird at Moorfields Eye Hospital in London, England.

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