Preliminary study on the efficacy of subretinal injection of Aflibercept in the treatment of refractory polypoidal choroidal vasculopathy
Objective To observe the efficacy and safety of subretinal injection of Aflibercept for the treatment of refractory or recurrent polypoidal choroidal vasculopathy(PCV).Methods A prospective clinical research.From January to June 2022,18 patients of 18 eyes with PCV diagnosed in The Affiliated Eye Hospital of Nanchang University were included in the study.All patients underwent best corrected visual acuity(BCVA),indocyanine green angiography and optical coherence tomography(OCT).The BCVA examination was performed using the international standard visual acuity chart,which was converted to logarithm of the minimum angle of resolution(logMAR)visual acuity during statistics.The large choroidal vessel thickness(LVCT),central retinal thickness(CRT),sub-foveal choroidal thickness(SFCT)and retinal pigment epithelium detachment(PED)height were measured by enhanced depth imaging technique of OCT.The choroidal vascular index(CVI)was calculated.There were 18 patients of 18 eyes,11 males of 11 eyes and 7 females of 7 eyes.The age was(64.22±3.86)years old.The disease duration was(5.22±1.80)years.The patient had received intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs for(7.72±1.36)times.The logMAR BCVA of the affected eyes was 1.28±0.25.The SFCT,CRT,LVCT,PED height were(436.56±9.80),(432.44±44.29),(283.78±27.10),(342.44±50.18)pm,respectively,and CVI was 0.65±0.01.All eyes were treated with a single subretinal injection of 40 mg/ml Aflibercept 0.05 ml(including Aflibercept 2.0 mg).According to the results of OCT and BCVA after treatment,the lesions were divided into active type and static type.The active lesions were treated with intravitreal injection of Aflibercept at the same dose as before.Quiescent lesions were followed up.Examinations were performed 1-3,6,9 and 12 months after treatment using the same equipment and methods before treatment.The BCVA,LVCT,CRT,SFCT,PED height,CVI,interretinal or subretinal fluid,lesion regression rate,injection times,and complications during and after treatment were observed.The BCVA,SFCT,CRT,LVCT,PED height and CVI before and after treatment were compared by repeated measures analysis of variance.Results Eighteen eyes received subretinal and/or intravitreal injection of Aflibercept(1.61±0.85)times(1-4 times).At the last follow-up,the polypoid lesions regressed in 4 eyes and PED disappeared in 1 eye.Compared with before treatment,BCVA(F=50.298)gradually increased,CRT(F=25.220),PED height(F=144.16),SFCT(F=69.77),LVCT(F=136.69),CVI(F=72.70)gradually decreased after treatment.The differences were statistically significant(P＜0.001).Macular hole occurred in 1 eye after treatment,and the hole closed spontaneously 3 months after treatment.No serious complications such as retinal tear,retinal detachment,endophthalmitis and vitreous hemorrhage occurred during and after treatment.Conclusion Subretinal injection of Aflibercept is safe and effective in the treatment of refractory PCV.
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