Aflibercept treatment in polypoidal choroidal vasculopathy
Reviewed by Sofia Rokerya

The authors present a study to evaluate the anatomical and functional efficacy of aflibercept intravitreal (IVT) as a monotherapy in polypoidal choroidal vasculopathy (PCV) in a Caucasian population treated with initial three-monthly aflibercept IVT, followed by a bimonthly regimen for six months. Each patient received five Aflibercept IVT. The mean age of the study patients was 71 years (range 52-93). There were 21 males and 13 females. Twenty-eight patients were treatment naïve, whereas six patients had previously been treated with Ranibizumab. The mean best-corrected visual acuity (BCVA) at baseline was 54.8 letters while the final mean BCVA, at six months, was 67.8 letters. At the end of the six-month follow-up, a gain of ≥5 letters was obtained in 64% of the cases. The mean central foveal retinal thickness significantly decreased from 390.7µm at baseline to 271.7µm at three months (p<0.001) and to 263.1µm at six months (p<0.001). The central retinal thickness decreased by 127.6µm between the baseline and six-month visits. The mean subfoveal choroidal thickness significantly decreased by 64.8µm: from 269µm at baseline to 204.2µm after six months. The size of the branching vascular network (BVN) was 9.6mm2 (range 5.9; 13.2) at baseline and 6.9mm2 at six months (0.95 CI: 3.2; 10.6, p=0.23). At baseline, FA showed a leakage in 97.2% (n=33) of the study patients; this had reduced to 38.5% (n=13) at six months (odds ratio [OR] = 0.02, p<0.001). Subretinal fluid was present in 62.2% (n=21) of the study patients at baseline; this had reduced to 20.6% (n=7) at week 28 (OR = 0.16, p<0.001). Subretinal hemorrhages were observed in 52.9% (n=18) of the patients at baseline and in none (p<0.001) after six months; retinal pigment epithelium (RPE) detachments were observed in 85.5% (n=29) of the patients at baseline and in 41.2% (n=14) (p<0.001) at week 28, with an OR of 0.12 (0.95 CI: 0.05; 0.32). At baseline, 64 active polyps were detected on ICGA and SD-OCT. At week 28, there were 25 active polyps; 15 were thrombosed and 24 had disappeared. No serious adverse effects were reported during this study. Conclusion: a bimonthly aflibercept regimen following three monthly IVT demonstrated significant improvement in VA and anatomical regression of polypoidal lesions in Caucasian PCV patients. Limitations: Absence of control group for comparison.

Aflibercept treatment in polypoidal choroidal vasculopathy: results of a prospective study in a Caucasian population.
Wolff B, Vasseur V, Cahuzac A, et al.
OPHTHALMOLOGICA
2018;240:208-12.