Graefes Arch Clin Exp Ophthalmol DOI 10.1007/s00417-014-2835-8
LETTER TO THE EDITOR
Intravitreal aflibercept treatment of retinal angiomatous proliferation: a pilot study and short-term efficacy Konstantinos T. Tsaousis & Vasileios E. Konidaris & Somnath Banerjee & Theodoros Empeslidis
Received: 4 September 2014 / Accepted: 9 October 2014 # Springer-Verlag Berlin Heidelberg 2014
Retinal angiomatous proliferation (RAP) is a type of neovascular age-related macular degeneration (AMD) with a reportedly poor prognosis and limited response to several therapies including direct laser photocoagulation, transpupillary thermotherapy, surgical removal, and photodynamic therapy (PDT) [1]. However, the introduction of intravitreal anti-vascular endothelial growth factor (anti-VEGF) medications has offered a novel alternative for RAP treatment. Multiple studies have shown that ranibizumab may be effective in these cases especially those in stages 1 and 2 [2, 3]. Following the approval of aflibercept for use in the British national health system, we have designed a pilot study to investigate the short-term results of intravitreal aflibercept administered to RAP patients with no previous treatments. Notably, previous studies confirmed the efficacy of aflibercept in wet age-related macular degeneration and macular edema due to retinal vein occlusions [4, 5]. Twelve patients (12 eyes; mean age, 80±7.08 years) with RAP lesions at stage 1 and 2 without any previous treatments were recruited from the outpatient medical retina service of the University Hospital of Leicester, in the UK, between November 2013 and January 2014 and were enrolled in a prospective, consecutive, and nonrandomized manner. The study conformed to the tenets of the Declaration of Helsinki. All participants provided written informed consent after verbal explanation. Before therapy, all patients were examined K. T. Tsaousis : V. E. Konidaris : S. Banerjee : T. Empeslidis Ophthalmology Department, Leicester Royal Infirmary, Leicester, UK K. T. Tsaousis (*) Ophthalmology Department, Medical Retina, Leicester Royal Infirmary, Infirmary Square, Leicester, Leicestershire LE1 5WW, UK e-mail:
[email protected]
thoroughly with visual acuity (LogMAR) measurement, optical coherence tomography (3D OCT-1000, Topcon Corporation, Tokyo, Japan), and fluorescein angiography performed to confirm the diagnosis. Patients were administered 2 mg of aflibercept (Eylea, 40 mg/ml, Bayer, Germany) intravitreously every 30 days for a total three injections. One month after the third treatment, the patients were reexamined and numerical data were collected. The primary study outcomes were the change in central subfield (1 mm as indicated in the ETDRS grid) retinal thickness (CRT), and the bestcorrected distance visual acuity (BCDVA, LogMAR). Secondary indices for statistical analysis were retrieved from the optical coherence tomography report: (1) average macular thickness (μm) (nine subfields of 6 mm area in an ETDRS grid); (2) central foveal point thickness (μm); and (3) total volume (mm3) in a 6 mm macular area. Difference between the pretreatment and posttreatment values were determined using one-way analysis of variance (ANOVA) with a 5 % significance level. Data were collected prospectively, and analyzed using Microsoft Excel 2007 for Windows (Microsoft Corporation, Redmond, WA, USA) and SPSS version 16.0 for Windows (SPSS Inc., Chicago, IL, USA). All subjects showed a decrease in the central retinal thickness (mean 128±62.94 μm). In 10/12 eyes visual acuity improved following treatment (mean 0.14±0.16 LogMAR). Posttreatment visual acuity significantly correlated with the pretreatment visual acuity (p
