Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study
Purpose: This prospective case series investigates the visual and anatomical outcomes including detailed volumetrics of eyes with vascularized pigment epithelial detachments (PED) treated with aflibercept in eyes with neovascular age-related macular degeneration (nAMD) through meticulous analysis in...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993620302310 |
| _version_ | 1818392371900973056 |
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| author | Clement K. Chan David Sarraf Prema Abraham Maziar Lalezary Steven G. Lin Xuejing Chen Muneeswar Gupta Nittala SriniVas Sadda |
| author_facet | Clement K. Chan David Sarraf Prema Abraham Maziar Lalezary Steven G. Lin Xuejing Chen Muneeswar Gupta Nittala SriniVas Sadda |
| author_sort | Clement K. Chan |
| collection | DOAJ |
| description | Purpose: This prospective case series investigates the visual and anatomical outcomes including detailed volumetrics of eyes with vascularized pigment epithelial detachments (PED) treated with aflibercept in eyes with neovascular age-related macular degeneration (nAMD) through meticulous analysis in a reading center setting. Methods: We conducted a single-arm multicenter, prospective, open-labeled, interventional case series, comparing visual and anatomic outcomes at 12 months with baseline for intense aflibercept therapy. Eyes with submacular vascularized PED due to AMD received 2.0 mG of intravitreal aflibercept at baseline and then monthly for 6 months. During the subsequent 6 months, mandatory aflibercept therapy was given for every other month, while additional aflibercept injections were allowed between mandatory injections if necessary, at 4 weeks after last injection, contingent on pre-defined visual and anatomic re-treatment criteria. Standardized ETDRS vision measurement, anterior and posterior segment examination, and high-density spectral-domain optical coherence tomography scans were obtained at baseline and monthly, while fundus photography and fluorescein angiography were obtained at baseline, 3,6, and 12 months. Indocyanine-green angiography was obtained at baseline and 3 months. Meticulous multidimensional assessment of the scanned multimodal serial images was then performed by Doheny Image Reading Center. Results: Of 36 eyes and patients with mean age of 80, mean baseline and 12-month-ETDRS BCVA was 59 ± 8.9 letters (20/66), and 65 ± 27 letters (20/50), respectively; (6.5 letters improvement, p = 0.02). Significant reductions from baseline to month-12 were noted for multiple anatomic measures, including PED maximum height, entire lesion and central 1-mm subfield of PED mean thickness and volume, and mean subretinal hyperreflective material (SHRM) thickness and volume, also entire lesion of retinal thickness, retinal volume, and mean subretinal fluid (SRF) thickness (mean reductions in magnitude ranging from 37.5 to 91.7%, all p < 0.001). FA measurements also showed significant decrease from baseline to month-12, including area and greatest linear diameter (GLD) of fibrovascular PED, area and GLD of NV area and leakage (mean reductions in magnitude from 41.9 to 87.7%, p value from 0.002 to <0.001). This case series shows that while majority of reductions in SRF volume occurred during first month from baseline, majority of reduction in retinal, PED, and SHRM volumes occurred during first 2 months after onset of anti-VEGF injections. RPE tears developed in 5 eyes (13.9%) correlating with eyes with large PED height and volume at baseline (mean height >800 μm, mean volume >4 mm3). Geographic atrophy (GA) was noted in only 1 eye at baseline, but in 16 eyes (44.4%) by 12 months. Conclusions and Importance: Significant improvement in vision and anatomic measures including volumetrics of vPED were noted at 12 months after aflibercept therapy. Besides substantial PED height, large PED volume at baseline also correlated with RPE tears in 13.9% of eyes with vPED after anti-VEGF therapy. Reduction in SHRM correlated directly with decrease in PED, and more than 40% of study eyes developed GA by 12 months following intense anti-VEGF therapy. |
| first_indexed | 2024-12-14T05:28:22Z |
| format | Article |
| id | doaj.art-02de637543294ff38c4e3c23e243a5bc |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-14T05:28:22Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-02de637543294ff38c4e3c23e243a5bc2022-12-21T23:15:27ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362020-12-0120100916Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN studyClement K. Chan0David Sarraf1Prema Abraham2Maziar Lalezary3Steven G. Lin4Xuejing Chen5Muneeswar Gupta Nittala6SriniVas Sadda7Southern California Desert Retina Consultants, Palm Desert, CA, USA; Loma Linda University Eye Institute, Loma Linda, CA, USA; Corresponding author. Southern California Desert Retina Consultants, 36949 Cook Street, Suite 101, Palm Desert, CA 92211, USA.Division of Retinal Disorder and Ophthalmic Genetics, UCLA, Los Angeles, CA, USA; Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine University of California Los Angeles, Los Angeles, CA, USABlack Hills Regional Eye Institute, Rapid City, SD, USASouthern California Desert Retina Consultants, Palm Desert, CA, USA; Doctor Retina PC, Beverly Hills, CA, USASouthern California Desert Retina Consultants, Palm Desert, CA, USADepartment of Ophthalmology, Boston University School of Medicine, Boston, MA, USADoheny Eye Institute, University of California Los Angeles, Los Angeles, CA, USADoheny Eye Institute, University of California Los Angeles, Los Angeles, CA, USAPurpose: This prospective case series investigates the visual and anatomical outcomes including detailed volumetrics of eyes with vascularized pigment epithelial detachments (PED) treated with aflibercept in eyes with neovascular age-related macular degeneration (nAMD) through meticulous analysis in a reading center setting. Methods: We conducted a single-arm multicenter, prospective, open-labeled, interventional case series, comparing visual and anatomic outcomes at 12 months with baseline for intense aflibercept therapy. Eyes with submacular vascularized PED due to AMD received 2.0 mG of intravitreal aflibercept at baseline and then monthly for 6 months. During the subsequent 6 months, mandatory aflibercept therapy was given for every other month, while additional aflibercept injections were allowed between mandatory injections if necessary, at 4 weeks after last injection, contingent on pre-defined visual and anatomic re-treatment criteria. Standardized ETDRS vision measurement, anterior and posterior segment examination, and high-density spectral-domain optical coherence tomography scans were obtained at baseline and monthly, while fundus photography and fluorescein angiography were obtained at baseline, 3,6, and 12 months. Indocyanine-green angiography was obtained at baseline and 3 months. Meticulous multidimensional assessment of the scanned multimodal serial images was then performed by Doheny Image Reading Center. Results: Of 36 eyes and patients with mean age of 80, mean baseline and 12-month-ETDRS BCVA was 59 ± 8.9 letters (20/66), and 65 ± 27 letters (20/50), respectively; (6.5 letters improvement, p = 0.02). Significant reductions from baseline to month-12 were noted for multiple anatomic measures, including PED maximum height, entire lesion and central 1-mm subfield of PED mean thickness and volume, and mean subretinal hyperreflective material (SHRM) thickness and volume, also entire lesion of retinal thickness, retinal volume, and mean subretinal fluid (SRF) thickness (mean reductions in magnitude ranging from 37.5 to 91.7%, all p < 0.001). FA measurements also showed significant decrease from baseline to month-12, including area and greatest linear diameter (GLD) of fibrovascular PED, area and GLD of NV area and leakage (mean reductions in magnitude from 41.9 to 87.7%, p value from 0.002 to <0.001). This case series shows that while majority of reductions in SRF volume occurred during first month from baseline, majority of reduction in retinal, PED, and SHRM volumes occurred during first 2 months after onset of anti-VEGF injections. RPE tears developed in 5 eyes (13.9%) correlating with eyes with large PED height and volume at baseline (mean height >800 μm, mean volume >4 mm3). Geographic atrophy (GA) was noted in only 1 eye at baseline, but in 16 eyes (44.4%) by 12 months. Conclusions and Importance: Significant improvement in vision and anatomic measures including volumetrics of vPED were noted at 12 months after aflibercept therapy. Besides substantial PED height, large PED volume at baseline also correlated with RPE tears in 13.9% of eyes with vPED after anti-VEGF therapy. Reduction in SHRM correlated directly with decrease in PED, and more than 40% of study eyes developed GA by 12 months following intense anti-VEGF therapy.http://www.sciencedirect.com/science/article/pii/S2451993620302310Aflibercept therapyAnti-vascular endothelial growth factor injectionNeovascular age-related macular degenerationGeographic atrophyRetinal pigment epithelial detachmentPigment epithelial detachment height and volume |
| spellingShingle | Clement K. Chan David Sarraf Prema Abraham Maziar Lalezary Steven G. Lin Xuejing Chen Muneeswar Gupta Nittala SriniVas Sadda Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study American Journal of Ophthalmology Case Reports Aflibercept therapy Anti-vascular endothelial growth factor injection Neovascular age-related macular degeneration Geographic atrophy Retinal pigment epithelial detachment Pigment epithelial detachment height and volume |
| title | Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study |
| title_full | Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study |
| title_fullStr | Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study |
| title_full_unstemmed | Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study |
| title_short | Meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular AMD in a prospective case series, the EVEN study |
| title_sort | meticulous multimodal analysis of aflibercept therapy for submacular vascularized pigment epithelial detachment associated with neovascular amd in a prospective case series the even study |
| topic | Aflibercept therapy Anti-vascular endothelial growth factor injection Neovascular age-related macular degeneration Geographic atrophy Retinal pigment epithelial detachment Pigment epithelial detachment height and volume |
| url | http://www.sciencedirect.com/science/article/pii/S2451993620302310 |
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