| Chapter 1 The effects of Aflibercept in pigment epithelial detachments secondary to wet age related macular degenerationWet age related macular degeneration(wAMD)belongs to advanced AMD,including neovascular AMD(nAMD),polypoidal choroidal vasculopathy(PCV)and retinal angiomatous proliferation(RAP).At present,intravitreal anti-vascular endothelial growth factor(VEGF)injection is the first-line treatment for wAMD.However,it is difficult to treat the patients with retinal pigment epithelial detachment.The purpose of this study was to evaluate the clinical efficacy of fusion protein anti-VEGF(Aflibercept)in the treatment of exudative age-related macular degeneration with retinal pigment epithelial detachments.Methods This is a retrospective study.From June 2018 to January 2021,thirty-five eyes of 29 patients with PED secondary to wAMD(whole group)were included in the study.All the study eyes have received IVA at month 0 and 1 and 3 then use a PRN regimen.PED maximum height(PEDH),PED area(PEDA),PED volume(PEDV),macular fovea retinal thickness(CMT)and PED count(PEDC)were scanned and measured by Topcon 3D-OCT 2000 device,setting mode of 6 mm×6 mm around the macular fovea.In the whole group,the eyes who had at least a 25%reduction in PED maximum height(PEDH)at month 3 were divided into response group(24 eyes);the rest were divided into partial response group(11 eyes).BCVA,CMT,PEDH,PED A,PEDV were observed at month 1,3,6,12 by groups.Repeated measures analysis of variance was used in the study.Result Except for PEDC(P>0.05),there were significant differences in the other indexes of the whole group and the response group at different time(P<0.05).In partial response group,there were statistically significant difference in BCVA,CMT and PEDH(P<0.05),but there were no statistically significant difference in PEDA,PEDV and PEDC(P>0.05).The number of eyes with a decrease of less than 25%of PEDH showed a downward trend in the load dose stage and tended to be stable in the PRN stage.Conclusion IVA has a good effect in the treatment of PED secondary to wAMD.Patient who has a good response at loading dose therapy would response well continually in a PRN regimen.Chapter 2 Short-term effects of Aflibercept in treatment-naive and refractory wet age-related macular degenerationThere are some wAMD patients who used anti-VEGF as the first choice to treat and not had a good effect in clinic.Most scholars believe that the patients with no obvious anatomical changes after anti-VEGF treatment once a month for 3 months are refractory wAMD.In the study,we defined refractory AMD as persistent intraretinal cysts(IRC)and/or sub retinal fluid(SRF)with pigment epithelial detachment(PED)not been better after more than 4 times(≥4)of anti-VEGF(ranibizumab and/or conbercept)therapy within 6 months.The study aims to observed the short-term effects of Aflibercept in treatment-naive and refractory wet age-related macular degeneration.Methods Forty-six eyes of 37 patients with wAMD were enrolled in the study,including 26 eyes of treatment-naive patients and 20 eyes of treatment-resistant ones.IVA treatment was given once a month for 3 consecutive months,followed by a PRN regimen.The best corrected visual acuity(BCVA),central macular thickniss thickness(CMT),PED height(PEDH)and PED volume(PEDV)of the two groups were comparable at baseline(P>0.05).And the response would be compared between the groups at month 1,3 and 6.Result There was significant difference at the time points(P<0.05)in the tow group.And there was no significant difference in the average BCVA,CMT,PEDH and PEDV between the two groups at month 1,3 and 6(P>0.05).IRC and SRF have recovered in some degree.Conclusion IVA can recover the anatomical and visual indexes of treatment-resistant wAMD in the short term,and the efficacy of treatment-resistant patients was not inferior to treatment-naive patients. |
PDF Full Text Request