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Kim, Kiyoung, MD*; Kim, Eung Suk, MD, PhD*; Kim, Yonguk, MD*; Yang, Ji Ho, MD; Yu, Seung-Young, MD, PhD*; Kwak, Hyung Woo, MD, PhD*

doi: 10.1097/IAE.0000000000001947
Original Study

Purpose: To investigate the outcomes of intravitreal aflibercept in refractory pigment epithelial detachment (PED) with or without subretinal fluid (SRF) in patients with neovascular age-related macular degeneration.

Methods: A prospective, nonrandomized, interventional case series involved 40 patients with persistent vascularized PED previously treated with at least 3 injections of intravitreal bevacizumab or ranibizumab. Intravitreal aflibercept was administered as 3 initial loading doses every 4 weeks, followed by pro re nata retreatment every 8 weeks over 48 weeks. Pigment epithelial detachment was classified into solid-, hollow-, or mixed-type according to the reflective properties visualized using optical coherence tomography. The mean changes in best-corrected visual acuity, central subfield thickness, and the volumes of SRF and PED were analyzed.

Results: The PED volume (baseline: 0.43 ± 0.55 mm3) significantly reduced to 0.23 ± 0.32 mm3 at Week 8 (P = 0.003) and increased to 0.36 ± 0.41 mm3 at Week 48 (P = 0.345). The SRF volume (baseline: 0.52 ± 0.64 mm3) significantly reduced to 0.24 ± 0.43 mm3 at Week 48 (P = 0.021). The mean baseline best-corrected visual acuity was 20/75 (47.5 letters); it showed no significant difference at Week 48 (+4.4 letters; P = 0.125). The baseline central subfield thickness was 323.2 ± 92.3 μm; it significantly reduced to 281.2 ± 90.7 μm at Week 48 (P = 0.001). In solid-type PEDs, there were poorer improvements in central subfield thickness, best-corrected visual acuity, and the volumes of the SRF and PED, with newly developed intraretinal cysts.

Conclusion: Intravitreal aflibercept in treatment-resistant neovascular age-related macular degeneration led to significant reduction in PED and SRF volume, central subfield thickness, and best-corrected visual acuity preserved, over 12 months. However, solid-type PED showed less improvement than hollow- or mixed-type PED.

This study prospectively assessed the 12-month outcomes of intravitreal aflibercept in refractory pigment epithelial detachment secondary to neovascular age-related macular degeneration. Three monthly loading doses of intravitreal aflibercept followed by bimonthly injection led to reduction in subretinal fluid and pigment epithelial detachment dimensions and preserved visual acuity for 12 months. Refractory pigment epithelial detachment with hyperreflective components was the least responsive subtype, showing newly developed, vision-threatening, intraretinal cysts.

*Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea; and

Department of Ophthalmology, Seonam University Myongji Hospital, Goyang, Republic of Korea.

Reprint requests: Seung-Young Yu, MD, PhD, Department of Ophthalmology, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea; e-mail:

Funded by Bayer through an investigator-initiated trial. Bayer played no role in the design, execution, or analysis of the data, or in the writing of the report.

None of the authors has any conflicting interests to disclose.

K. Kim and E. S. Kim contributed equally to this work.

© 2019 by Ophthalmic Communications Society, Inc.