AFLIBERCEPT FOR POLYPOIDAL CHOROIDAL VASCULOPATHY: As Needed Versus Fixed Interval Dosing

To evaluate the functional and morphologic outcomes of patients with polypoidal choroidal vasculopathy undergoing intravitreal aflibercept (IVA) treatment using every 2-month injections compared with a pro re nata (PRN) regimen after 3 initial monthly doses.

The authors prospectively studied all the treatment-naive patients with polypoidal choroidal vasculopathy who were scheduled to undergo IVA using every 2-month injections or PRN after induction treatment between March 2013 and October 2013. All patients who had a follow-up period of 1 year or longer were included in the study. The best-corrected visual acuity in the 2 groups was compared before treatment and at 4 months, 6 months, and 12 months after the initial treatment. The regression of the polyps was also assessed using indocyanine-green angiography at baseline and 12 months.

Forty-two eyes were assessed at the 12-month follow-up examination. Twenty-five eyes were treated with IVA injections every 2-month after 3 initial monthly doses, and 17 eyes were treated using PRN after loading doses. The mean number of administered IVA was 7.0 in the every 2-month group and 5.0 ± 2.9 in the PRN group, with significant difference between the 2 groups (P < 0.01). Both groups showed significant improvement of the mean logarithm of the minimum angle of resolution values for best-corrected visual acuity at 12 months, as compared with baseline values (P < 0.01 in every 8-week group and P = 0.03 in PRN group, respectively). No significant difference in the improvement of best-corrected visual acuity between the 2 groups was observed at baseline or at 4 months, 6 months, and 12 months after treatment (P > 0.05, respectively) although there was a trend toward better results in the every 8-week group. The rate of polyp regression was 48.0% (12/25) in the every 8-week group and 52.9% (9/17) in the PRN group, with no significant difference between the 2 groups (P = 0.50).

Among the 2 treatment modalities, IVA was well tolerated and improved the visual outcomes in patients with polypoidal choroidal vasculopathy as evaluated at 1-year follow-up examinations. However, there was a trend toward better vision improvement with fixed treatment every 2 months.