Офтальмохирургия. 2017; : 38-44
АФЛИБЕРЦЕПТ В ЛЕЧЕНИИ РЕЗИСТЕНТНОЙ ПОЛИПОИДНОЙ ХОРИОИДАЛЬНОЙ ВАСКУЛОПАТИИ: КРАТКОСРОЧНЫЕ РЕЗУЛЬТАТЫ
https://doi.org/10.25276/0235-4160-2017-4-38-44Аннотация
Полипоидная хориоидальная васкулопатия (ПХВ) – редкий подтип возрастной макулярной дегенерации, характеризующийся формированием ветвящейся сосудистой сети (ВСС) и полипов. В ряде случаев наблюдается резистентность к проводимому лечению, в частности Ранибизумабом. В свою очередь, у ранее не леченных пациентов с ПХВ ингибитор ангиогенеза Афлиберцепт, имеющий сравнительно больший аффинитет к молекулам VEGF-А, уже успел продемонстрировал свою эффективность.
Цель. Оценить первые результаты применения Афлиберцепта при полипоидной хориоидальной васкулопатии, резистентной к предшествующей комбинированной терапии.
Материал и методы. Восемь пациентов (9 глаз) с резистентной к лечению ПХВ (три и более ежемесячных интравитреальных инъекций 0,5 мг Ранибизумаба или в комбинации с фотодинамической терапией с Хлорином е6) включены в проспективное исследование. Через 1 мес. после 3 ежемесячных интравитреальных инъекций 2 мг Афлиберцепта по данным ОКТ, ОКТ-ангиографии, флюоресцеиновой ангиографии и индоцианин зеленой ангиографии (ИЗАГ) анализировались изменения остроты зрения, центральной светочувствительности (ЦСЧ) и центральной толщины сетчатки (ЦТС), резорбция субретинальной жидкости, куполообразной отслойки пигментного эпителия, полипов и ВСС.
Результаты. Острота зрения до и после лечения не показала статистически значимых различий (0,5±0,2 и 0,6±0,2 соответственно, p=0,4). Выраженную динамику продемонстрировала ЦСЧ с 21,5±2,7 до 24,0±3,7 дБ (p=0,02). Отмечалась резорбция субретинальной жидкости со статистически значимым уменьшением ЦТС с 336,3±55,1 до 284,3±60,1 мкм (p=0,03). Среди 6 глаз с куполообразной отслойкой РПЭ в двух произошло полное, и в трех – частичное прилегание, у одного пациента высота отслойки увеличилась. По данным ИЗАГ, ОКТ и ОКТ-ангиографии регресс полипов отмечен в 6 глазах из 9, однако ВСС сохранялась.
Заключение. Краткосрочные результаты использования Афлиберцепта у пациентов с резистентной ПХВ показали его эффективность в отношении уменьшения экссудации, закрытия полипов и повышения центральной светочувствительности сетчатки.
Список литературы
1. Дога А.В., Педанова Е.К., Володин П.Л., Майорова А.М. Первые результаты фотодинамической терапии при полипоидной хориоидальной васкулопатии как подтипе возрастной макулярной дегенерации // Современные технологии в офтальмологии. – 2017. – № 1 (14). – С. 70-73.
2. Arakawa A., Inoue M., Sato S. et al. Efficacy of intravitreal aflibercept injections for Japanese patients with polypoidal choroidal vasculopathy // Clin.Ophthalmology. – 2017. – № 11. – P. 797-802.
3. Bessho Н., Honda S., Imai H. et al. Natural course and funduscopic findings of polypoidal choroidal vasculopathy in a Japanese population over one year of follow-up // Retina. – 2011. – Vol. 31. – P. 1598-1602.
4. Cho H.J., Kim J.W., Lee D.W. et al. Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy // Eye (Lond.). – 2012. – Vol. 26. – P. 426-433.
5. ClinicalTrials.gov. Visual Outcome in Patients with Symptomatic Macular PCV Treated with either Ranibizumab as Monotherapy or Combined with Verteporfin // Photodynamic Therapy (EVEREST II). – 2014. – Available online. – URL: http://clinicaltrials.gov/ct2/show/NCT01846273?term=everest&rank=7.
6. Gomi F., Oshima Y., Mori R. et al. Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy // Retina. – 2015. – Vol. 35 (8). – P. 1569-1576.
7. Hara C., Sawa M., Sayanagi K., Nishida K. Oneyear results of intravitreal aflibercept for polypoidal choroidal vasuculopathy // Retina. – 2016. – Vol. 36 (1). – P. 37-45.
8. Hikichi T., Higuchi M., Matsushita T. et al. One-year results of three monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in Japanese patients // Am. J. Ophthalmol. – 2012. – Vol. 154. – P. 117-124.
9. Hirakata T., Fujinami K., Watanabe K., Sasaki M. et al. One-year outcome of intravitreal afliberce pt injection for age-related macular degeneration resistant to ranibizumab: rapid morphologic recovery and subsequent visual improvement // Clin. Ophthalmol. – 2016. – Vol. 10. – P. 969-977.
10. Hirami Y., Tsujikawa A., Otani A. et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy // Retina. – 2007. – Vol. 27. – P. 335-341.
11. Jeon S., Lee W.K., Kim K.S. Adjusted retreatment of polypoidal choroidal vasculopathy after combination therapy: Results at 3 years // Retina. – 2013. – Vol. 33. – P. 1193-1200.
12. Kang H.M., Koh H.J. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy // Am. J. Ophthalmol. – 2013. – Vol. 156. – P. 652-660.
13. Kokame G.T., Lai J.C., Wee R. et al. Prospective clinical trial of Intravitreal aflibercept treatment for polypoIdal choroidal vasculopathy with hemorrhage or exudation (EPIC study): 6 month results // BMC Ophthalmol. – 2016. – Vol. 16. – P. 127.
14. Kokame G.T., Yeung L., Lai J.C. Continuous antiVEGF treatment with ranibizumab for polypoidal choroidal vasculopathy: 6-month results // Br. J. Ophthalmol. – 2010. – Vol. 94. – P. 297-301.
15. Lai T.Y., Chan W.M., Liu D.T. et al. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy// Br. J. Ophthalmol. – 2008. – Vol. 92, № 5. – P. 661-666.
16. Leal S., Silva R., Figueira J. et al. Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy: results after 3 years of follow-up // Retina. – 2010. – Vol. 30. – P. 1197-1205.
17. Lee W.K., Ogura Y., Iida T. et al. Efficacy and Safety of Intravitreal Aflibercept in Polypoidal Choroidal Vasculopathy: 12-Month Results of the PLANET // Abstract at ARVO 2017 Annual Meeting.
18. Miki A., Honda S., Kojima H. et al. Visual outcome of photodynamic therapy for typical neovascular age-
19. Mori R., Yuzawa M., Lee Z. et al. Factors influencing visual outcome of polypoidal choroidal vasculopathy one year after photodynamic therapy // Graefes Arch. Clin. Exp. Ophthalmol. – 2010. – Vol. 248. – P. 1233-1239.
20. Ojima Y., Tsujikawa A., Otani A. et al. Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy // Am. J. Ophthalmol. – 2006. – Vol. 141. – P. 958-960.
21. Oshima Y., Kimoto K., Yoshida N. et al. OneYear Outcomes following Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in Japanese Patients: The APOLLO Study // Ophthalmologica. – 2017. – Vol. 238, № 3. – P. 163-171.
22. Saito M., Kano M., Itagaki K. et al. Switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy refractory to ranibizumab // Retina. – 2014. – Vol. 34. – P. 2192-2201.
23. Sho K., Takahashi K., Yamada H. et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics // Arch. Ophthalmol. – 2003. – Vol. 121, № 10. – P. 1392-1396.
24. Spaide R.F., Donsoff I., Lam D.L. et al. Treatment of polypoidal choroidal vasculopathy with photodynamic therapy // Retina. – 2002. – Vol. 22. – P. 529-535.
25. Tsujikawa A., Ooto S., Yamashiro K. et al. Treatment of polypoidal choroidal vasculopathy by intravitreal injection of bevacizumab // Jpn. J. Ophthalmol. – 2010. – Vol. 54. – P. 310-319.
26. Yannuzzi L.A, Sorenson J., Spaide R.F. et al. Idiopathic polypoidal choroidal vasculopathy (IPCV) // Retina – 1990. – Vol. 10. – P. 1-8.
27. Yannuzzi L.A, Wong D.W., Sforzolini B.S. et al. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration // Arch. Ophthalmol. – 1999. – Vol. 117. – P. 1503-1510.
Fyodorov Journal of Ophthalmic Surgery. 2017; : 38-44
AFLIBERCEPT IN TREATMENT OF RESISTANT POLYPOID CHOROIDAL VASCULOPATHY: SHORT-TERM RESULTS
https://doi.org/10.25276/0235-4160-2017-4-38-44Abstract
Polypoid choroidal vasculopathy (PCV) is a rare subtype of age-related macular degeneration, characterized by a formation of a branching vascular network (BVN) and polyps. In a number of cases a resistance to the performed therapy was observed in particular using Ranibizumab. In its turn, the angiogenesis inhibitor Aflibercept with a relatively greater affinity for VEGF-A molecules had already demonstrated its efficacy in previously untreated patients with PCV.
Purpose. To evaluate the first results of Aflibercept treatment in polypoid choroidal vasculopathy, resistant to a previous combined therapy.
Material and methods. The prospective study included 8 patients (9 eyes) with treatment-resistant PCV (three or more intravitreal injections of 0.5mg of Ranibizumab monthly or in combination with photodynamic therapy (PDT) with Chlorin e6). One month after 3 monthly intravitreal injections of 2mg of Aflibercept, changes in visual acuity, central retinal sensitivity (CRS) and central retinal thickness (CRT), a resorption of the subretinal fluid, dome-shaped retinal pigment epithelial detachment, polyps and BVN were evaluated according to the OCT data, OCTangiography, fluorescein angiography (FAG) and indocyanine green angiography (ICGA).
Results. Visual acuity before and after treatment did not show the statistically significant difference (0.5±0.2 and 0.6±0.2, respectively, p=0.4). The CRS demonstrated a pronounced positive dynamic from 21.5±2.7 to 24.0±3.7dB (p=0.02). Resorption of the subretinal fluid was noted with a statistically significant decrease in the CRT from 336.3±55.1 to 284.3±60.1µm (p=0.03). Among 6 eyes with dome-shaped RPE detachment, two showed a complete attachment, and three a partial attachment, in one patient the height of retinal detachment increased. According to ICGA, OCT and OCT angiography data, the regression of polyps was detected in 6 of 9 eyes, however, the BVN still persisted.
Conclusion. Short-term results of Aflibercept treatment in patients with resistant PCV showed its efficacy in relation to the reduction of exudation, the polyps closure and the increase of central retinal sensitivity.
References
1. Doga A.V., Pedanova E.K., Volodin P.L., Maiorova A.M. Pervye rezul'taty fotodinamicheskoi terapii pri polipoidnoi khorioidal'noi vaskulopatii kak podtipe vozrastnoi makulyarnoi degeneratsii // Sovremennye tekhnologii v oftal'mologii. – 2017. – № 1 (14). – S. 70-73.
2. Arakawa A., Inoue M., Sato S. et al. Efficacy of intravitreal aflibercept injections for Japanese patients with polypoidal choroidal vasculopathy // Clin.Ophthalmology. – 2017. – № 11. – P. 797-802.
3. Bessho N., Honda S., Imai H. et al. Natural course and funduscopic findings of polypoidal choroidal vasculopathy in a Japanese population over one year of follow-up // Retina. – 2011. – Vol. 31. – P. 1598-1602.
4. Cho H.J., Kim J.W., Lee D.W. et al. Intravitreal bevacizumab and ranibizumab injections for patients with polypoidal choroidal vasculopathy // Eye (Lond.). – 2012. – Vol. 26. – P. 426-433.
5. ClinicalTrials.gov. Visual Outcome in Patients with Symptomatic Macular PCV Treated with either Ranibizumab as Monotherapy or Combined with Verteporfin // Photodynamic Therapy (EVEREST II). – 2014. – Available online. – URL: http://clinicaltrials.gov/ct2/show/NCT01846273?term=everest&rank=7.
6. Gomi F., Oshima Y., Mori R. et al. Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy // Retina. – 2015. – Vol. 35 (8). – P. 1569-1576.
7. Hara C., Sawa M., Sayanagi K., Nishida K. Oneyear results of intravitreal aflibercept for polypoidal choroidal vasuculopathy // Retina. – 2016. – Vol. 36 (1). – P. 37-45.
8. Hikichi T., Higuchi M., Matsushita T. et al. One-year results of three monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in Japanese patients // Am. J. Ophthalmol. – 2012. – Vol. 154. – P. 117-124.
9. Hirakata T., Fujinami K., Watanabe K., Sasaki M. et al. One-year outcome of intravitreal afliberce pt injection for age-related macular degeneration resistant to ranibizumab: rapid morphologic recovery and subsequent visual improvement // Clin. Ophthalmol. – 2016. – Vol. 10. – P. 969-977.
10. Hirami Y., Tsujikawa A., Otani A. et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy // Retina. – 2007. – Vol. 27. – P. 335-341.
11. Jeon S., Lee W.K., Kim K.S. Adjusted retreatment of polypoidal choroidal vasculopathy after combination therapy: Results at 3 years // Retina. – 2013. – Vol. 33. – P. 1193-1200.
12. Kang H.M., Koh H.J. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy // Am. J. Ophthalmol. – 2013. – Vol. 156. – P. 652-660.
13. Kokame G.T., Lai J.C., Wee R. et al. Prospective clinical trial of Intravitreal aflibercept treatment for polypoIdal choroidal vasculopathy with hemorrhage or exudation (EPIC study): 6 month results // BMC Ophthalmol. – 2016. – Vol. 16. – P. 127.
14. Kokame G.T., Yeung L., Lai J.C. Continuous antiVEGF treatment with ranibizumab for polypoidal choroidal vasculopathy: 6-month results // Br. J. Ophthalmol. – 2010. – Vol. 94. – P. 297-301.
15. Lai T.Y., Chan W.M., Liu D.T. et al. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy// Br. J. Ophthalmol. – 2008. – Vol. 92, № 5. – P. 661-666.
16. Leal S., Silva R., Figueira J. et al. Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy: results after 3 years of follow-up // Retina. – 2010. – Vol. 30. – P. 1197-1205.
17. Lee W.K., Ogura Y., Iida T. et al. Efficacy and Safety of Intravitreal Aflibercept in Polypoidal Choroidal Vasculopathy: 12-Month Results of the PLANET // Abstract at ARVO 2017 Annual Meeting.
18. Miki A., Honda S., Kojima H. et al. Visual outcome of photodynamic therapy for typical neovascular age-
19. Mori R., Yuzawa M., Lee Z. et al. Factors influencing visual outcome of polypoidal choroidal vasculopathy one year after photodynamic therapy // Graefes Arch. Clin. Exp. Ophthalmol. – 2010. – Vol. 248. – P. 1233-1239.
20. Ojima Y., Tsujikawa A., Otani A. et al. Recurrent bleeding after photodynamic therapy in polypoidal choroidal vasculopathy // Am. J. Ophthalmol. – 2006. – Vol. 141. – P. 958-960.
21. Oshima Y., Kimoto K., Yoshida N. et al. OneYear Outcomes following Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in Japanese Patients: The APOLLO Study // Ophthalmologica. – 2017. – Vol. 238, № 3. – P. 163-171.
22. Saito M., Kano M., Itagaki K. et al. Switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy refractory to ranibizumab // Retina. – 2014. – Vol. 34. – P. 2192-2201.
23. Sho K., Takahashi K., Yamada H. et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics // Arch. Ophthalmol. – 2003. – Vol. 121, № 10. – P. 1392-1396.
24. Spaide R.F., Donsoff I., Lam D.L. et al. Treatment of polypoidal choroidal vasculopathy with photodynamic therapy // Retina. – 2002. – Vol. 22. – P. 529-535.
25. Tsujikawa A., Ooto S., Yamashiro K. et al. Treatment of polypoidal choroidal vasculopathy by intravitreal injection of bevacizumab // Jpn. J. Ophthalmol. – 2010. – Vol. 54. – P. 310-319.
26. Yannuzzi L.A, Sorenson J., Spaide R.F. et al. Idiopathic polypoidal choroidal vasculopathy (IPCV) // Retina – 1990. – Vol. 10. – P. 1-8.
27. Yannuzzi L.A, Wong D.W., Sforzolini B.S. et al. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration // Arch. Ophthalmol. – 1999. – Vol. 117. – P. 1503-1510.
