Outcome of intravitreal aflibercept for refractory pigment epithelial detachment with or without subretinal fluid and secondary to age-related macular degeneration

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 mm; it significantly reduced to 281.2 ± 90.7 mm 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, solidtype PED showed less improvement than hollow- or mixed-type PED.