Abstract
Objective
To evaluate the impact of subfoveal choroidal thickness (SFCT) and other clinical
biomarkers in intravitreal anti-vascular endothelial growth factor response in treatment-naive
Caucasian patients diagnosed with polypoidal choroidal vasculopathy (PCV/AT1).
Design
Cross-sectional study.
Participants
Treatment-naive patients diagnosed with PCV/AT1 recruited in a single centre from
January 2013 to December 2020.
Methods
Eligibility was determined in treatment-naive PCV patients who received a loading
dose of 3 injections of 0.5 mg ranibizumab. A diagnosis of PCV/AT1 was made based
on the diagnostic criteria in the efficacy and safety of verteporfin photodynamic
therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in
patients with sumptomatic macular polypoidal choroidal vasculopathy study. Choroidal
thickness was manually measured by enhanced depth imaging technology in Spectralis
spectral domain optical coherence tomography.
Results
Eighty-three eyes of 83 patients were included in this study, 47 patients diagnosed
with PCV/AT1 with a good response to 3 intravitreal injections of ranibizumab and
36 with a poor response. The receiver operating characteristic curve of treatment
effect against the SFCT revealed that the area under the curve was 0.85 (range, 0.74–0.96).
Based on the Youden index, the optimal SFCT cut-off point for predicting a poor response
to anti-vascular endothelial growth factor is 257 µm. In the multivariate analysis,
the SFCT remained statistically significant (odds ratio 1.02 [range, 1.01–1.04]; P = 0.008). The combined effect of treatment effect against clinical biomarkers produced
an area under the curve of 0.90 (range, 0.82–0.98).
Conclusion
SFCT is a risk factor for a poor response to the 3 loading injections of ranibizumab
in treatment-naive PCV/AT1 Caucasian patients. A cut-off point of 257 µm could be
a valuable parameter for defining the population at risk for an inadequate response
to ranibizumab.
Objectif
Évaluer l’épaisseur choroïdienne sous-fovéale (ECSF) et d'autres biomarqueurs cliniques
de la réponse à l'administration intravitréenne d'un anti-VEGF (facteur de croissance
endothélial vasculaire) à des patients caucasiens jamais traités qui ont fait l'objet
d'un diagnostic de vasculopathie polypoïdale choroïdienne (VPC, ou « dilatation anévrysmale
type 1 » [AT1]).
Nature
Étude transversale.
Participants
Patients jamais traités qui ont fait l'objet d'un diagnostic de VPC/AT1 dans un établissement
unique, recrutés entre janvier 2013 et décembre 2020.
Méthodes
On a déterminé l'admissibilité de patients jamais traités auxquels on a administré
une dose d'attaque de 3 injections de 0,5 mg de ranibizumab. Le diagnostic de VPC/AT1
reposait sur les critères diagnostiques retenus dans le cadre de l’étude sur l'efficacité
et l'innocuité de la thérapie photodynamique à la vertéporfine, administrée en association
avec le ranibizumab ou en monothérapie vs le ranibizumab en monothérapie, chez des
patients présentant une vasculopathie polypoïdale choroïdienne maculaire symptomatique.
L’épaisseur choroïdienne a été mesurée manuellement à l'aide de la tomographie par
cohérence optique (OCT) en domaine spectral à l'imagerie à profondeur améliorée réalisée
sur la plateforme Spectralis.
Résultats
Ainsi, 83 yeux de 83 patients ont été admis à cette étude : 47 patients atteints de
VPC/AT1 qui ont eu une bonne réponse à la suite de l'administration de 3 injections
intravitréennes de ranibizumab et 36 patients qui ont eu une réponse médiocre au même
traitement. Selon la courbe caractéristique de la performance de l'effet du traitement
sur l'ECSF, l'aire sous la courbe était de 0,85 (fourchette : 0,74–0,96). D'après
l'indice de Youden, le seuil optimal de l'ECSF permettant de prédire une réponse médiocre
à l'administration d'un anti-VEGF se situe à 257 µm. Lors de l'analyse multivariée,
l'ECSF est demeurée statistiquement significative (rapport de cotes : 1,02 [fourchette :
1,01–1,04]; p = 0,008). L'effet combiné du traitement ainsi que des biomarqueurs cliniques a donné
lieu à une aire sous la courbe de 0,90 (fourchette : 0,82–0,98).
Conclusion
L'ECSF représente un facteur de risque de réponse médiocre au traitement d'attaque
reposant sur 3 injections de ranibizumab chez des patients caucasiens jamais traités
atteints de VPC/AT1. Un seuil de 257 µm représente un paramètre très utile pour identifier
les sujets chez lesquels le ranibizumab risque d'avoir un effet médiocre.
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References
- Idiopathic polypoidal choroidal vasculopathy (IPCV).Retina. 1990; 10: 1-8
- Polypoidal choroidal vasculopathy and treatments.Curr Opin Ophthalmol. 2008; 19: 208-212
- Understanding aneurysmal type 1 neovascularization (polypoidal choroidal vasculopathy): a lesson in the taxonomy of “expanded spectra”—a review.Clin Exp Ophthalmol. 2018; 46: 189-200
- The pachychoroid disease spectrum—and the need for a uniform classification system.Ophthalmol Retin. 2019; 3: 1013-1015
- Prevalence of polypoidal choroidal vasculopathy in white patients with exudative age-related macular degeneration: systematic review and meta-analysis.Retina. 2018; 38: 2363-2371
- Anti–vascular endothelial growth factor resistance in exudative macular degeneration and polypoidal choroidal vasculopathy.Ophthalmol Retin. 2019; 3: 744-752
- Polypoidal choroidal vasculopathy in Canada.Can J Ophthalmol. 2020; 55: 199-211
- Polypoidal choroidal vasculopathy in Asians.J Clin Med. 2015; 4: 782-821
- Polypoidal choroidal vasculopathy: definition, pathogenesis, diagnosis, and management.Ophthalmology. 2018; 125: 708-724
- Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy in the PLANET study, a randomized clinical trial.JAMA Ophthalmol. 2018; 136: 786-793
- Comparison of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: the EVEREST II randomized clinical trial.JAMA Ophthalmol. 2020; 138: 935-942
- Eye. 2019; 33 (Pachychoroid disease.): 14-33
- Difference between pachychoroid and nonpachychoroid polypoidal choroidal vasculopathy and their response to anti–vascular endothelial growth factor therapy.Retina. 2020; 40: 1403-1411
- Enhanced depth imaging spectral-domain optical coherence tomography.Am J Ophthalmol. 2008; 146: 496-500
- Defining response to anti-VEGF therapies in neovascular AMD.Eye. 2015; 29: 721-731
- Early treatment diabetic retinopathy study design and baseline patient characteristics: ETDRS report number 7.Ophthalmology. 1991; 98: 741-756
- The age-related eye disease study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1).Ophthalmology. 2012; 119: 2282-2289
- Analysis of choroidal thickness and vascularity in patients with unilateral polypoidal choroidal vasculopathy.Graefes Arch Clin Exp Ophthalmol. 2020; 258: 1157-1164
- Comparison of clinical features and 3-month treatment response among three different choroidal thickness groups in polypoidal choroidal vasculopathy.PLoS One. 2017; 12: 1-13
- Polypoidal choroidal vasculopathy in Caucasians.Graefes Arch Clin Exp Ophthalmol. 2000; 238: 752-759
- Toward a specific classification of polypoidal choroidal vasculopathy: idiopathic disease or subtype of age-related macular degeneration.Invest Ophthalmol Vis Sci. 2015; 56: 3187-3195
- The spectrum of polypoidal choroidal vasculopathy in Caucasians: clinical characteristics and proposal of a classification.Graefes Arch Clin Exp Ophthalmol. 2021; 259: 351-361
- Polypoidal choroidal vasculopathy in Caucasians morphological findings from multimodal retinal imaging.Ophthalmologica. 2021; 244: 315-325
- Choroidal morphology in eyes with polypoidal choroidal vasculopathy and normal or subnormal subfoveal choroidal thickness.Retina. 2016; 36: S73-S82
- Subfoveal choroidal thickness as a predictor of treatment response to anti-vascular endothelial growth factor therapy for polypoidal choroidal vasculopathy.Graefes Arch Clin Exp Ophthalmol. 2016; 254: 1497-1503
- Polypoidal choroidal vasculopathy.Surv Ophthalmol. 2004; 49: 25-37
- Presenting characteristics and prevalence of polypoidal choroidal vasculopathy in Scandinavian patients with treatment-naive exudative age-related macular degeneration.Acta Ophtalmol. 2018; 96: 475-480
- Management of polypoidal choroidal vasculopathy: experts consensus in Taiwan.J Formos Med Assoc. 2020; 119: 569-576
- Refractory neovascular age-related macular degeneration secondary to polypoidal choroidal vasculopathy.Am J Ophthalmol. 2009; 148: 70-78
- Clinical characteristics of polypoidal choroidal vasculopathy and anti-vascular endothelial growth factor treatment response in caucasians.Ophthalmologica. 2020; 243: 178-186
- Polypoidal choroidal vasculopathy in Caucasian patients with presumed neovascular age-related macular degeneration and poor ranibizumab response.Br J Ophthalmol. 2014; 98: 188-194
- Prospective clinical trial of intravitreal aflibercept treatment for polypoidal choroidal vasculopathy with hemorrhage or exudation (EPIC study): 6 month results.BMC Ophthalmol. 2016; 16: 127
- Indocyanine green angiographic and optical coherence tomographic findings support classification of polypoidal choroidal vasculopathy into two types.Acta Ophthalmol. 2013; 91: e474-e481
- Comparison of OCT angiography and indocyanine green angiographic findings with subtypes of polypoidal choroidal vasculopathy.Br J Ophthalmol. 2017; 101: 51-55
- Subfoveal choroidal thickness as a potential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age-related macular degeneration.Am J Ophthalmol. 2014; 157: 1013-1021
- Choroidal thickness in relation to ethnicity measured using enhanced depth imaging optical coherence tomography.Retina. 2016; 36: 82-90
- Genetic variants affecting anti-vegf drug response in polypoidal choroidal vasculopathy patients: a systematic review and meta-analysis.Genes (Basel). 2020; 11: 1-13
- Genetic association of age-related macular degeneration and polypoidal choroidal vasculopathy.Asia-Pacific J Ophthalmol. 2020; 9: 104-109
- Pathological features of surgically excised polypoidal choroidal vasculopathy membranes.Clin Exp Ophthalmol. 2004; 32: 297-302
Article info
Publication history
Published online: October 19, 2021
Identification
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© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
