title: TYPE 1 VERSUS TYPE 3 NEOVASCULARIZATION IN PIGMENT EPITHELIAL DETACHMENTS ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY: A Prospective Study.
abstract: OBJECTIVE
  To evaluate the response to aflibercept therapy for Type 1 and Type 3 neovascularization in pigment epithelial detachments associated with treatment-naive, neovascular age-related macular degeneration.
  
  
  METHODS
  In this multicentered, prospective study, eligible eyes underwent an intravitreal aflibercept injection protocol for 12 months. Visual acuity and morphologic features of the pigment epithelial detachments were compared at baseline and follow-up intervals between eyes with Type 1 versus Type 3 neovascularization.
  
  
  RESULTS
  Thirty-six eyes were analyzed. At 12 months, Type 1 lesions showed a 4.5 ± 23 Early Treatment of Diabetic Retinopathy Study letter improvement (P = 0.1665) versus a 14 ± 11 (P = 0.0072) letter improvement with Type 3 lesions. Both Type 1 and 3 eyes showed a significant decrease in pigment epithelial detachment size, subretinal fluid, and subretinal hyperreflective material; however, Type 3 eyes had a greater reduction in pigment epithelial detachment size and subretinal hyperreflective material, as well as a reduction in central retinal thickness. Type 1 eyes required an average of 1.636 (range, 1-4) injections to resolve fluid, which was greater than Type 3 eyes, which required an average of 1.143 (range, 1-2) injections (P = 0.0251).
  
  
  CONCLUSIONS
  Intravitreal aflibercept injections were efficacious for pigment epithelial detachments, but baseline and follow-up anatomical and functional outcomes differed in Type 1 versus Type 3 neovascularization. The better response of Type 3 eyes with fewer injections suggests that differentiation of the neovascularization subtype at the initial diagnosis may allow for a more tailored, optimal therapy.
authors.affiliation: *Department of Ophthalmology, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles, Los Angeles, California; †Department of Ophthalmology, David Geffen School of Medicine, Doheny Eye Institute, University of California Los Angeles, Los Angeles, California; ‡Southern California Desert Retina Consultants, Palm Desert, California; §Department of Ophthalmology, Loma Linda University Eye Institute, Loma Linda, California; ¶Black Hills Regional Eye Institute, Rapid City, South Dakota; and **Department of Ophthalmology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA.
authors.forename: Xuejing
authors.initials: X
authors.lastname: Chen
authors.forename: Mayss
authors.initials: M
authors.lastname: Al-Sheikh
authors.forename: Clement K
authors.initials: CK
authors.lastname: Chan
authors.forename: Amir H
authors.initials: AH
authors.lastname: Hariri
authors.forename: Prema
authors.initials: P
authors.lastname: Abraham
authors.forename: Maziar
authors.initials: M
authors.lastname: Lalezary
authors.forename: Steven G
authors.initials: SG
authors.lastname: Lin
authors.forename: SriniVas
authors.initials: S
authors.lastname: Sadda
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D005260:Female; D057092:Geographic Atrophy / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012163:Retinal Detachment / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015861:Retinal Neovascularization / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor