Response of Pigment Epithelial Detachment to Anti-Vascular Endothelial Growth Factor Treatment in Age-Related Macular Degeneration

OBJECTIVE: To evaluate the therapeutic response of pigment epithelial detachment (PED) to anti vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (nAMD), and identify predictive factors for PED resolution after treatment. DESIGN: Retrospective, interventional case series. METHODS: A total of 202 treatment-naive nAMD eyes presenting PED at baseline were retrospectively included and analyzed. All patients were treated with an initial series of 3 monthly loading injections of ranibizumab or aflibercept, followed by additional injections as required. RESULTS: After 12 months of treatment, the mean PED height decreased from 453 +/- 261 mu m at baseline to.230 +/- 142 mu m (P =.002), and the mean best corrected visual acuity improved from 0.71 +/- 0.41 logarithm of the minimal angle of resolution (Snellen equivalent, 20/102) to 0.60 +/- 0.36 (20/79) (P = .024). The proportion of complete PED resolution after treatment was 19.3% (39 eyes). Multivariate logistic regression analysis was used to find baseline characteristics associated with a higher chance of PED resolution, including lower PED height at baseline (P =.018), polypoidal choroidal vasculopathy (P = .015), or retinal angiomatous proliferation (P = .010) compared to typical nAMD; serous PED (P = .022) compared to fibrovascular PED; and aflibercept (P = .039) compared to ranibizumab. CONCLUSIONS: PEDs secondary to nAMD showed significant functional and anatomic improvement after intravitreal anti-VEGF injections over 12 months. However, the anti-VEGF treatment showed limited efficacy for the complete resolution of PED. The PED type, nAMD subtype, baseline PED height, and anti-VEGF drug type was associated with a higher probability of PED resolution after treatment. (C) 2016 Elsevier Inc. All rights reserved.