Fixed Dosal

Fixed Dosing (FD), Pro Re Nata (PRN) and Treat-and-Extend (TAE) Regimen of AFLIBERCEPT in Treatment of Polypoidal Choroidal Vasculopathy (PCV): a Systematic Review and Meta-analysis

BACKGROUND:

Neovascular age-related macular degeneration (AMD) is a leading cause of blindness in the developed world. Polypoidal choroidal vasculopathy (PCV) is a form of neovascular or "wet" age-related macular degeneration (AMD) involving the choroidal vasculature characterized by the presence of an inner choroidal branching vascular network terminating in polypoidal structures better seen by indocyanine green angiography (ICGA).
It Can be variable in severity characterized by recurrent serosanguineous detachments, fluid and lipid accumulation resulting eventually in chorioretinal atrophy and permanent visual loss in about 50% of patients.
Photodynamic therapy (PDT) has been the standard treatment for PCV for years. Anti-vascular endothelial growth factor (Anti VEGF) agents (bevacizumab and ranibizumab) were introduced later on. Several studies reported better visual outcomes with anti-VEGF agents than with PDT. However, the rate for regression of polypoidal lesions was lower than that with PDT. So the optimal treatment for PCV is still controversial.

Aflibercept (Eylea), a new anti-VEGF agent, is a recombinant fusion protein formed by the binding domains of VEGF receptor 1 and 2 fused to the Fc portion of IgG1. It has the advantages of having higher affinity for VEGF-A than ranibizumab, having the ability to bind VEGF-B and placental growth factor and longer half-life in the vitreous cavity. Several studies investigated the efficacy of aflibercept in PCV patients regarding visual and anatomical