Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab

PURPOSE: To report the effects of aflibercept on eyes with large retinal pigment epithelial detachment (PED) associted with polypoidal choroidal vasculopathy (PCV). METHODS: We reviewed the medical records of patients with PEDs associated with PCV that were treated with aflibercept after intravitreal ranibizumab had failed. RESULTS: Three eyes of patients aged 72, 79, and 80 years were studied. Reflective material was seen in the PED along the outer surface of the retinal pigment epithelium (RPE) by spectral-domain optical coherence tomography (SD-OCT). A complete resolution of the serous PEDs was found after two aflibercept injections; however, all eyes had a fibrovascular PED. In addition, one eye developed a retinal hemorrhage and a recurrent PED just after the third injection of aflibercept. The visual acuity in this eye decreased from 10/20 to 2/20. CONCLUSION: The reflective material below the outer surface of the RPE in serous PED suggests the presence of neovascularization. Intravitreal aflibercept could be considered for large PEDs in eyes with PCV but should be carefully applied.