Choroidal Morphology Changes After Aflibercept Therapy in Pachychoroid Neovasculopathy

In the present study, investigators attempt to evaluate the short-term, detailed changes in choroidal morphology after three monthly injections of aflibercept in pachychoroid neovasculopathy. The association between these changes and clinical outcomes will be additionally investigated. The primary purpose of this study is to provide reference data regarding the aflibercept-related morphologic changes that implicate structural and functional choroidal alteration, and hence its clinical implications.

Inclusion Criteria:Willing, committed, and able to return for all clinic visits and complete all study related procedures.Able to read, (or, if unable to read due to visual impairment, be read to verbatim by the person administering the informed consent or a family member) understand and willing to sign the informed consent form.Signed informed consentPatients aged 50 years or olderPatients diagnosed with treatment naïve pachychoroid neovasculopathyDiagnostic criteria of PNVPresence of type 1 MNVSubfoveal choroidal thickness ≥250 µmFocal or diffuse choroidal thickeningPresence of dilated choroidal vessels (pachyvessels)Thinning or absence of choriorapillaris and Sattler's layer overlying pachyvesselsAbsence of drusen or pseudodrusen, except for pachydrusenETDRS BCVA letter score ≥25 letters (approximately 20/320 or better) in the study eyeExclusion Criteria:Any prior ocular (in the study eye) or systemic treatment or surgery for neovascular AMD except dietary supplements or vitamins.Prior treatment with anti-VEGF agentsKnown serious allergy to the fluorescein sodium for injection in angiography.Significant media opacities, including cataract, in the study eye that might interfere with visual acuity, assessment of safety, or fundus photography.Any concurrent ocular condition in the study eye which, in the opinion of the investigator, could either increase the risk to the patient beyond what is to be expected from standard procedures of intraocular injection, or which otherwise may interfere with the injection procedure or with evaluation of efficacy or safety.Any ocular or periocular infection within the last 2 weeks prior to Screening in either eye.Any history of uveitis in either eye.Presence of definite chorioretional anastomosisSubretinal hemorrhage that is either 50% or more of the total lesion area, or if the blood is under the fovea and is 1 or more disc areas in size in the study eye. (If the blood is under the fovea, then the fovea must be surrounded 270 degrees by visible choroidal neovascularization.)Scar or fibrosis, making up > 50% of total lesion in the study eye.Scar, fibrosis, or atrophy involving the center of the fovea in the study eye.Presence of retinal pigment epithelial tears or rips involving the macula in the study eye.History or clinical evidence of diabetic retinopathy, diabetic macular edema or any other vascular disease affecting the retina, other than AMD, in either eye.Any concurrent intraocular condition in the study eye (e.g. cataract) that, in the opinion of the investigator, could require either medical or surgical intervention during the 76 week study period.Prior vitrectomy in the study eyeAny history of macular hole of stage 2 and above in the study eye.Any intraocular or periocular surgery within 3 months of Day 1 on the study eye, except lid surgery, which may not have taken place within 1 month of day 1, as long as its unlikely to interfere with the injection.Prior trabeculectomy or other filtration surgery in the study eye.Uncontrolled glaucoma (defined as intraocular pressure ≥ 25 mmHg despite treatment with antiglaucoma medication) in the study eye.Active intraocular inflammation in either eye.Active ocular or periocular infection in either eye.Aphakia or pseudophakia with absence of posterior capsule (unless it occurred as a result of a yttrium aluminum garnet posterior capsulotomy) in the study eye.History of corneal transplant or corneal dystrophy in the study eye.