Analysis of the efficacy of subretinal injection and intravitreal injection of conbercept in the treatment of polypoidal choroidal vasculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Teng , Yu Xiao , Wu Xiaojian , Zou Yuling , Liu Kangcheng , Zou Hua , Wu Wei , Xu Chenghao ,  You Zhipeng

Affiliated Eye Hospital of Nanchang University, Eye Hospital of Jiangxi Province, Nanchang 330006, China;

Corresponding author：

You Zhipeng, Email: yzp@sina.com

Keywords：

Polypoid choroidal vasculopathy; Subretinal injection; Intravitreal injection; Conbercept

DOI：

10.3760/cma.j.cn511434-20240112-00023

Video：

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Objective To observe the clinical effect of subretinal injection and intravitreal injection of conbercept in the treatment of polypoid choroidal vasculopathy (PCV). Methods A prospective, randomized double-blind controlled study. From June 2022 to January 2023, 35 patients of 35 eyes with PCV diagnosed at Affiliated Eye Hospital of Nanchang University were included in the study. All patients were first-time recipients of treatment. Best corrected visual acuity (BCVA), optical coherence tomography (OCT), and indocyanine green angiography (ICGA) were performed in all affected eyes. BCVA was performed using an international standard visual acuity chart and converted to logarithmic minimum resolved angle (logMAR) visual acuity for statistical purposes. Enhanced depth imaging with OCT instrument was used to measure the macular retinal thickness (MRT), subfoveal choroidal thickness (SFCT), and pigment epithelium detachment (PED) height. Randomized numerical table method was used to divide the patients into subretinal injection group (group A) and vitreous cavity injection group (Group B), 18 cases with 18 eyes and 17 cases with 17 eyes, respectively. Comparison of age (t=0.090), disease duration (t=−0.370), logMAR BCVA (t=−0.190), MRT (t=0.860), SFCT (t=0.247), and PED height (t=−0.520) between the two groups showed no statistically significant difference (P＞0.05). The eyes of group A were given one subretinal injection of 10 mg/ml conbercept 0.05 ml (containing conbercept 0.5 mg), and subsequently administered on demand (PRN); eyes in group B were given intravitreal injection of 10 mg/ml conbercept 0.05 ml (containing conbercept 0.5 mg). The treatment regimen was 3+PRN. Lesions were categorized into active and quiescent according to the results of post-treatment OCT and BCVA. Active lesions were treated with intravitreal injection of conbercept at the same dose as before; stationary lesions were followed up for observation. BCVA and OCT were performed at 1, 2, 3, 6 and 9 months after treatment; ICGA was performed at 3, 6 and 9 months. BCVA, MRT, SFCT, and PED height changes before and after treatment were compared and observed in the affected eyes of the two groups. Independent sample t-test was used to compare between the two groups. Results With the prolongation of time after treatment, the BCVA of the affected eyes in groups A and B gradually increased, and the MRT, SFCT, and PED height gradually decreased. Compared with group B, at 2, 3, 6, and 9 months after treatment, the BCVA of group A was significantly improved, and the difference was statistically significant (t=−2.215, −2.820, −2.559, −4.051; P＜0.05); at 1, 2, 3, 6, and 9 months after treatment, the MRT of the affected eyes in group A (t=−2.439, −3.091, −3.099, −3.665, −5.494), SFCT (t=−3.370, −3.058, −3.268, −4.220, −4.121), and PED height (t=−3.460, −4.678, −4.956, −5.368, −6.396) were significantly reduced, and the differences were statistically significant (P＜0.05). No complications such as intraocular inflammation, high intraocular pressure, or vitreous hemorrhage occurred in any of the affected eyes during or after treatment. Conclusion Compared with the intravitreal injection of conbercept, the subretinal injection of conbercept can more effectively reduce the height of MRT, SFCT, PED height, and improve the visual acuity of the affected eyes with PCV.

Citation： Liu Teng, Yu Xiao, Wu Xiaojian, Zou Yuling, Liu Kangcheng, Zou Hua, Wu Wei, Xu Chenghao, You Zhipeng. Analysis of the efficacy of subretinal injection and intravitreal injection of conbercept in the treatment of polypoidal choroidal vasculopathy. Chinese Journal of Ocular Fundus Diseases, 2024, 40(6): 421-428. doi: 10.3760/cma.j.cn511434-20240112-00023 Copy

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13.	刘炳乾, 卢百阳, 王雪, 等. 抗VEGF注射治疗对息肉状脉络膜血管病变患者脉络膜新生血管的抑制作用观察[J]. 海军医学杂志, 2023, 44(4): 392-396. DOI: 10.3969/j.issn.1009-0754.Liu BQ, Lu BY, Wang X, et al. Observation on the inhibitory effects of anti-VEGF injection on choroidal neovascularization in the patients with polypoid choroidal vasculopathy[J]. Journal of Navy Medicine, 2023, 44(4): 392-396. DOI: 10.3969/j.issn.1009-0754.
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20.	Yao TT, Yang Y, Jin XL, et al. Intraocular pharmacokinetics of anti-vascular endothelial growth factor agents by intraoperative subretinal versus intravitreal injection in silicone oil-filled eyes of proliferative diabetic retinopathy: a randomized controlled pilot study[J/OL]. Acta Ophthalmol, 2020, 98(7): e795-e800[2020-02-29]. https://pubmed.ncbi.nlm.nih.gov/32114709/. DOI: 10.1111/aos.14386.
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23.	曾苗, 陈晓, 洪玲, 等. 视网膜下注射平衡盐溶液治疗难治性糖尿病黄斑水肿的初步报告[J]. 中华眼底病杂志, 2020, 36(6): 462-466. DOI: 10.3760/cma.j.cn511434-20190304-00065.Zeng M, Chen X, Hong L, et al. Subretinal injection of balanced salt solution for the resolution of refractory diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2020, 36(6): 462-466. DOI: 10.3760/cma.j.cn511434-20190304-00065.
24.	Ijuin N, Tsujinaka H, Hirai H, et al. Clinical implications of pachyvessels in polypoidal choroidal vasculopathy[J]. BMC Ophthalmol, 2020, 20(1): 170. DOI: 10.1186/s12886-020-01443-8.
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1. Cher YX, Zhang YQ, Chen CZ, et al. Chinese guideline on the management of polypoidal choroidal vasculopathy (2022)[J]. Chin Med Sci J, 2023, 38(2): 77-93. DOI: 10.24920/004213.
2. Cheung C, Lai T, Teo K, et al. Polypoidal choroidal vasculopathy: consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup[J]. Ophthalmology, 2021, 128(3): 443-452. DOI: 10.1016/j.ophtha.2020.08.006.
3. 任晴, 崔蕾, 高磊. 息肉样脉络膜血管病变的临床特征与手术治疗进展[J]. 国际眼科杂志, 2018, 18(10): 1810-1814. DOI: 10.3980/j.issn.1672-5123.2018.10.12.Ren Q, Cui L, Gao L. Clinical features and progress of surgical therapy for polypoidal choroidal vasculopathy[J]. Int Eye Sci, 2018, 18(10): 1810-1814. DOI: 10.3980/j.issn.1672-5123.2018.10.12.
4. Chen LJ, Cheng CK, Yeung L, et al. Management of polypoidal choroidal vasculopathy: experts consensus in Taiwan[J]. J Formos Med Assoc, 2020, 119(2): 569-576. DOI: 10.1016/j.jfma.2019.04.012.
5. Sen P, Manayath G, Shroff D, et al. Polypoidal choroidal vasculopathy: an update on diagnosis and treatment[J]. Clin Ophthalmol, 2023, 17: 53-70. DOI: 10.2147/OPTH.S385827.
6. 朱哲. 影响息肉状脉络膜血管病变(PCV)患者发生黄斑区视网膜下纤维化瘢痕的相关因素分析[D]. 长春: 吉林大学, 2021.Zhu Z. Analysis of related factors affecting subretinal fibrosis scar in macular area in patients with polypoid choroidal vasculopathy (PCV)[D]. Changchun: Jilin University, 2021.
7. 梁燕华, 宋艳萍, 丁琴, 等. 单纯光动力疗法与玻璃体腔注射雷珠单抗以及两者联合治疗息肉样脉络膜血管病变疗效比较[J]. 中华眼底病杂志, 2016, 32(1): 31-35. DOI: 10.3760/cmaj. issn. 1005-1015.2016. 01.008.Liang YH, Song YP, Ding Q, et al. Efficacy of photodynamic therapy and intravitreal injection of ranibizumab in patients with polypoidal choroidal vasculopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(1): 31-35. DOI: 10.3760/cmaj.issn.1005-1015.2016.01.008.
8. Irigoyen C, Amenabar Alonso A, Sanchez-Molina J, et al. Subretinal injection techniques for retinal disease: a review[J]. Journal of Clinical Medicine, 2022, 11(16): 4717. DOI: 10.3390/jcm11164717.
9. Del AE, Rimpela AK, Heikkinen E, et al. Pharmacokinetic aspects of retinal drug delivery[J]. Prog Retin Eye Res, 2017, 57: 134-185. DOI: 10.1016/j.preteyeres.2016.12.001.
10. Simunovic MP, Xue K, Jolly JK, et al. Structural and functional recovery following limited iatrogenic macular detachment for retinal gene therapy[J]. JAMA Ophthalmol, 2017, 135(3): 234-241. DOI: 10.1001/jamaophthalmol.2016.5630.
11. 赵燕, 吴建华, 严立. 玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉状脉络膜血管病变的临床观察[J]. 临床眼科杂志, 2018, 26(1): 1-4. DOI: 10.3969/j.issn.1006-8422.2018.01.001.Zhao Y, Wu JH, Yan L. Clinical observation on the treatment of polypoidal choroidal vasculopathy with intravitreal ranibizumab in-jection and photodynamic therapy[J]. J Clin Ophthalmol, 2018, 26(1): 1-4. DOI: 10.3969/j.issn.1006-8422.2018.01.001.
12. 龚培, 王情, 吴福进. 康柏西普治疗息肉状脉络膜血管病变的疗效及对患者血液流变学的影响[J]. 临床合理用药杂志, 2023, 16(2): 149-152. DOI: 10.15887/j.cnki.13-1389/r.2023.02.046.Gong P, Wang Q, Wu FJ. Efficacy of Conbercept in the treatment of polypoid choroidal vascular lesions and its effect on the hemorheology of patients[J]. Chin J of Clinical Rational Drug Use, 2023, 16(2): 149-152. DOI: 10.15887/j.cnki.13-1389/r.2023.02.046.
13. 刘炳乾, 卢百阳, 王雪, 等. 抗VEGF注射治疗对息肉状脉络膜血管病变患者脉络膜新生血管的抑制作用观察[J]. 海军医学杂志, 2023, 44(4): 392-396. DOI: 10.3969/j.issn.1009-0754.Liu BQ, Lu BY, Wang X, et al. Observation on the inhibitory effects of anti-VEGF injection on choroidal neovascularization in the patients with polypoid choroidal vasculopathy[J]. Journal of Navy Medicine, 2023, 44(4): 392-396. DOI: 10.3969/j.issn.1009-0754.
14. Tripepi D, Jalil A, Ally N, et al. The role of subretinal injection in ophthalmic surgery: therapeutic agent delivery and other indications[J/OL]. Int J Mol Sci, 2023, 24(13): 10535[2023-06-23]. https://pubmed.ncbi.nlm.nih.gov/37445711/. DOI: 10.3390/ijms241310535.
15. Haupert CL, McCuen BN, Jaffe GJ, et al. Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration[J]. Am J Ophthalmol, 2001, 131(2): 208-215. DOI: 10.1016/s0002-9394(00)00734-0.
16. Romano MR, Rossi T, Borgia A, et al. Management of refractory and recurrent macular holes: a comprehensive review[J]. Surv Ophthalmol, 2022, 67(4): 908-931. DOI: 10.1016/j.survophthal.2022.01.006.
17. Malik D, Tarek M, Caceres del Carpio J, et al. Safety profiles of anti-VEGF drugs: Bevacizumab, Ranibizumab, Aflibercept and ziv-Aflibercept on human retinal pigment epithelium cells in culture[J]. Br J Ophthalmol, 2014, 98 Suppl 1: S11-16. DOI: 10.1136/bjophthalmol-2014-305302.
18. Takahashi K, Morizane Y, Hisatomi T, et al. The influence of subretinal injection pressure on the microstructure of the monkey retina[J/OL]. PLoS One, 2018, 13(12): e209996[2018-12-31]. https://pubmed.ncbi.nlm.nih.gov/30596769/. DOI: 10.1371/journal.pone.0209996.
19. Peng J, Liang T, Chen C, et al. Subretinal injection of ranibizumab in advanced pediatric vasoproliferative disorders with total retinal detachments[J]. Graefe's Arch Clin Exp Ophthalmol, 2020, 258(5): 1005-1012. DOI: 10.1007/s00417-020-04600-3.
20. Yao TT, Yang Y, Jin XL, et al. Intraocular pharmacokinetics of anti-vascular endothelial growth factor agents by intraoperative subretinal versus intravitreal injection in silicone oil-filled eyes of proliferative diabetic retinopathy: a randomized controlled pilot study[J/OL]. Acta Ophthalmol, 2020, 98(7): e795-e800[2020-02-29]. https://pubmed.ncbi.nlm.nih.gov/32114709/. DOI: 10.1111/aos.14386.
21. Inoue M, Arakawa A, Yamane S, et al. Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy[J]. Eye (Lond), 2013, 27(9): 1013-1021. DOI: 10.1038/eye.2013.179.
22. Connor KM, Krah NM, Dennison RJ, et al. Quantification of oxygen-induced retinopathy in the mouse: a model of vessel loss, vessel regrowth and pathological angiogenesis[J]. Nat Protoc, 2009, 4(11): 1565-1573. DOI: 10.1038/nprot.2009.187.
23. 曾苗, 陈晓, 洪玲, 等. 视网膜下注射平衡盐溶液治疗难治性糖尿病黄斑水肿的初步报告[J]. 中华眼底病杂志, 2020, 36(6): 462-466. DOI: 10.3760/cma.j.cn511434-20190304-00065.Zeng M, Chen X, Hong L, et al. Subretinal injection of balanced salt solution for the resolution of refractory diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2020, 36(6): 462-466. DOI: 10.3760/cma.j.cn511434-20190304-00065.
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Chinese Journal of Ocular Fundus Diseases

Analysis of the efficacy of subretinal injection and intravitreal injection of conbercept in the treatment of polypoidal choroidal vasculopathy

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