Response of serous retinal pigment epithelial detachments to intravitreal aflibercept in polypoidal choroidal vasculopathy refractory to ranibizumab
An 80-year-old man presented with a large serous PED. FA displayed an occult CNV, and IA images showed a PCV. His BCVA was 10/20 OS. Three monthly injections of ranibizumab slightly flattened the PED, but a recurrence was observed after 3 months. Three additional monthly injections of ranibizumab (total of six injections) failed to reduce the PED, and hyper-reflective materials were seen beneath the outer surface of the RPE in the SD-OCT images. We switched to aflibercept, and after the two additional monthly injections, an exudative CNV lesion was observed instead of the serous PED. OCT showed a loss of optical free space and highly reflective materials, suggesting the formation of fibrovascular PED. One day after the third monthly injection of aflibercept, a subretinal hemorrhage and recurrent PED were observed. BCVA was reduced to 2/20 ().