Abstract
Purpose: To determine the correlation between therapeutic effects of IVA treatment on typical AMD (tAMD), and polypoidal choroidal vasculopathy (PCV) and the history of hypertension, diabetes mellitus, smoking history and single nucleotide polymorphisms (SNPs).Methods: Prospective, interventional study. Subjects were assigned to 125 untreated patients with exudative AMD (tAMD: 58 patients, PCV: 67 patients, male: 91:34, mean age 73.4 years). Among the tAMD patients, there were 28 bimonthly injections 30 who received pro re nata (PRN) injections after three monthly injections. Among the PCV patients, 33 were treated with bimonthly injections and 34 received PRN injections after three monthly injections. Therapeutic effects were evaluated by best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (CCT), and exudative change after 3 months and 1 year from initial treatment, and also the history of hypertension, diabetes mellitus, smoking and five SNPs (rs10490924, rs800292, rs699947, rs1061170, rs13278062).Results: Improvements of BCVA, CRT were observed in all groups at 1 year after initial treatment. The one-yearchange in CRT showed significant improvement in nonsmokers than smokers in tAMD. The one-year change in CRT indicated a significant improvement in non-diabetic patients in PCV. There was more exudation at both 3 months and 1 year who had smoking history in tAMD. With respect to the rs1061170 mutation of tAMD, in the case with TT type, significant residual exudation was noted at both 3 and 12 months.Conclusions: The history of smoking and diabetes could be influence to IVA treatment for AMD.
Highlights
The estimated prevalence of early Age-related Macular Degeneration (AMD) is reportedly 6.8% and that of late age-related macular degeneration 1.5% [1]
The choroidal thickness in eyes with typical AMD decreased significantly in response to intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) treatment, as demonstrated at the 1, 3- and 6-month examinations, while IVA-treated eyes showed further significant reductions in choroidal thickness as compared to those treated with ranibizumab [5]
A report on single nucleotide polymorphisms (SNPs) associated with AMD found that ARMS2/HTRA1 might be useful for predicting the requirement for additional treatment after 3 monthly injections of ranibizumab [6]
Summary
The estimated prevalence of early Age-related Macular Degeneration (AMD) is reportedly 6.8% and that of late age-related macular degeneration 1.5% [1]. AMD is increasing due to the aging of the Japanese population [2]. Advanced age is the major risk factor for AMD, with more than 10% of the population older than 80 years having late AMD. Systemic risk factors include cigarette smoking, obesity, sunlight exposure, and cardiovascular diseases. Cigarette smoking in particular is a strong and consistent risk factor for AMD. AMD patients are at increased risk for cardiovascular disease and stroke. Several genetic loci have been associated with AMD, including two major loci in complement factor H (CFH) and ARMS2/HTRA1 [1]. A report on single nucleotide polymorphisms (SNPs) associated with AMD found that ARMS2/HTRA1 might be useful for predicting the requirement for additional treatment after 3 monthly injections of ranibizumab [6]. The genetic variants rs12614 (CFB), rs699947 (VEGFA) and rs7993418 (VEGFR1) were associated with a good response to ranibizumab, while rs12603486 and rs1136287 (SERPINF1) were associated with a poor response to this treatment [7]
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