Abstract
We investigated the long-term visual and anatomical outcomes of aflibercept monotherapy for exudative age-related macular degeneration (AMD) with good baseline best-corrected visual acuity (BCVA). A medical chart review was performed for 40 consecutive patients with baseline decimal BCVA ≥ 0.6 secondary to exudative AMD. Three monthly injections were administrated, and thereafter additional injection was performed if needed over 5 years. In total, 13 eyes with neovascular AMD (nAMD) and 27 eyes with polypoidal choroidal vasculopathy (PCV) were enrolled. In both groups, the mean BCVA significantly improved at the 12-month visit (p < 0.05). However, the significant improvement in BCVA disappeared at the 24-month visit, and the final mean BCVA was equivalent to that at baseline (p = 0.17 in the nAMD group and p = 0.15 in the PCV group). The median number of injections required after the loading dose was 15.0 during the 5-year follow-up (nAMD:15.0 vs. PCV:15). During the study period, 37 (92.5%) eyes required retreatment(s). Cox regression analysis demonstrated that the protective allele of ARMS2 A69S was associated with a retreatment-free period from the initial injection (p = 0.041, repeated forward selection method). As-needed aflibercept monotherapy is a preferable treatment option for exudative AMD with good initial visual acuity regardless of nAMD or PCV during the 5-year study period.
Highlights
Age-related macular degeneration (AMD), one of the leading causes of legal blindness in advanced countries with older-aged populations [1], is a chronic inflammatory disease with a varied etiology [2]
We investigated the 5-year visual and anatomic outcomes for patients secondary to exudative AMD with good best-corrected visual acuity (BCVA) ≥ 0.6, who were initially administrated three monthly aflibercept monotherapy followed by as-needed injection
A retrospective medical chart review was performed in consecutive treatment-naïve eyes secondary to neovascular AMD or polypoidal choroidal vasculopathy (PCV) with baseline BCVA ≥ 0.6 in the decimal scale, receiving 3 monthly intravitreal aflibercept injections (IAIs) at the University of Yamanashi Hospital between January 2013 and July 2015
Summary
Age-related macular degeneration (AMD), one of the leading causes of legal blindness in advanced countries with older-aged populations [1], is a chronic inflammatory disease with a varied etiology [2]. The intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors has greatly changed the treatment of exudative AMD. It was first reported that a monthly administration of ranibizumab improved the best corrected visual acuity (BCVA) in eyes with exudative AMD in the ANCHOR/MARINA [3,4]. A subsequent study, PIER, demonstrated that the quarterly administration of ranibizumab after three-monthly loading injections failed to improve BCVA in eyes with exudative AMD [5]. The PRONTO study demonstrated that monthly monitoring and as-needed reinjection after three monthly loading ranibizumab injections is an effective treatment option for improving BCVA [6]. Anti-VEGF therapy has become the first-line treatment for exudative AMD worldwide; repeated injections after the loading phase are required for most eyes [7]. The management of recurrence is essential for patients with AMD to maintain good vision for their lifetime
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