Abstract
Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. In the present study, we studied 140 treatment naïve eyes with typical neovascular AMD (n = 71) or polypoidal choroidal vasculopathy (PCV) (n = 69) and investigated the incidence and risk factors of retreatment after 3-monthly intravitreal aflibercept injection for exudative AMD during the 12-month period. At 12 months, best-corrected visual acuity (BCVA) improved significantly from 0.45 ± 0.39 to 0.26 ± 0.33 (P = 4.1 × 10−11). Multiple regression analysis revealed that better baseline BCVA (P = 3.6 × 10−14) and thicker subfoveal choroidal thickness (P = 0.039) were associated with better BCVA at 12-months. Retreatment was required in 94 out of 140 (67.1%) eyes. Multivariate logistic regression analysis revealed that older age (P = 7.2 × 10−3) and T-allele of ARMS2 A69S (rs10490924) variants (P = 1.9 × 10−3) were associated with retreatment. Cox-regression analysis revealed that older age (P = 1.0 × 10−2) and T-allele of the ARMS2 gene (P = 6.0 × 10−3) were associated with retreatment-free period. The number of retreatment episodes was significantly different among the ARMS2 genotypes (P = 8.1 × 10−4). These findings might be helpful for physicians when considering the optimal treatment regimen for exudative AMD.
Highlights
Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes
While intravitreal injection therapy with anti-vascular endothelial growth factor (VEGF) agents has become the standard treatment for exudative Age-related macular degeneration (AMD) worldwide, retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes, including hemorrhage and intraretinal or subretinal fluid
We retrospectively studied the efficacy of the pro re nata (PRN) regimen for aflibercept after the 3-monthly loading injections for exudative AMD and investigated the 12-month visual outcome and incidence of retreatment as well as their respective risk factors
Summary
Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. Fixed-interval regimen and TAE are referred to as proactive treatments, which aim to maintain the integrity of the photoreceptors by intravitreal injection of anti-VEGF agents before the recurrence of exudative changes. These are theoretically endless treatment modalities that could lead to the potential for overtreatment, because patients must receive intravitreal injections forever, regardless of the presence or absence of choroidal neovascularization. HARBOR Study Group demonstrated that three monthly intravitreal ranibizumab followed by monthly-monitoring and as-needed retreatment was equivalent as monthly intravitreal ranibizumab, with 8.2 and 10.1 letters gained at 12 month, respectively[9]
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