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Barbara Kloeckener-Gruissem, Moreno Menghini, Florian Sutter, Johannes Fleischhauer, Malaika Kurz-Levin, Wolfgang Berger, Daniel Barthelmes; Long-term Studies On The Anti-VEGF Treatment Success In Age-related Macular Degeneration (amd). Invest. Ophthalmol. Vis. Sci. 2012;53(14):5168.
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The optimal treatment strategy of patients with neovascular age-related macular degeneration (AMD) is currently under debate. Widely applied is a so-called loading phase with initially three consecutive intravitreal anti-VEGF injections. Recently it was demonstrated that genetic factors could influence the visual acuity (VA) outcome. Furthermore, studies have suggested that patients carrying specific genetic variations may require a higher number of injections. The aim of this study was to assess the respective impact of genetic factors and treatment strategies on the VA outcome.
Retrospective analysis of the clinical data of neovascular AMD patients treated with intravitreal ranibizumab during a follow up period of 24 months. Assessment of course of VA was performed. The effect of a loading phase, the influence of an initial gain in visual acuity with respect to the extended treatment period of 12 and 24 months as well as the effect of a genetic component on these conditions were analyzed. Genotypes for SNP rs1061170 at CFH were identified and their frequencies were compared between different groups.
A total of 238 eyes were included in the final analyses. 62 eyes had received a loading phase. The VA outcome for eyes, which received loading phase and those that did not, were similar. Furthermore, eyes showing an initial gain in VA tended to retain the improvement during the study period. The homozygous CC genotype of SNP rs1061170 at CFH was more frequently found in patients belonging to the group of poor responders (75 percentile) after 24 months (OR=3.57784; CI 1.22180to 10.4771; P=0.0200), as previously reported for 12 months follow-up.
Loading phase does not seem to influence the long-term outcome of visual acuity. The initial gain is a predictive factor for the long-term course of VA. So far, genetic variations as opposed to various treatment schedules are the only factors found to influence the VA outcome.
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