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Pooja Gupta Garg, Andy Lee, Alice T Lyon, Rukhsana Mirza, Amani Fawzi, Manjot Gill; Clinical outcomes and OCT analysis of Anti-VEGF treatments with neovascular aged-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4982.
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© ARVO (1962-2015); The Authors (2016-present)
Neovascular age-related macular degeneration (NV-AMD) is a leading cause of vision loss in Americans who are 50 years and older. Anti-vascular endothelial growth factor (VEGF) agents have evolved as the treatment of choice for NV-AMD. Patients fall on a spectrum of favorable to poor response with treatment. This study aims to identify the long-term outcomes and correlation to imaging of anti-VEGF treatments.
The study design is a retrospective electronic chart review of patients from 4 physician investigators in a large urban referral center between March 2008 and October 2015. Methods were approved by our institution’s IRB. The dataset was restricted to records of treatment naïve patients with the ICD9 diagnosis code 362.52 for NV-AMD and CPT code 67028 for intravitreal injection. OCT images were individually analyzed for presence of intraretinal, subretinal, and sub-RPE fluid.
Over a 7-year period, patients consisted of 154 (70.3%) females and 65 (29.7%) males greater than 50 years old. Four investigators treated 115 right eyes and 132 left eyes (219 unique patients) with 3222 intravitreal injections – 420 Bevacizumab (B); 1243 Ranibizumab (R); 1559 Aflibercept (A). Of these patients, 12 eyes received only one injection (6 B; 1 R; 5 A). The remaining 235 patients received an average of 13.7 ± 12 injections (mean ± SD). At the initial visit, 17 (7%) patients presented with VA of CF or worse and 230 patients (93%) had an average initial VA of 0.543 logMAR (20/69 Snellen). At the final visit, 25 (10%) patients had a VA worse than CF while 222 patients (90%) had an average final VA of 0.471 logMAR (20/60 Snellen). Over the course of 7-year follow-up, 177 eyes maintained recordable Snellen VA. Of these, 110 eyes (62%) maintained VA within 2 lines, 21 eyes (12%) lost more than 2 lines, and 46 (26%) gained more than 2 lines. Of the eyes that gained more than 2 lines, there was an average of 14.43 injections (10% B; 33% R; 57% A). Of the eyes that lost more than 2 lines, there was an average of 21.52 injections (12% B; 42% R; 46% A). The presence or absence of fluid type on OCT imaging and its correlation with visual acuity will be reported.
Gathering correlative data on the practical outcomes of anti-VEGF treatments provide clarity to their everyday use. Future studies are needed in further understanding the beneficial response of anti-VEGF on NV-AMD.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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