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Sarah Mrejen, Jesse J Jung, Roberto Gallego-Pinazo, Irene Rusu, Marcela Marsiglia, Sucharita Boddu, K Bailey Freund; Long-Term Visual Outcomes for a Treat and Extend Anti-VEGF Regimen in Eyes with Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3970.
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To assess long-term visual outcomes of neovascular age-related macular degeneration (AMD) patients treated with anti-VEGF therapy using a Treat and Extend Regimen (TER) and to correlate these results with neovascular lesion type.
Of the 374 treatment-naïve patients with neovascular AMD treated by a single physician between October 2005 and March 2013 with a TER of intravitreal anti-VEGF therapy, 231 patients met the following inclusion criteria: age ≥50 years, visual acuity of 20/20-20/800, absence of permanent structural damage to the central fovea, and a minimum of 12-months of follow-up. Neovascular lesions were classified using fluorescein angiography (FA) alone as occult choroidal neovascularization (CNV), classic CNV, retinal angiomatous proliferation (RAP) and mixed CNV, and using an anatomic classification based on both FA and optical coherence tomography (OCT) as Types 1 (sub-RPE), 2 (subretinal), 3 (intraretinal) and 4 (mixed) neovascularization (NV). Correlations were made between long-term visual acuity, number of intravitreal anti-VEGF injections, and neovascular lesion type using both classifications.
231 patients (266 eyes) with a mean (±SD) age of 81.2 (±7.9) years received a mean number of 28.6 (±14.9) intravitreal anti-VEGF injections during a mean follow-up of 3.6 years (range 1 to 7 years), with a retention rate of 64%. The mean visual acuity was 20/91 at baseline, 20/67 at 1 year, 20/72 at 3 years and 20/72 at 6 years. By lesion type, the mean VA at baseline was 20/73, 20/145, 20/176, and 20/167 for Types 1, 2, 3, and 4 NV, respectively. At 6 years, the mean VA was 20/48, 20/42, 20/112, and 20/92 for Types 1, 2, 3, and 4 NV, respectively. At final visit, after a mean follow-up of 3.6 years, the mean VA was 20/85 for the entire cohort and 20/59, 20/93, 20/93 and 20/151 for Types 1, 2, 3, and 4 NV, respectively. The mean number of injections per year was 8.0 for the entire cohort and 8.5, 7.6, 7.8 and 7.8 for Types 1, 2, 3, and 4 NV, respectively.
Patients with Type 1 NV had better long-term visual outcomes compared to the other neovascular lesion types, despite receiving more intravitreal anti-VEGF injections. Other results from the same study cohort showed that patients with Type 1 NV were less likely to develop GA, which may account partly for their better long-term visual results.
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