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A. Tannan, C. Li, T. S. Stevens; Predicting Treatment Outcomes in Patients With Newly Diagnosed Exudative Age-Related Macular Degeneration Based on Initial Presentation. Invest. Ophthalmol. Vis. Sci. 2010;51(13):907.
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To determine if baseline characteristics of patients with exudative Age-related Macular Degeneration (AMD) can be used to predict response to treatment with intravitreal anti-VEGF antibodies.
A retrospective chart analysis was performed on 202 eyes (185 patients) that initiated treatment for exudative AMD with intravitreal anti-VEFG injections between March 2006 and March 2008. Baseline Optical Coherence Tomography (OCT), Fluorescein Angiography (FA), and initial best-corrected visual acuity (BCVA) were obtained. Time-course of intravitreal injections and final BCVA were also noted. Patients were separated into 3 groups for data analysis based on treatment course. Group 1 included 57 eyes that received less than 4 consecutive injections with noted regression of their disease; Group 2 included 97 eyes that required more than 3 injections with pauses of greater than 4 months during the treatment; and, Group 3 included 48 eyes that received continuous treatment without pauses of greater than 4 months. Statistical analysis of the data was completed using a cumulative logit model, Welch Two Sample t-test, and One Sample z-test.
The mean follow-up time for each group was 20.3 (range 4-37), 27.8 (range 10-41), and 29.2 (range 14-44) months respectively. The AIC-optimal model found that subretinal fluid (SRF) had a significant effect on the predicted probability of being in one of the 3 groups (p= 0.0483). This model was supported by the Deviance goodness-of-fit statistic (p=0.8822).When compared to patients without SRF, patients with SRF had an odds ratio of 0.551 for being in Group 1 and an odds ratio of 1.814 for being in Group 3 (95% CI [0.305, 0.996] and [1.004, 3.279] respectively). Follow-up data revealed a significant decline in vision in group 2 (mean change in LogMAR of 0.1598, p=0.0018). There was no significant change in visual acuity in Groups 1 and 3. The mean change in LogMAR was -0.0507 for Group 1 and -0.0136 for Group 3 (p=0.3176 and p=0.8316 respectively).
AMD patients with SRF are more likely to require continuous treatment than those without SRF. Patients who received intermittent treatment had significant worsening of their visual acuity when compared to those who received continuous treatment or responded well to initial treatment.
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