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Sebastian M Waldstein, Victor Chong, Michael Larsen, James Warburton, Andreas Weichselberger, Jonathan Wright, Ursula Schmidt-Erfurth; Association of fluid recurrence with visual maintenance following the loading phase in anti-VEGF therapy for neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2016;57(12):533.
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© ARVO (1962-2015); The Authors (2016-present)
Parameters such as baseline (BL) vision and certain lesion characteristics correlate with visual gain during anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD). However, it is also important to understand individual differences in required treatment intensity to maintain this gain, which may allow treatment regimens to be individually customized. This study examined the association between specific courses of best corrected visual acuity (BCVA) development and fluid accumulation patterns on optical coherence tomography (OCT) after the completion of the loading phase of anti-VEGF therapy in nAMD patients.
Post-hoc analysis was performed on data from treatment-naïve nAMD patients enrolled in the EXCITE (n=353) and SUSTAIN (n=513) studies with fixed 12-weekly (q12) or PRN maintenance regimens after loading phase. Three groups were identified based on change in BCVA: 1) gain/maintain (BCVA change from BL–month M3 ≥0 and from M3–M12 ≥-5); 2) gain/loss (BCVA from BL–M3 ≥0 and BCVA from M3–M12 ≤-5); 3) no gain (BCVA from BL–M3 <0). Morphological parameters included presence of subretinal fluid (SRF) and intraretinal cystoid fluid (IRF). Fluid status at M4 (after the first treatment-free visit at M3) was compared between the groups.
In EXCITE q12 patients (n=238), in the gain/maintain (n=98) and no gain (n=35) groups, IRF was stable after treatment discontinuation at M4 (IRF present in 14% of patients at M3 and 18% at M4; and 23% and 29%, respectively). In the gain/loss group (n=91), IRF presence increased significantly from M3 to M4 (from 13% at M3 to 37% at M4). New IRF at M4 was associated with decline in mean BCVA from M3 to M12 with this q12 regimen; increases in IRF later in the treatment period, i.e. at M5, were not associated with a BCVA decline. Loss of BCVA did not demonstrate strong associations with dynamic changes in SRF.
Declining BCVA after the loading phase with discontinuous anti-VEGF treatment was associated with an early increase in IRF, which suggests that patients with such fluid recurrence would likely benefit from more intensive treatment. Customizing individual treatment regimens in this manner may lessen the logistical burden which is increasingly evident in the treatment of nAMD.
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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