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Marion Ronit Munk, Petra Arendt, Siqing Yu, Andreas Ebneter, Sebastian Wolf, Martin Zinkernagel; The impact of the vitreomacular interface (VMI) in neovascular AMD (nAMD) in a treat and extent regimen (TE) with exit strategy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3762.
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Evaluate the impact of the VMI in a TE regimen with exit strategy in patients with nAMD
In this retrospective study, all eyes treated according to a TE regimen with at least 3 intravitreal injections of ranibizumab or aflibercept between 2014 and 2015 were reviewed. Eyes reaching the exit criterion were included. The exit criterion was defined as dry macula during 3 consecutive 16-weekly injection visits. Eyes were regularly monitored, without injections thereafter. The impact of the VMI on mean treatment interval, number of injections, central retinal thickness (CRT) decrease and BCVA improvement as well as CNV recurrences was assessed
598 eyes of 488 patients were identified. Out of these, 100 eyes (17%) of 95 patients (mean age: 80±9) met the exit criteria and were included in this study. Mean number of administered injections was 23.7±14.7 during a mean treatment duration of 4.5±2.5yrs. At treatment initiation, 74% had a posterior vitreous detachment (PVD). At treatment cessation 86% showed a PVD with a release rate of 48% in eyes with vitreomacular adhesion (VMA) at baseline. Numerical, but no statistical difference in CRT decrease (PVD:-87±18µm vs. VMA:-23±46µm, p=0.1) and BCVA improvement (PVD:+3±2 vs. VMA:-1±3 letter, p=0.3) between the PVD and the VMA group were noted. There was also no difference in mean injection interval (PVD: 13.2±0.3 vs. VMA: 12.8±0.4weeks, p=0.5), number of injections (PVD: 22.8±1.7 vs. VMA: 26.2±2.8, p=0.3) or absolute treatment duration (PVD: 226 ±15 vs. VMA: 263±26weeks) until cessation. 15% eyes showed CNV recurrence after a mean of 41±7 weeks. VMA at treatment cessation was significantly associated with disease recurrence (p=0.006): VMA eyes showed in 43% disease recurrence during the observational period, in contrast to 10.5% of eyes with PVD. Additional data from the full 598 eye data set will be presented
There was a high prevalence of PVD and release rates in our patient cohort reaching the TE exit criterion. VMA was associated with significantly higher recurrence rates. This indicates that eyes with VMA reaching TE exit criterion should be very carefully monitored for new disease activity. Even continuation of treatment until VMA release may be considered
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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