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Michael Grinton, Michael McKenna, Sreekumari Pushpoth, Philip Severn; Investigating visual and anatomical outcomes of patients treated with ranibizumab and aflibercept for wet macular degeneration in the United Kingdom over a 3 year period. Invest. Ophthalmol. Vis. Sci. 2018;59(9):821.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal anti-vascular endothelial growth factor (VEGF) has revolutionised the treatment of wet age related macular degeneration (AMD) however despite use of the drug patients’ visual acuity is known to deteriorate from the second year onwards. The exact cause and processes responsible for the decrease in vision is uncertain. This study aims to provide detailed information of the visual outcomes and the associated prevalence of ongoing exudative activity, development of geographic atrophy (GA) and fibrotic scar formation throughout 3 years of treatment for wet AMD.
A retrospective observational clinical study of patients treated for exudative AMD with intravitreal Aflibercept and Ranibizumab at James Cook University Hospital, United Kingdom. By reviewing case notes and OCT scans of 234 patients we obtained the following information: visual acuity (VA), central macular thickness (CMT), evidence of macular exudation and the presence of GA and fibrotic scarring. This process was then repeated post loading of anti-VEGF, at 1 to 2 years and at 3 years.
The mean age was 79 years old. Prior to starting treatment (n=234): 31% of patients had a VA of 6/12 (20/40) or better, mean CMT was 333μm, all patients showed evidence of retinal or subretinal fluid, 1% had GA and 4% had fibrotic scarring. After loading of anti-VEGF (after 3 monthly injections) (n=204): 38% of patients had a VA of 6/12 or better, 76% of patients showed evidence of retinal or subretinal fluid, 9% had GA and 9% had fibrotic scarring. At between 1 and 2 years of treatment (n=96): 26% had a visual acuity of 6/12 or better, mean CMT was 233μm, 72% of patients showed evidence of retinal or subretinal fluid, 17% had GA and 14% fibrotic scarring. At 3 years of treatment (n=77): mean CMT was 254 μm, 41% showed evidence of retinal or subretinal fluid, 34% had GA and 32% had fibrotic scarring.
Further evidence of the efficacy of the anti-VEGF in the resolution of retinal and subretinal fluid is shown with the most improvement in resolution of fluid on OCT seen within the loading phase of anti-VEGF. The study also illustrates the increasing prevalence of both geographic atrophy and fibrotic scar formation in the 3 years after diagnosis and commencement of treatment although further studies are required to investigate the aetiology of this.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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