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Manju Chandran, Sidharth Praveen, Lorraine North, Hasan Naveed, Leena Bhat, Sely Mathew, Narendran Nair, Geeta Menon; Real world data of Anti-VEGF treatment (Aflibercept) in treatment naive Neovascular Age Related Macular Degeneration (nAMD) over 3 years. Invest. Ophthalmol. Vis. Sci. 2018;59(9):839.
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To evaluate 3 year visual and anatomic outcomes of a fixed dosing protocol for one year followed by as needed dosing of intravitreal Aflibercept in the management of treatment naïve nAMD.
A single center retrospective analysis from electronic medical records identified 97 treatment naïve patients with nAMD. All patients underwent Early Treatment Diabetic Retinopathy study(ETDRS) visual acuity assessment, slit lamp biomicroscopy, Fundus Fluorescein Angiography(FFA) and Optical Coherence Tomography(OCT) scans.The Aflibercept regimen adhered to the VIEW study protocol of three monthly doses followed by treatment once every 8 weeks in the first year. From the second year onwards dosing as needed protocol was followed depending on established retreatment criteria. Retreatment criteria were the presence of subretinal fluid, visual acuity decrease of more than 5 letters and presence of new retinal haemorrhage. Follow up was for a period of about 36 months. Primary outcomes were mean change in Best Corrected Visual Acuity (BCVA) from baseline to months 12, 24, and 36; and the secondary outcome was mean change in Central Macular Thickness (CMT) from baseline to months 12, 24 and 36.
97 eyes were treated (45 male, 55 female; 53 Right eye, 44 Left eye; with a mean age of 81.8 years. 71% completed 2 year follow up and 19% had 3 year follow up.FFA showed majority as occult lesions (51%), with the rest being Retinal Angiomatosis Proliferans (RAP) 16%, Classic (12%), and Mixed (18%)Mean BCVA gains from baseline were 5.32 letters at Month 12, 4.56letters at Month 24 and 5.67 letters at Month 36 (P value< 0.01).Mean Central Macular Thickness was 414.8 µm at baseline. There was a mean change of -95.39 µm at 12 months, -114.39 µm at 24 months and -131.52 µm at 36 months (P-value <0.001).Overall 55% had gained more than 5 letters at month 12, however only 34% had the same gain at 36 months. 94% of patients had stabilization of vision at month 12, and 93% at month 24 and 36.The average number of injections in the second year was 4.6 and third year was 3.9. No adverse events were noted during this period.
Our study demonstrates that there was a significant visual acuity gain and anatomical profile improvement with Aflibercept use for nAMD and this persists into year 3 of treatment.
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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