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Kathrine Leth-Møller, Ditte Borup Jakobsen, Anna Stage Vergmann, Thomas Lee Torp, Einar Stefansson, Tunde Peto, Jakob Grauslund; Retinal vascular structure independently predicts initial treatment-response in neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3255.
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We aimed to determine if specific markers of retinal vascular structure are able to predict the initial treatment-response in treatment-naïve patients with neovascular age-related macular degeneration (nAMD).
Fifty eight eyes of 58 patients with treatment-naïve nAMD were included at baseline (BL). At BL, advanced markers of retinal vascular structure were measured by a trained grader using a semi-automated software (Singapore I Vessel Assessment, version 4.0, Singapore). Patients were treated with three monthly intravitreal injections with 2.0 mg aflibercept. One month after the last injection, patients were categorized as full treatment responders (FTR) or none/partial responders according to predefined criterias. Four eyes were excluded due to missing data at follow-up (F/U). A full treatment response was defined as loss of < 5 Early Treatment Diabetic Retinopathy Study Letters and no residual intra- or subretinal fluid and no macular hemorrhage.
Median age was 79 years, 30.0% were male, 28.3% were active smokers, and 9.4% had diabetes. Of the 54 eyes attending F/U, 24 (44.4%) were full treatment responders, and 30 (55.6%) were none/partial responders. Median age in FTR patients was higher at baseline (81.5 vs. 77 years, p=0.04), but otherwise there was no statistically significant difference in gender, smoking or diabetes between groups (p>0,5for all). In addition, FTR had a lower venular length-diameter ratio (LDR) (7.3 vs. 15.9, p=0.0063), but did not differ according to arteriolar LDR, central retinal arteriolar or venular equivalent, branching angles, branching coefficients, junctional exponent deviation, or tortuosity. In an age- and sex-adjusted multiple logistic regression model, increasing venular LDR was independently associated with a lower chance of FTR (odds ratio 0.89 per 1-point increment in venular LDR, 95% confidence interval 0.82-0.98, p=0.021).
Higher retinal venular LDR is independently associated with an 11 % lower chance of FTR in patients with nAMD. If confirmed by larger, longitudinal studies, this could be used to personalize treatment by stratifying patients according to their potential future treatment demands.
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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