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Sophie Klimscha, Léon Coulibaly, Amir Sadeghipour, Bianca S Gerendas, Sebastian M Waldstein, Ursula Schmidt-Erfurth; Influence of posterior vitreous detachment on extendability of treat-and-extend anti-VEGF therapy in neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2018;59(9):819.
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Posterior vitreous detachment (PVD) may be associated with stable visual acuity outcomes despite fewer retreatments in fixed as well as treat-and-extent (T&E) regimens of anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD). This post-hoc analysis evaluated the influence of PVD on best-corrected visual acuity (BCVA) outcomes and treatment frequency in a large, prospective, multicenter, randomized trial.
Available data from patients enrolled in the T&E arm of the TREND study were included into the analysis. Baseline PVD status was graded by a certified reader on spectral domain-optical coherence tomography images. Independent samples t-test was applied to evaluate the influence of PVD on BCVA change from baseline to month 12. To compare treatment frequency between patients with and without PVD, Pearson Chi-Square test and Mann-Whitney U test were performed.
Data of n=265 patients were available for analysis. At baseline PVD was present in 54.8% of patients. BCVA change from baseline to month 12 did not differ between patients with or without PVD at baseline (+6.0 vs. +7.5 ETDRS letters, p=0.42). However, patients with PVD required statistically significantly fewer injections (median 8 vs. median 9 injections, p=0.035). Further, a higher proportion of patients with PVD was successfully extended (defined as reaching and maintaining at least an 8-week interval between injections) compared to patients without PVD (43.8% vs. 33.0%, p=0.079). Figure 1 shows a histogram of retreatments.
In a T&E regimen of anti-VEGF therapy in nAMD, patients with PVD at baseline show increased treatment extendability compared to patients without PVD, with similar BCVA gains. This study, conducted on the basis of a large prospective, multicenter trial, confirms that PVD represents an important factor in the management of nAMD patients.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Figure 1: Histogram of the total number of retreatments during 12 months of a Treat and Extend regimen. Patients with posterior vitreous detachment (PVD+) showed an increased extendability.
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