Abstract
Purpose :
To investigate the predictors of five-year visual outcome for exudative age-related macular degeneration (AMD) treated with intravitreal aflibercept (IVA) using treat and extend regimen (TAE).
Methods :
Subjects comprised 48 eyes of 48 patients (28 males and 20 females) treated with IVA using TAE regimen for treatment-naïve AMD at Department of Ophthalmology, Osaka City University Hospital between February 2013 and October 2013, for whom 5 year had elapsed since treatment. Mean age was 73 years old (range 49-92). The best corrected visual acuity (BCVA) examination, fluorescein angiography, indocyanine green angiography and optical coherence tomography (OCT) were performed at baseline. Patients were treated with 3 monthly (4-5 weeks) injection for loading phase, and they were followed by extension of the treatment interval by 2 weeks (up to maximum 13 weeks) provided there were no signs of exudate in OCT. If signs of activity were detected, treatment intervals were shortened to 5 weeks. Patients were classified into 3 groups; eyes successfully treated with TAE for 5 years (Group 1), eyes treated with TAE for less than 5 years (Group 2) and eyes converted to or combined with photodynamic therapy (PDT) (Group 3) and were analyzed. BCVA was measured using Landolt C chart and converted to logarithm minimum angle resolution (logMAR) for calculation.
Results :
Group 1, 2 and 3 included 17 eyes (35%), 26 eyes (54%) and 5 eyes (10%), respectively. In Group 2, TAE was performed in the average of 17 months (range 3-37 months). In Group 3, the average time to apply PDT was 32 months (range 16-40 months).The BCVA was changed from 0.30 to 0.16 in Group 1, 0.31 to 0.41 in Group 2 and 0.30 to 0.11 in Group 3, with no significant difference (Group 1: p=0.15, Group 2: p=0.66, Group 3: p=0.72). A baseline BCVA and a duration of TAE were identified as independent factors significantly associated with the final BCVA using the multivariate analysis (R2=0.33, p<0.01).
Conclusions :
The present study suggested that a good baseline BCVA and continuation of TAE were associated with a good visual prognosis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.