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SATOSHI KUWAYAMA, Aki Kato, Tsutomu Yasukawa, Iichiro Sugita, Munenori Yoshida, Miho Nozaki, Yoshio Hirano, Junko Kondo, Tomohiro Abe, Kimiko Sugita, Takahide Okita, Hiroshi Morita, Kazuhiko Sugitani, Naomi Inoue, Noriaki Takase, Yuichiro Ogura; Psychological impact of treat-and-extend ranibizumab therapy in patients with age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2019;60(9):89.
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Patients with neovascular age-related macular degeneration (nAMD) are reported to be subject to depression, strongly associated with severe vision loss. A treat-and-extend (TAE) regimen is a scheduled regimen to arrange an interval of intravitreal injections according to the treatment response of eyes with nAMD. The purpose of this study is to assess the status of anxiety and depression in patients with nAMD using Hospital Anxiety and Depression Scale (HADS) and investigate two-year visual outcomes and psychological impacts of the TAE regimen.
In this prospective, multicenter, single-arm study, patients diagnosed as treatment-naïve nAMD at Nagoya City University Hospital and Sugita Eye Hospital were enrolled. First, 2 monthly intravitreal injections of ranibizumab (IVRs) were performed. Then, if exudative changes were absent at the visit for the previous injection, the intervals to the next injection were extended from 4 to 6 weeks, from 6 to 8, from 8 to 12, and from 12 to 16 weeks. If exudative changes were present, the interval was inversely shortened. At each visit, best-corrected visual acuity (BCVA) was measured and fundus examination and optical coherence tomography (OCT) were performed. To assess visual outcomes, BCVA and the central retinal thickness (CRT) on OCT at baseline and at weeks 52 and 104 were compared. The HADS test was performed at baseline and at weeks 52 and 104.
Twenty-five eyes of 25 patients were enrolled. Fourteen patients were diagnosed as typical AMD and 11 patients polypoidal choroidal vasculopathy. The mean age was 71.7 years. The mean BCVA was significantly improved from 66.9 letters at baseline to 72.5 letters at week 52 and 73.4 letters at week 104 (p<0.01). BCVA was improved by 15 letters or more in 6 patients (24.0%). The mean CRT was significantly improved from 305 µm at baseline to 257 µm at week 52 and 246 µm at week 104 (p<0.01). The mean injection number of ranibizumab was 11.1 (ranging 9-15). The HADS test showed that the anxiety score significantly decreased from 5.4 point at baseline to 3.2 point at week 104 (p<0.01). The depression score slightly decreased from 3.9 point at baseline to 3.4 point at week 104, although there was no significant difference.
The TAE regimen of IVR may be effective not only to preserve vision but also to reduce the anxiety of patients with nAMD.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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