External limiting membrane disruption predicts long-term outcome in strict Treat-and-Extend regimen in neovascular age-related macular degeneration

Author: Katja Hatz (Switzerland)

Co-authors: Laura Hoffmann

Purpose

To determine long-term outcomes in visual acuity and outcome predicting factors in patients with neovascular age-related macular degeneration (nAMD) applying a strict treat-and-extend regimen (TER).

Setting/Venue

Retrospective study at Vista Eye Clinic Binningen, Switzerland.

Methods

Up to eight-year retrospective follow-up of treatment-naïve subjects with nAMD starting treatment with either ranibizumab or aflibercept in a strict TER without loading dose but with predefined exit criteria.

Results

Two hundred-eleven (211) eyes of 187 patients with a mean follow-up of 60.3±20.9 months were included. Mean BCVA increased from initially 63.9±15.5 ETDRS letters (20/55) to 70.0±14.7 (20/40) after one year (+6.1 letters, p<0.001) and to 68.5±18.1 (20/43) (+4.6 letters, p=0.028) at 5 years. During follow-up 30.3% of eyes reached exit criteria. A worse BCVA (p=0.001) and a better external limiting membrane (ELM) disruption score at baseline predicted (p=0.019) BCVA gain at 5 years. The probability of reaching the exit criteria was significantly associated with a low central retinal thickness (CRT) (p=0.025), a better ELM disruption score (p=0.044) and the absence of a central pigment epithelial detachment (PED) (p=0.05) at baseline.

Conlusions

Significant visual gains were sustained after 5 years of follow-up in a TER in a real-world setting. Integrity of ELM at baseline predicted BCVA gain and anatomic disease stability at 5 years of treatment.

Financial Disclosure

Dr Hoffmann has no conflicts of interests to disclose; PD Dr Hatz has received financial compensation from Novartis Switzerland, Bayer Switzerland, Alcon, Allergan and Roche for consultancies and contract research.