Author: Kimberly Spooner (Australia)
Co-authors: Samantha Fraser-Bell, Thomas Hong, James Wong, Andrew Chang
Purpose
To evaluate long-term functional and anatomical outcomes of choroidal neovascular membranes (CNV) in patients, continuously treated with anti-vascular endothelial growth factors (VEGF) for neovascular age-related macular degeneration (nAMD).
Setting/Venue
Retrospective, observational study.
Methods
Consecutive nAMD patients who initiated anti-VEGF treatment between November 2006 and December 2009 were retrospectively assessed. The type of neovascularisation and clinical activity were assessed by clinical examination, fluorescein angiography and spectral domain optical coherence tomography (SD-OCT). Functional and anatomical outcomes by CNV subtype were observed.
Results
Of the 1202 eyes who initiated ranibizumab, 376 eyes completed 10-years of follow-up. The prevalence of type 1 CNV was 42% (n=158), type 2 was 45% (n=168), type 3 was 6% (n=24), and polypoidal choroidal vasculopathy (PCV) was 7% (n=26). Mean baseline visual acuity (VA) was 57.4±15.9 for type 1 lesions, 54.7±16.1 for type 2, 56.2±17.1 for retinal angiomatous proliferation (RAP) lesions, and 54.0±17.5 for PCV. After 10-years of treatment, those with RAP exhibited the greatest mean change in VA, followed by type 1 CNV (5.4±14.2 and 1.9.±17.7 letters, respectively). PCV followed by type 2 subgroups had the poorest outcomes (-2.3±18.1 and -0.2±17.4 letters, respectively). All these changes were statistically significant (p<0.05).
Conlusions
We present ten-year real-life outcomes in treatment-naive patients with 4 types of CNV in the neovascular form of AMD. Eyes with RAP lesions demonstrated the greatest improvements in vision whereas, eyes with PCV type demonstrated a poorer functional and anatomical response to treatment. The CNV subtype may be a long-term predictor of response to anti-VEGF treatment.
Financial Disclosure
At time of research, K.Spooner was an employee of Sydney Retina. At time of presentation, KS is an employee of Allergan Australia. A.Chang is a consultant for Allergan, Bayer, Novartis and Roche. S.Fraser-Bell is a consultant for Allergan, Bayer, Roche and Novartis.
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