Author: Yu-Ting Jeng (Taiwan)
Co-authors: Tso-Ting Lai, Chao-Wen Lin, Yi-Ting Hsieh, Chang-Ping Lin, Tzyy-Chang Ho, Chang-Hao Yang
Purpose
To investigate the percentage of fluid tolerance duration in patients with neovascular age-related macular degeneration (AMD) treated with aflibercept, and its impact on the functional and morphological outcome at 18 months, using real world data.
Setting/Venue
National Taiwan University Hospital, Taipei City, Taiwan
Methods
Treatment-naïve patients receiving aflibercept injection for neovascular AMD between January 2016 and July 2019 were retrospectively reviewed. Patients were treated as pro re nata (PRN) dosing strategy by their attending physicians. A minimum follow-up time of 18 months was required. We excluded patients with polypoidal choroidal vasculopathy, initial best corrected visual acuity (BCVA) less than 2/200, prior treatment of photodynamic therapy, or other vitreoretinal diseases affecting vision. Tolerance percentage was defined as accumulated duration of retinal fluid without treatment divided by total duration of retinal fluid. Eyes were grouped as strict (tolerance percentage = 0), moderate (tolerance percentage <30%), and relax (tolerance percentage > 30%) based on the result. The primary endpoints were the change of central retinal thickness (CRT) and BCVA at 18th month. Analysis of variance (ANOVA) test was used to compare the difference between three groups.
Results
A total of 90 eyes were eligible for the final analysis. The mean tolerance duration was 0% in the strict group (20 eyes), 19.4% in the moderate group (22 eyes), and 50.8% in the relax group (48 eyes). There was no significant difference of baseline BCVA and CRT between the three groups. After 18 months, the total injection number (mean±standard deviation) of strict, moderate, and relax group was 7.50 ± 2.24, 6.95 ±2.15, and 4.92±1.69, respectively, and there was significant intergroup difference (P < 0.001). The final logMAR BCVA of the three groups was 0.697±0.464, 0.741±0.450, and 0.715±0.482, respectively (P = 0.953). There was also no significant difference in BCVA and CRT change at 18 months between the three groups (logMAR BCVA change: 0.022±0.360, -0.092±0.433, and -0.084±0.397, P = 0.56; CRT change: -71.65±84.68, -62.95±105.27, -57.50±81.39 um, P = 0.83), despite the higher percentage of the duration of completely dry retina to the total follow up time in the strict group (46.3±23.2%, 28.5±21.8%, 25.1±23.7%, P < 0.01).
Conlusions
Aflibercept is an effective tool for the treatment of neovascular AMD. In a real-world setting, the final visual acuity, change of CRT and BCVA over 18 months were similar whether the patient underwent a strict regimen or a fluid-tolerant regimen. Compared with fluid-tolerant strategy, a shorter treatment interval or a more proactive treatment strategy may be needed to achieve better final outcomes in eyes with neovascular AMD.
Financial Disclosure
None
Comments
-
