Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration

Abstract

With the advent of anti-vascular endothelial growth factor (VEGF) therapy, clinicians are now focused on various treatment strategies to better control neovascular age-related macular degeneration (NVAMD), a leading cause of irreversible blindness. Herein, we retrospectively reviewed consecutive patients with treatment-naïve NVAMD initially classified based on fluorescein angiography (FA) alone or with an anatomic classification utilizing both FA and optical coherence tomography (OCT) and correlated long-term visual outcomes of these patients treated with an anti-VEGF Treat-and-Extend Regimen (TER) with baseline characteristics including neovascular phenotype. Overall, 185 patients (210 eyes) were followed over an average of 3.5 years (range 1–6.6) with a retention rate of 62.9%, and visual acuity significantly improved with a TER that required a mean number of 8.3 (±1.6) (± standard deviation) intravitreal anti-VEGF injections/year (range 4–13). The number of injections and the anatomic classification were independent predictors of visual acuity at 6 months, 1, 2, 3 and 4 years. Patients with Type 1 neovascularization had better visual outcomes and received more injections than the other neovascular subtypes. There were no serious adverse events. A TER provided sustained long-term visual gains. Eyes with Type 1 neovascularization had better visual outcomes than those with other neovascular subtypes.

One-Year Outcomes of the Treat-and-Extend Approach with Aflibercept in Age-Related Macular Degeneration: Effects on Typical Choroidal Neovascularization and Retinal Angiomatous Proliferation

“…Nevertheless, in accordance with the results reported by Daniel et al [8] , where the mean visual acuity improvement from baseline was greater at 1 year in the RAP subgroup, and in opposition to the results observed by Mrejen et al [13] , where type 1 CNV was associated with better visual outcomes, we found that patients in the typical subgroup were less likely to gain ≥ 3 lines of BCVA at the endpoint. These differences can be explained by the fact that the subfoveal membranes with the poorest initial BCVAs may represent cases of more advanced CNV that have a quick initial response to anti-VEGF but a lower likelihood of achieving a good functional outcome [2] .…”

“…However, more recently, Mrejen et al [13] , after evaluating the effectiveness of a TER approach with anti-VEGF, concluded that a better long-term prognosis may be achieved with more injections in type 1 CNV; conversely, a subanalysis of the CATT trial [8] revealed that at 1 year, eyes with retinal angiomatous proliferation (RAP) lesions presented greater mean visual acuity improvements and were less likely to have fluid, leakage, scarring, and subretinal hyperreflective material on optical coherence tomography (OCT).…”

Type 3 neovascularisation: long-term analysis of visual acuity and optical coherence tomography anatomical outcomes

“…Using an anatomical grading system which includes SD-OCT to aid in the classification of neovascular lesion subtypes, Mrejen et al found that long-term visual outcome significantly differed based on the treated lesion subtype 25. Eyes with type 1 NV appeared to have the best long-term VA, while eyes with other lesion subtypes (including type 3) incrementally lost vision after an initial phase of visual improvement.…”

Incidence and risk factors of massive subretinal hemorrhage in retinal angiomatous proliferation

“…[8–10] However, it has been suggested that long-term visual outcomes of RAP might be limited due to the development of geographic atrophy (GA) after repeated anti-VEGF injections. [11, 12]…”