The Effects of Treatment Regimen on the Initial Management of Macular Neovascularization Subtypes in Age-Related Macular Degeneration

Abstract

OBJECTIVE: To evaluate the effect of initial treatment regimen individualization, (Pro Re nata (PRN) or Treat-and-Extend (TAE)), according to macular neovascularization (MNV) subtype, on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective is to compare the treatment burden between each MNV subtypes. METHODS: Consecutive treatment-naïve nAMD patients were retrospectively included. MNV subtype was graded by 2 independent blinded investigators on multimodal imaging. Functional and anatomical outcomes were analysed according to treatment regimen and MNV subtypes. RESULTS: A total of 281 eyes from 243 patients were included in the study. According to the treatment regimen, there was no significant difference in best-corrected visual acuity gain within the 2 first year of treatment for type 1 (p=0.106) and type 3 MNV (p=0.704). Conversely, there was a significant difference in favour of TAE regimen for type 2 (p=0.017) and type 4 MNV (p=0.047). Type 1 MNV had a higher proportion of visits with subretinal fluid (p=0.0007), but not with intraretinal fluid (p=0.22). The mean interval between the last 2 injections was significantly shorter for type 1 MNV (p=0.0045). CONCLUSION: The individualization of the initial treatment protocol according to MNV subtype can improve the functional outcome and may decrease the treatment burden.

Long Intervals between Intravitreal Injections Using a Treat-and-Extend Protocol in a Real-Life Context in AMD: The LIRE Study

“…Other studies have shown different distributions of the CNV subtypes, with subtype 1 found in 34-61% of eyes and subtype 3 in 2-40% of eyes [22,[25][26][27]. The predominance of type 1 CNV in our study is in accordance with the recent publications by Mathis et al [28,29]. These eyes might need a higher number of injections [30,31].…”