Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients

Wada, Iori; Oshima, Yuji; Shiose, Satomi; Kano, Kumiko; Nakao, Shintaro; Kaizu, Yoshihiro; Ishibashi, Tatsuro; Sonoda, Koh Hei

doi:10.1007/s00417-019-04361-8

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…Overall mean number of injections received was 52.2 over a period of 10 years. Previous studies on long-term outcomes at 1,2 5 and 7 years have all shown the reduced effectiveness of anti-VEGF agents in clinical practice and most reports have attributed these results to the reduced number of injections over time [5,6,[10][11][12][13]. Qin et al in their study on long term outcomes of exudative AMD treatment have attributed the variable results to the differences in frequency and regularity of anti-VEGF treatment [14].…”

Section: Discussionmentioning

confidence: 99%

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Chandra

Arpa

Menon

et al. 2020

Eye

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Purpose Single center, noninterventional cohort study to assess 10-year visual and anatomical outcomes following initiation of treatment with antivascular endothelial growth factor (anti-VEGF) agents in neovascular age-related macular degeneration (AMD) patients. Neovascular AMD patients initiated on intravitreal anti-VEGF injections in 2008–2009 and continued to be followed up for at least 10 years were included in this study. Methods The Moorfields OpenEyes database was searched for all patients who were initiated on anti-VEGF therapy for neovascular AMD in 2008–2009 and the visual acuity (VA) in Early Diabetic Retinopathy Study (ETDRS) letters and injection records were analyzed for those who have had at least 10-year follow-up. The spectral-domain optical coherence tomography (SD-OCT) scans, color fundus photos, and fundus fluorescein angiography (FA) were graded by two retinal physicians. The outcomes were also compared between those with good and poor VA outcomes based on pre-defined criteria. The primary end point was change in VA at 10 years; secondary outcomes included percentage with VA of 20/40 or better, 20/70 or better, VA gains and losses, anatomic outcomes and number of injections. Results After a mean of 10.04 years after initiation of anti-VEGF therapy, the mean decline in VA from baseline was −2.1 ETDRS letters (SD 19.9, p = 0.65). One hundred eyes (67.1%) achieved a VA threshold of 20/70 or better, 33.5% achieved a VA of 20/40 or better, and 76.5% eyes maintained VA defined as a loss of less than 15 letters. Fourteen percent of study eyes had VA of 20/200 or worse and 23.5% declined by 15 letters or more. 87.5% of eyes were switched from ranibizumab to aflibercept during the course of 10 years and the eyes received a mean of 52.2 (SD 18.1) injections over 10 years. From this cohort, 87 (58.3%) eyes are having on-going treatment. On OCT, 34.9% had persistent fluid at the last visit, 6.7% patients showed new onset atrophy compared to baseline, and 43.7% had increased area of macular atrophy. The mean area of atrophy at the final visit was 4.15 mm 2 . Comparison between the good and worse visual outcome groups showed lower baseline VA, fovea-involving atrophy and final area of atrophy had a statistically significant negative effect on the final visual outcome ( p < 0.05). Conclusions Regular monitoring and anti-VEGF treatment over 10 years reduce the risk of visual loss of 15 letters or more in patients with neovascular AMD. The most common cause of substantial visual decline was macular atrophy.

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Section: Discussionmentioning

confidence: 99%

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Chandra

Arpa

Menon

et al. 2020

Eye

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“…A disadvantage of reactive treatment is that it is difficult to determine a dosing schedule. It has been reported that long-term visual acuity may decline because the treatment after recurrence could damage the retina [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Three-year outcome of aflibercept treatment for Japanese patients with neovascular age-related macular degeneration

et al. 2020

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Background To evaluate the three-year outcome after intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration (nAMD). Methods Forty-nine treatment-naïve nAMD patients (50 eyes) were enrolled in this prospective study. The eyes received IAI at two-month intervals in the first year. The treatment regimen was changed to IAI based on a treat-and-extend approach in the second and third years. Results Twenty-nine eyes of 28 patients were successfully followed up over 36 months. The nAMD subtypes included 15 eyes with typical AMD and 14 eyes with polypoidal choroidal vasculopathy. The number of IAIs performed over the 3 years was 17.2 ± 3.1 (mean ± standard deviation). The mean logMAR, which was 0.42 at baseline, improved to 0.19 ( P = 0.001) at 12 months, and 0.26 ( P = 0.049) at 36 months. The central retinal thickness (CRT) was 329 ± 120 μm at baseline, 151 ± 38 μm ( P < 0.001) at 12 months, and 143 ± 61 μm ( P < 0.001) at 36 months. The mean subfoveal choroidal thickness (SFCT) was 288 ± 97 μm at baseline, 243 ± 82 μm ( P < 0.001) at 12 months, and 208 ± 63 μm ( P < 0.01) at 36 months. The changes in logMAR, CRT, and SFCT over the study period did not differ between typical AMD and PCV. Conclusion Long-term aflibercept injection can achieve visual improvement and reduce the thickness of the retina and choroid in nAMD. Morphological improvement of these tissues may not be sufficient to sustain earlier visual improvement over the long-term.

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“…Another explanation could be that the progression of atrophic changes may be furthered by decreased perfusion and resulting ischaemia, as the regression of CNV with anti-VEGF may eliminate the only remaining blood supply for the outer retina [92]. Published reports demonstrate a potential protective effect of sub-RPE choroidal neovascularization (type 1 CNV) in slowing macular atrophy in eyes with nAMD [21,23,36,40,52,[93][94][95].…”

Section: Discussionmentioning

confidence: 99%

“…• The 5-year results from Wada et al showed that undertreatment correlated with a higher MA incidence, and that a higher number of injections did not increase the risk for MA development. They reported also that treatment switching from ranibizumab to aflibercept was not associated with a higher MA occurrence [52].…”

Section: Anti-vegf Type and Treatment Frequencymentioning

confidence: 96%

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A Review of Macular Atrophy of the Retinal Pigment Epithelium in Patients with Neovascular Age-Related Macular Degeneration: What is the Link? Part II

2020

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Introduction: To explore the potential link between macular atrophy (MA) of the retinal pigment epithelium (RPE) in patients with neovascular age-related macular degeneration (nAMD) and anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods: Through a balanced overview of the field from a largely clinical perspective, we looked at available evidence on the topic of MA correlation with anti-VEGF therapy and examined possible risk factors for MA development in the context of nAMD treatment with anti-VEGF. Results: Links have been reported to connect both MA incidence and progression to treatment frequency and to the anti-VEGF drug type. Conclusions: All reports agree on the fact that de novo development of MA in anti-VEGFtreated eyes is frequent and multifactorial. Research data shows an expansion of atrophy during anti-VEGF treatment. There are mixed conclusions about the correlation of MA incidence or progression with treatment-related risk factors. It mostly appears that there is no straightforward link. More clinical research is still needed to further understand this association.

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Five-year treatment outcomes following intravitreal ranibizumab injections for neovascular age-related macular degeneration in Japanese patients

Cited by 16 publications

References 29 publications

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Three-year outcome of aflibercept treatment for Japanese patients with neovascular age-related macular degeneration

A Review of Macular Atrophy of the Retinal Pigment Epithelium in Patients with Neovascular Age-Related Macular Degeneration: What is the Link? Part II

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