Intravitreal aflibercept for exudative age-related macular degeneration with good visual acuity: 2-year results of a prospective study

Abstract

PurposeWe report the 2-year outcomes of intravitreal aflibercept (IVA) for exudative age-related macular degeneration (AMD) with good visual acuity (VA) and examine the baseline factors associated with good visual outcome.Materials and methodsThis multicenter, prospective study evaluated 39 eyes (39 AMD patients) enrolled from August 2013 to August 2014 at 12 and 24 months. Only patients with initial best-corrected VA (BCVA) >0.3 logarithm of the minimum angle of resolution (20/40 Snellen) were eligible. Three consecutive monthly IVA injections were followed by 2 monthly injections for 12 months. Thereafter, patients received injections on a treat- and-extend regimen for up to 24 months. Outcome measures included BCVA and central macular thickness (CMT) at 12 and 24 months. Post hoc analysis, BCVA, and CMT were evaluated by AMD types (typical AMD [tAMD], type 1, and type 2 polypoidal choroidal vasculopathy [PCV]). Baseline characteristics and BCVA associations were evaluated with linear regression analysis and Student’s t-test.ResultsMean age was 69 years and 26 of 39 eyes were male. tAMD, type 1 and type 2 PCV occurred in 18, 12, and 9 eyes, respectively. Baseline mean BCVA was 0.097 logarithm of the minimum angle of resolution (20/25 Snellen) and showed significant improvement to 0.058 (20/22 Snellen, P=0.03) at 12 months and 0.066 (20/23) at 24 months. CMT improved significantly from 320 (99) µm (mean [SD]) to 250 (93) µm (P=0.002) at 12 months and 240 (93) µm (P=0.0005) at 24 months. BCVA and CMT were not significantly different among the three groups. Only subretinal hemorrhage (SRH) was significantly associated with improved BCVA. BCVA change from baseline was −0.12 with SRH and −0.011 without SRH (P=0.017) at 12 months.ConclusionIVA showed good efficacy for exudative AMD with good VA at 24 months. tAMD and type 1 and 2 PCV showed similar prognosis. Baseline SRH predicted favorable long-term vision in AMD with good VA.

One-year Results of Aflibercept Treatment for Polypoidal Choroidal Vasculopathy with Good Visual Acuity

“…As for follow-up intervals, both of those previous studies had follow-up examinations monthly, while in the current study, follow-up visits were scheduled only every 1 to 3 months. Therefore, recurrence could have [41]. The mean change of log-MAR BCVA they reported was similar to our study.…”

“…Therefore, recurrence could have been detected late, which would have resulted in delayed administration. However, similar to current study, Sakamoto et al, who injected intravitreal aflibercept in PCV with good visual acuity, showed no significant improvement in BCVA at 12 months [ 41 ]. The mean change of logMAR BCVA they reported was similar to our study.…”

“…Of the 29 eyes, 17 PCV eyes were included, but no subgroup analysis was implemented for PCV. Sakamoto et al [ 41 ] injected aflibercept in AMD patients with initial visual acuity greater than 0.5 (typical AMD 18 eyes and PCV 21 eyes). While BCVA improved significantly at 12 months (0.06 logMAR) compared to baseline (0.10 logMAR) for the entire study group, PCV eyes showed a lack of significance compared to the baseline (0.07 logMAR) in 12 months (0.05 logMAR).…”

“…The size of lesions would be smaller, the activity of the disease would be less severe, damaged retinal tissues that cannot be recovered would be less prevalent in eyes with good visual acuity, and so, the final vision would be better. Table 3 summarizes the BCVA change at 12 months after intravitreal anti-VEGF treatment of previous studies and current study [20,[34][35][36][37][38][39]41].…”

Evolution of treatment paradigms in neovascular age-related macular degeneration: a review of real-world evidence

“…Regardless of study type, intravitreal aflibercept administered in a bimonthly regimen following three initial monthly doses was consistently associated with gains in VA at Year 1, with improvements in vision ranging from +3.0 to +8.0 letters from baseline. [48][49][50][51][52][53][54][55][56] Talks et al concluded that the VA gains observed were comparable to those reported in the VIEW 1 and 2 phase III trials. 48 Several real-world studies have compared the effectiveness of intravitreal aflibercept bimonthly treatment with intravitreal aflibercept and ranibizumab PRN regimens.…”