Long-term incidence and timing of reactivation in patients with type 3 neovascularization after initial treatment

Kim, Jae Hui; Chang, Young Suk; Kim, Jong Woo; Kim, Chul Gu; Lee, Jun Young

doi:10.1007/s00417-019-04306-1

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…This could be attributed to the difference between the remission periods of each study; our study evaluated a longer remission period of 24 months compared to that of previous studies 29 , 30 . Since type 3 MNV is almost reactivated within 7–12 months after the loading injection 28 , it did not show a difference in the recurrence frequency as compared to the other MNV types during the 24-month follow-up.…”

Section: Discussionmentioning

confidence: 85%

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Neovascular age-related macular degeneration without exudative recurrence over 24 months after initial remission

Cho

Jeon

Yoon

et al. 2022

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We investigated the characteristics of neovascular age-related macular degeneration (AMD), which rarely recurs after initial remission. This study retrospectively analyzed 392 neovascular AMD patients treated with anti-vascular endothelial growth factor (VEGF). All patients received three monthly loading doses of anti-VEGF injections, followed by a pro re nata (as needed) regimen for 24 months. The baseline characteristics associated with the odds of having no recurrence within 24 months were evaluated using multivariate modeling. After the initial three loading injections over 24 months, 58 (14.8%) eyes showed no exudative recurrence and did not require additional anti-VEGF injections. These patients without exudative recurrence had significantly better best-corrected visual acuity (P = 0.003) and lower central subfoveal thickness (P = 0.035) at 24 months than those with exudative recurrence. Additionally, the incidence of macular atrophy was significantly lower in the former than in the latter (8.6% vs. 21.9%; P = 0.020). Multivariate analysis revealed that younger age (odds ratio [OR], 0.901; P = 0.033), smaller lesion size (OR, 0.589; P = 0.016), and absence of fibrovascular pigment epithelial detachment (PED) (OR, 1.349; P = 0.028) were associated with higher odds of no recurrence during follow-up. Approximately 15% of the neovascular AMD patients showed no exudative recurrence after initial remission during the 24-month follow-up. The infrequent recurrence after initial remission correlated with younger age, smaller lesion size, and absence of fibrovascular PED.

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Section: Discussionmentioning

confidence: 85%

“…The frequency of recurrence during anti-VEGF treatment may be affected by the subtype of neovascular AMD, because the response to anti-VEGF varies slightly among the neovascular AMD subtypes 28 . Previously, several studies reported that the subtype of neovascular AMD is associated with the frequency of exudative recurrence.…”

Section: Discussionmentioning

confidence: 99%

Neovascular age-related macular degeneration without exudative recurrence over 24 months after initial remission

Cho

Jeon

Yoon

et al. 2022

Sci Rep

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“…It is well-known that there is no lesion reactivation after initial treatment in some neovascular AMD patients 23,24 . In type 3 MNV, this proportion is reported to be 19% during a mean follow-up of 27.5 months 25 . In fact, 19.7% of patients in the present study did not experience lesion reactivation during the 24 month followup period.…”

Section: Discussionmentioning

confidence: 97%

Comparison of 24-month treatment outcomes between as-needed treatment and switching to treat-and-extend in type 3 macular neovascularization

Kim

2022

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This study aimed to compare 24-month treatment outcomes between patients with type 3 macular neovascularization (MNV) treated using an as-needed regimen and those who switched to treat-and-extend (TAE). This retrospective study included 32 patients who were initially treated with an as-needed regimen but switched to TAE (TAE group) and 74 patients who were treated with an as-needed regimen throughout the follow-up period (as-needed group). The number of anti-vascular endothelial growth factor (VEGF) injections and degree of change in best-corrected visual acuity (BCVA) over 24 months were compared between the two groups. The incidence of fibrotic scarring, tears of the retinal pigment epithelium (RPE), and subretinal hemorrhage was also evaluated. The number of anti-VEGF injections was higher in the TAE group (mean: 11.7) than in the as-needed group (mean: 6.9; P < 0.001). The BCVA outcome (measured using the mean logarithm of the minimal angle of resolution [logMAR]) was significantly better in the TAE group (mean improvement of logMAR 0.15) than in the as-needed group (mean deterioration of logMAR 0.15). The incidence of fibrotic scarring (6.3% vs. 18.9%), RPE tears (3.1% vs. 6.8%), and subretinal hemorrhage (0% vs. 9.5%) was relatively lower in the TAE group. Treatment outcomes of the TAE group were better than those of the as-needed group, suggesting that switching to the TAE regimen would be a useful approach for patients with type 3 MNV requiring efficient treatment.

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“…[15][16][17] The asneeded regimen has an advantage over TAE in minimizing unnecessary injections and subsequently decreasing the treatment burden owing to frequent injections. In addition, since approximately 19% of type 3 MNV do not reactivate after initial loading injections, 18 as-needed retreatment can be an appropriate approach for patients without lesion reactivation. However, one important concern with the as-needed regimen is the possibility of undertreatment.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Timing of Pigment Epithelial Detachment and Subretinal Fluid Development in Type 3 Macular Neovascularization associated with Age-related Macular Degeneration

Kim

2023

Retina

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Purpose: To evaluate the incidence and timing of pigment epithelial detachment (PED) and subretinal fluid (SRF) development in type 3 macular neovascularization. Methods: This retrospective study included 84 patients who were diagnosed with treatment-naïve type 3 macular neovascularization who did not show SRF at diagnosis. All patients were initially treated with three loading injections of ranibizumab or aflibercept. After the initial loading injections, as-needed regimen was performed for retreatment. The development of either PED or SRF was identified. The incidence and timing of PED development in patients without PED at diagnosis and that of SRF development in patients with PED at diagnosis were evaluated. Results: The mean follow-up period was 41.3 ± 20.7 months after diagnosis. Among the 32 patients without serous PED at diagnosis, PED developed in 20 (62.5%) at a mean of 10.9 ± 5.1 months after diagnosis. PED development was noted within 12 months in 15 patients (46.8%; 75.0% among the PED development cases). In 52 patients with serous PED and without SRF at diagnosis, 15 developed SRF (28.8%) at a mean of 11.2 ± 6.4 months after diagnosis. SRF development was noted within 12 months in nine patients (17.3%; 66.6% among the SRF development cases). Conclusion: PED and SRF developed in a substantial proportion of patients with type 3 macular neovascularization. The average period of development of these pathologic findings was within 12 months of diagnosis, suggesting the need for active treatment during the early treatment period to improve treatment outcomes.

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Long-term incidence and timing of reactivation in patients with type 3 neovascularization after initial treatment

Cited by 9 publications

References 32 publications

Neovascular age-related macular degeneration without exudative recurrence over 24 months after initial remission

Neovascular age-related macular degeneration without exudative recurrence over 24 months after initial remission

Comparison of 24-month treatment outcomes between as-needed treatment and switching to treat-and-extend in type 3 macular neovascularization

Incidence and Timing of Pigment Epithelial Detachment and Subretinal Fluid Development in Type 3 Macular Neovascularization associated with Age-related Macular Degeneration

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