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

Abstract

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.

Incidence and characteristics of neovascular age-related macular degeneration with over a 12-month remission after three monthly aflibercept administration: 60 months results of a pro re nata regimen.

“…Several investigators investigated factors predictive of complete remission after the loading injections and reported that smaller lesion size and younger age were associated with complete remission. 10 In this study, protective variants of ARMS2 and younger ages were associated with a 12-month remission. The risk allele of ARMS2 was reportedly associated with larger lesion size.…”

“…Several studies have investigated the incidence of a complete remission rate after the initial loading phase of anti-VEGF therapy for exudative AMD. Cho et al 10 Fig. 4.…”

“…Several studies have investigated the incidence of a complete remission rate after the initial loading phase of anti-VEGF therapy for exudative AMD. Cho et al 10 reported that 58 (14.8%) of 392 eyes showed complete remission 24 months after the initial 3 monthly loading aflibercept injections. Kuroda et al 11 reported that 34.3% and 25.2% of eyes with exudative AMD showed complete remission after the initial 3 monthly loading ranibizumab injections during the first and second year, respectively.…”

The Activity of Substance P (SP) on the Corneal Epithelium

“…In the cornea, SP has been shown to cause avascular hemangiogenesis and lymphangiogenesis in mice models. Topical application of NK1 antagonist, Lanepitant, was shown to reduce the angiogenesis within the inflamed cornea, and this was also shown to occur with topical Fosaprepitant [173,174]. In a recent paper, ocular mast cells were also shown to cause increased inflammatory angiogenesis or neovascularization due to release of VEGF-A in mouse models of corneal inflammation [175].…”

“…Fosaprepitant [173,174]. In a recent paper, ocular mast cells were also shown to cause increased inflammatory angiogenesis or neovascularization due to release of VEGF-A in mouse models of corneal inflammation [175].…”