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

Authors Sakamoto S, Takahashi H, Inoue Y, Arai Y, Inoda S, Kakinuma N, Fujino Y, Tanabe T, Kawashima H, Yanagi Y

Received 28 December 2017

Accepted for publication 21 March 2018

Published 25 June 2018 Volume 2018:12 Pages 1137—1147


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Shinichi Sakamoto,1 Hidenori Takahashi,1,2 Yuji Inoue,1 Yusuke Arai,1 Satoru Inoda,1 Natsuko Kakinuma,2 Yujiro Fujino,2 Tatsuro Tanabe,2 Hidetoshi Kawashima,1 Yasuo Yanagi3–5

1Department of Ophthalmology, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan; 2Department of Ophthalmology, Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan; 3Medical Retina, Singapore National Eye Centre, Singapore; 4Medical Retina, Singapore Eye Research Institute, Singapore; 5Eye-ACP, Duke NUS Medical School, National University of Singapore, Singapore

Purpose: We 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 methods: This 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.
Results: Mean 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.
Conclusion: IVA 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.

Keywords: polypoidal choroidal vasculopathy, aflibercept, age-related macular degeneration, fixed regimen, good visual acuity, prospective study, treat-and-extend

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