Factors Associated with Recurrence of Age-Related Macular Degeneration after Anti-Vascular Endothelial Growth Factor Treatment: A Retrospective Cohort Study

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• 作者：Yoshimasa Kuroda ; MD¹ ; Kenji Yamashiro ; MD ; PhD¹ ; ^{yamashro@kuhp.kyoto-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Masahiro Miyake ; MD¹ ; Munemitsu Yoshikawa ; MD¹ ; Hideo Nakanishi ; MD ; PhD¹ ; Akio Oishi ; MD ; PhD¹ ; Hiroshi Tamura ; MD ; PhD¹ ; Sotaro Ooto ; MD ; PhD¹ ; Akitaka Tsujikawa ; MD ; PhD² ; Nagahisa Yoshimura ; MD ; PhD¹
• 关键词：AMD ; age-related macular degeneration ; BCVA ; best-corrected visual acuity ; CNV ; choroidal neovascularization ; CVH ; choroidal vascular hyperpermeability ; GLD ; greatest linear dimension ; OCT ; optical coherence tomography ; PCV ; polypoidal choroidal vasculopathy ; PDT ; photodynamic therapy ; PRN ; pro re nata ; RAP ; retinal angiomatous proliferation ; TAE ; treat and extend ; tAMD ; typical age-related macular degeneration ; VA ; visual acuity ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：122
• 期：11
• 页码：2303-2310
• 全文大小：391 K

文摘

To investigate the predictive factors associated with recurrence after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD).

Design

Retrospective cohort study.

Participants

A total of 343 eyes of 326 patients with subfoveal neovascular AMD who were treated with an as-needed regimen after 3 monthly loading doses of intravitreal ranibizumab.

Methods

Patients were followed up by an as-needed regimen for more than 1 year after the first injection. Baseline data and CFH I62V and ARMS2 A69S polymorphisms were analyzed for their association with recurrence after anti-VEGF treatment. Regression analysis was used to identify independent predictors of visual acuity (VA) prognosis.

Main Outcome Measures

The primary end point was the presence or absence of recurrence. The secondary end point was VA improvement.

Results

In total, 236 eyes (68.8%) showed complete resolution of retinal exudative change after the 3 loading injections, and 81 eyes (34.3%) experienced no recurrence during the first year. Of the 236 eyes, 139 (58.9%) were followed for more than 2 years and 35 (25.2%) showed no recurrent retinal exudation during 24 months. Visual acuity improvement was significantly better in eyes without recurrence than in eyes with recurrence during the 2-year period. Baseline characteristics and genotypes had no influence on response to ranibizumab loading treatment. Stepwise analysis revealed that age (P < 0.001), subtype of AMD (P = 0.041), and VA at baseline (P < 0.001) were associated with VA at 24 months. Older patients (P = 0.006) and male patients (P = 0.018) tended to require re-treatment for recurrence during the first year, yet the statistical significance disappeared when evaluated in 2 years. The subtypes of neovascular AMD were solely associated with the interval to the recurrence, which was shorter in eyes with polypoidal choroidal vasculopathy (PCV) than in eyes with typical AMD (P = 0.015).

Conclusions

Older age and male sex may predict recurrence after 3 monthly ranibizumab injections, and PCV may be associated with shorter interval to recurrence. Predicting the risk of recurrence would help us to choose the most appropriate follow-up treatment strategy for patients with AMD.