The impact of the vitreomacular interface in neovascular AMD in a treat and extent regimen with exit strategy

Session Details

Session Title: Free Paper Session 4: AMD II

Session Date/Time: Thursday 07/09/2017 | 11:00-12:30

Paper Time: 11:06

Venue: Room 111

First Author: : M.Munk SWITZERLAND

Co Author(s): :    P. Arendt   S. Yu   L. Ceklic   A. Ebneter   S. Wolf   M. Zinkernagel              

Abstract Details

Purpose:

To evaluate the impact of the vitreomacular interface (VMI) in a treat and extend regimen (TER) with exit strategy in patients with neovascular age-related macular degeneration (nAMD)

Setting:

This retrospective study included 593 eyes of 498 patients with nAMD.

Methods:

Eyes were treated according to a TER with exit criterion, which was defined as no signs of disease activity during 3 consecutive 16-weekly injection visits. The impact of the VMI and the presence of an epiretinal membrane (ERM) assessed by SD-OCT on mean treatment interval, number of injections, the likelihood of fulfilling the exit criteria and CNV recurrences was evaluated. Eyes fulfilling the exit criteria were evaluated for the potential effect of VMI and ERM on central retinal thickness (CRT) decrease and BCVA improvement.

Results:

One-hundred eyes (17%) of 95 patients (mean age: 80±9 years) met the exit criteria. Among these, 15 eyes (15%) showed CNV recurrence after a mean of 41±7 weeks. During the TER period, eyes with PVD needed significantly fewer injections (10.6±5.9) compared to eyes with vitreomacular adhesion (VMA) (12.6±6.7, corrected p-value: p=0.0008) and accordingly the mean injection interval was shorter in VMA eyes (8.3±3.1 weeks) compared to PVD eyes (9.5±3.5 weeks, corrected p-value=0.0008). Presence of an ERM didn`t have a significant effect on the mean treatment interval or number of injections. Eyes with PVD at baseline and without an ERM were 9.2 and 11.4 more likely to fulfill the exit criteria than eyes with VMA and ERM, respectively (corrected p-value=0.006 and 0.004, respectively). While CRT decrease (corrected p-value=0.16) and BCVA improvement (corrected p-value=0.32) did not differ in respect to the VMI configuration, ERM had a significant impact on CRT decrease (ERM present: +11±198µm vs. ERM absent: -92±136µm, corrected p-value=0.041). VMA at treatment cessation was significantly associated with disease recurrence (likelihood ratio: 7.8, corrected p-value=0.013), while the presence of an ERM was not associated with CNV recurrence (corrected p-value=0.18).

Conclusions:

The configuration of the VMI and the presence of an ERM have a significant impact on the treatment frequency, the chance to meet the exit criteria in this TER regimen, and the recurrence risk after treatment cessation. This indicates that eyes with VMA should be carefully monitored for new disease activity after treatment stop. Continuation of treatment until VMA release may even be considered.

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