First Author: H.Matsumoto JAPAN
Co Author(s): M. Morimoto K. Mimura A. Ito H. Akiyama
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To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve neovascular age-related macular degeneration (AMD) and development of retinal pigment epithelium (RPE) atrophy.
Intravitreal anti-vascular endothelial growth factor (VEGF) therapy has become a major treatment strategy for neovascular AMD. However, the enlargement of RPE atrophy secondary to intravitreal anti-VEGF therapy has been reported. RPE atrophy is a critical factor related to visual acuity in patients with AMD.
We retrospectively studied 137 eyes with neovascular AMD including 62 eyes with typical AMD, 58 eyes with polypoidal choroidal vasculopathy, and 17 eyes with retinal angiomatous proliferation (RAP). We assessed best-corrected visual acuity (BCVA), central macular thickness (CMT), central choroidal thickness (CCT), RPE atrophy extent in the macular area for 2 years.
CMT and CCT were significantly reduced, while RPE atrophy was significantly enlarged after 1 and 2 years in all subtypes. RPE atrophy extent at baseline and enlarged area of RPE atrophy for 2 years were significantly larger in RAP than other subtypes. RPE atrophy extent was negatively correlated with CCT after 2 years in RAP (rs=-0.72, P<0.01). BCVA was significantly improved after 1 and 2 years in all subtypes other than RAP. In RAP, BCVA was significantly improved after 1 year, however, lost significance after 2 years.
Treat-and-extend intravitreal therapy with aflibercept may be effective for improvement of BCVA and exudative change in eyes with neovascular AMD. However, choroidal thinning during the treatment regimen might accelerate enlargement of RPE atrophy and affect BCVA after 2 years in RAP.