First Author: M.Eleftheriadou UK
Co Author(s): M. Gemenetzi M. Lukic P. Patel
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To report the number of aflibercept injections for neovascular age-related macular degeneration in treatment naive eyes during 3 years of follow up in a clinical setting.
Retrospective, observational analysis of data collected from patients with neovascular AMD, were extracted from our electronic medical records. Data from consecutive treated, treatment-naïve eyes in initiated on aflibercept for nAMD at least 3 years before data extraction were collected and analyzed.
Consecutively treated treatment-naïve eyes with aflibercept intravitreous injections, from 01/10/2013 to 31/02/2014, with 36±2 months follow up were included. Key exclusion criteria were: nAMD due to secondary reasons, less than 2 years of follow up, ≤3 intravitreal injections in year 1, ungradable OCT images and concomitant ocular conditions affecting BCVA or macular anatomy. Aflibercept was administrated as per VIEW protocol, 2 monthly for the first year after 3 initial monthly injections and in a treat and extend regimen for the second and third year. Deviations from this protocol were not considered to be an exclusion criterion. The primary outcome was the number of injections needed in total and in years 1, 2 and 3. Secondary outcomes included mean change in BCVA, change in central macular thickness (CMT) and percentage of patients with signs of active disease (macular fluid) on OCT imaging, determined by a single grader.
A total of 133 treated eyes of 126 patients were treated with a first aflibercept injection at all Moorfields Eye Hospital sites during the selected period and met the inclusion criteria for analysis. In the analysis of 3 year treatment outcomes, data from 107 eyes of 105 patients were available (81.9% of included eyes). The mean age of patients included in the analysis was 77.5(±8.4) years old (range 53-94 years), with 60% being females. In year one the mean (±SD) number injections was 7.3(±1.6) with a median (inter-quartile range) of 8 (3-10). In year 2 the mean(±SD) and median (IQR) numbers of injections were 4.3(±2.8) and 4 (0-12) respectively and a mean (±SD) and median (IQR) in year 3 of 3.9(±3.3), 4(0-12) injections. The baseline mean VA (±SD) was 53.7±15.7 ETDRS letter score with a mean visual acuity (±SD) gain at the end of 3 year follow-up of 5.9 (±15.6) letters. The mean reduction in central macular thickness on SD-OCT imaging was 76.8 (±100.3) microns and 69.5% of eyes had no macular fluid after 3 year follow up
There are not enough data regarding the optimal treatment approach in treatment naïve patients with aflibercept from year 2 and onwards. In this study, using a treat and extend regime, the mean number of injections needed in year 3 is small and the proportion of eyes with a dry macula is high. However, monitoring these patients even after discontinuing treatment is very important due to the risk of recurrence. The biggest challenge in a real life setting is the capacity to achieve optimal treatment in clinical practice. This study showed good visual and anatomical outcomes with only few injections in year 3.