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Enríquez-Fuentes JE, Oribio-Quinto C, Pascual-Santiago MA, Alarcón-García AD, Fernández-Vigo JI. Long-term results of treatment of neovascular age-related macular degeneration using antiangiogenic drugs: A review of the literature. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:195-204. [PMID: 38216049 DOI: 10.1016/j.oftale.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/16/2023] [Indexed: 01/14/2024]
Abstract
Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA > 70 letters. The 67.9% of patients remained stable at the end of follow-up (< 15 letter loss), with a severe loss (≥ 15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.
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Affiliation(s)
- J E Enríquez-Fuentes
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.
| | - C Oribio-Quinto
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - M A Pascual-Santiago
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - A D Alarcón-García
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain; Centro Internacional de Oftalmología Avanzada, Madrid, Spain
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Kim JG, Kim YC, Kang KT. Two-Year Follow-Up Study of Patients with Neovascular Age-Related Macular Degeneration Undergoing Anti-VEGF Treatment during the COVID-19 Pandemic. J Clin Med 2024; 13:867. [PMID: 38337561 PMCID: PMC10856664 DOI: 10.3390/jcm13030867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND regular intravitreal anti-vascular endothelial growth factor (VEGF) treatment is crucial for patients with neovascular age-related macular degeneration (nAMD), and delayed treatment can exacerbate disease progression. METHODS we compared the outcomes of on-time versus delayed intravitreal anti-VEGF treatment for patients with nAMD. This study was conducted during the coronavirus disease 2019 (COVID-19) pandemic with a 2-year follow-up period. The best-corrected visual acuity (BCVA) and anatomical findings were evaluated before the pandemic, during the pandemic, and at 6-, 12-, 18-, and 24-months post-pandemic. RESULTS The delayed and on-time groups comprised 54 and 72 patients, respectively. After the pandemic, the injection interval increased by 0.65 ± 1.51 months (p = 0.003), with 22.2% of the patients in the delayed group switching to the treat-and-extended regimen (p < 0.001). The delayed group showed greater mean BCVA deterioration (p = 0.027) and central subfield thickness (p = 0.037) at 6 months and worse maximum subretinal fluid height (p = 0.022) at 18 months than the on-time group. No difference was observed between the groups in the second year. CONCLUSION the negative effects of delaying anti-VEGF treatment because of the COVID-19 pandemic can be ameliorated by changing the treatment regimen and shortening treatment intervals.
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Affiliation(s)
- Jae-Gon Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea; (J.-G.K.); (Y.C.K.)
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon 34141, Republic of Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea; (J.-G.K.); (Y.C.K.)
| | - Kyung Tae Kang
- Department of Ophthalmology, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Republic of Korea; (J.-G.K.); (Y.C.K.)
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Vofo BN, Beykin G, Levy J, Chowers I. Long-term outcome of neovascular age-related macular degeneration: association between treatment outcome and major risk alleles. Br J Ophthalmol 2022; 106:1555-1560. [PMID: 34083208 DOI: 10.1136/bjophthalmol-2021-319054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/04/2021] [Accepted: 04/30/2021] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the long-term functional and anatomical outcomes of neovascular age-related macular degeneration (nvAMD) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) for up to 10 years, and to identify associated risk factors. METHODS Clinical and optical coherence tomography findings were retrieved for nvAMD cases treated with intravitreal anti-VEGF compounds using a treat-and-extend protocol. In addition, the major risk alleles for AMD in the CFH (rs1061170), HTRA1 (rs1200638) and C3 (rs2230199) genes were genotyped. RESULTS From 276 eligible eyes in 206 patients, 80 eyes (29%) in 66 patients (32.0%) had a follow-up period of ≥8 years and were included in this study. Over a 10-year period, 73.3±28.0 (mean±SD) anti-VEGF injections were administered. Best-corrected visual acuity (BCVA; LogMAR) deteriorated from 0.55±0.53 at baseline to 1.00±0.73 at 10 years (p<0.0005). Central subfield thickness (CST) decreased from 415.8±162.1 µm at baseline to 323±113.6 µm (p<0.0005) after three monthly injections and remained lower than baseline throughout the follow-up period. Visual outcome was associated with BCVA and intraretinal fluid (IRF) at baseline, macular atrophy, and macular thinning at follow-up. The decrease in CST was inversely correlated with the number of CFH and/or C3 risk alleles carried by the patient (Pearson's r: -0.608; p=0.003). CONCLUSIONS Patients with nvAMD who received anti-VEGF therapy for 10 years developed substantial vision loss associated with the presence of IRF at baseline and macular atrophy. Major risk alleles for AMD in two complement genes were associated with a reduced long-term reduction in macular thickness.
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Affiliation(s)
| | - Gala Beykin
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
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Fu DJ, Keenan TD, Faes L, Lim E, Wagner SK, Moraes G, Huemer J, Kern C, Patel PJ, Balaskas K, Sim DA, Bunce C, Stratton I, Keane PA. Insights From Survival Analyses During 12 Years of Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration. JAMA Ophthalmol 2021; 139:57-67. [PMID: 33211064 PMCID: PMC7677877 DOI: 10.1001/jamaophthalmol.2020.5044] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Although multiple imputation models for missing data and the use of mixed-effects models generally provide better outcome estimates than using only observed data or last observation carried forward in clinical trials, such approaches usually cannot be applied to visual outcomes from retrospective analyses of clinical practice settings, also called real-world outcomes. Objective To explore the potential usefulness of survival analysis techniques for retrospective clinical practice visual outcomes. Design, Setting, and Participants This retrospective cohort study covered a 12-year observation period at a tertiary eye center. Of 10 744 eyes with neovascular age-related macular degeneration receiving anti-vascular endothelial growth factor (VEGF) therapy between October 28, 2008, and February 1, 2020, 7802 eyes met study criteria (treatment-naive, first-treated eyes starting anti-VEGF therapy). Eyes were excluded from the analysis if they received photodynamic therapy or macular laser, any previous anti-VEGF therapy, treatment with anti-VEGF agents other than ranibizumab or aflibercept, or had an unknown date or visual acuity (VA) value at first injection. Main Outcomes and Measures Kaplan-Meier estimates and Cox proportional hazards modeling were used to consider VA reaching an Early Treatment Diabetic Retinopathy Study (ETDRS) letter score of 70 (Snellen equivalent, 20/40) or better, duration of VA sustained at or better than 70 (20/40), and VA declining to 35 (20/200) or worse. Results A total of 7802 patients (mean [SD] age, 78.7 [8.8] years; 4776 women [61.2%]; and 4785 White [61.3%]) were included in the study. The median time to attaining a VA letter score greater than or equal to 70 (20/40) was 2.0 years (95% CI, 1.87-2.32) after the first anti-VEGF injection. Predictive features were baseline VA (hazard ratio [HR], 1.43 per 5 ETDRS letter score or 1 line; 95% CI, 1.40-1.46), baseline age (HR, 0.88 per 5 years; 95% CI, 0.86-0.90), and injection number (HR, 1.12; 95% CI, 1.10-1.15). Of the 4439 of 7802 patients (57%) attaining this outcome, median time sustained at an ETDRS letter score of 70 (20/40) or better was 1.1 years (95% CI, 1.1-1.2). Conclusions and Relevance In this cohort study, patients with neovascular age-related macular degeneration beginning anti-VEGF therapy were more likely to experience positive visual outcomes within the first 2.0 years after treatment, typically maintaining this outcome for 1.1 years but then deteriorating to poor vision within 8.7 years. These findings demonstrate the potential usefulness of the proposed analyses. This data set, combined with the statistical approach for retrospective analyses, may provide long-term prognostic information for patients newly diagnosed with this condition.
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Affiliation(s)
- Dun Jack Fu
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Tiarnan D Keenan
- Department of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Livia Faes
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom.,Eye Clinic of the Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Ernest Lim
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Siegfried K Wagner
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Gabriella Moraes
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Josef Huemer
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom.,Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Christoph Kern
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom.,Department of Ophthalmology, University Hospital of Munich, Munich, Germany
| | - Praveen J Patel
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Konstantinos Balaskas
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Dawn A Sim
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom.,School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Catey Bunce
- Gloucestershire Retinal Research Group, Gloucester, United Kingdom
| | - Irene Stratton
- National Institute for Health and Research Biomedical Center, Moorfields Eye Hospital, London, United Kingdom
| | - Pearse A Keane
- Moorfields Eye Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom.,School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
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Kikushima W, Sakurada Y, Sugiyama A, Yoneyama S, Matsubara M, Fukuda Y, Kashiwagi K. Five-Year Outcome of Aflibercept Monotherapy for Exudative Age-Related Macular Degeneration with Good Baseline Visual Acuity. J Clin Med 2021; 10:jcm10051098. [PMID: 33807964 PMCID: PMC7961756 DOI: 10.3390/jcm10051098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
We investigated the long-term visual and anatomical outcomes of aflibercept monotherapy for exudative age-related macular degeneration (AMD) with good baseline best-corrected visual acuity (BCVA). A medical chart review was performed for 40 consecutive patients with baseline decimal BCVA ≥ 0.6 secondary to exudative AMD. Three monthly injections were administrated, and thereafter additional injection was performed if needed over 5 years. In total, 13 eyes with neovascular AMD (nAMD) and 27 eyes with polypoidal choroidal vasculopathy (PCV) were enrolled. In both groups, the mean BCVA significantly improved at the 12-month visit (p < 0.05). However, the significant improvement in BCVA disappeared at the 24-month visit, and the final mean BCVA was equivalent to that at baseline (p = 0.17 in the nAMD group and p = 0.15 in the PCV group). The median number of injections required after the loading dose was 15.0 during the 5-year follow-up (nAMD:15.0 vs. PCV:15). During the study period, 37 (92.5%) eyes required retreatment(s). Cox regression analysis demonstrated that the protective allele of ARMS2 A69S was associated with a retreatment-free period from the initial injection (p = 0.041, repeated forward selection method). As-needed aflibercept monotherapy is a preferable treatment option for exudative AMD with good initial visual acuity regardless of nAMD or PCV during the 5-year study period.
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