Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration
Abstract
:1. Introduction
2. Methods
2.1. Data Collection
2.2. Injection Technique
2.3. Image Grading
2.4. Statistical Analysis
3. Results
3.1. Baseline Demographic Characteristics and Correlation with Visual Outcome
3.2. Neovascular Lesions and Number of Injections
Baseline Characteristics N = 128 Eyes | VA at 3 Years (logMAR) | VA Change at 3 Years (logMAR) | ≥3 Line Gainat 3 Years | ≥1 Line Lossat 3 Years | ||||
---|---|---|---|---|---|---|---|---|
Adjusted Mean (SE) | p Value | Adjusted Mean (SE) | p Value | Number (%) | p Value | Number (%) | p Value | |
Baseline VA | - | <0.001 | - | <0.001 | - | <0.001 | - | 0.11 |
6-month VA | - | <0.001 | - | 0.068 | - | 0.979 | - | 0.083 |
Total | 0.544 (0.037) | −0.106 (0.033) | 38 (28%) | 28 (22%) | ||||
Anatomic classification | 0.006 | 0.001 | 0.041 | 0.478 | ||||
1 | 0.390 (0.050) | −0.113 (0.048) | 18 (47%) | 9 (32%) | ||||
2 | 0.695 (0.129) | −0.215 (0.123) | 6 (16%) | 3 (11%) | ||||
3 | 0.534 (0.055) | −0.060 (0.051) | 9 (24%) | 9 (32%) | ||||
4 | 0.761 (0.096) | −0.109 (0.087) | 5 (13%) | 7 (25%) | ||||
Fluorescein classification | 0.544 (0.037) | 0.214 | −0.106 (0.033) | 0.194 | 0.521 | 0.613 | ||
1 | 0.463 (0.051) | −0.076 (0.043) | 18 (47%) | 13 (46%) | ||||
2 | 0.651 (0.109) | −0.269 (0.100) | 8 (21%) | 3 (11%) | ||||
3 | 0.606 (0.066) | −0.068 (0.064) | 9 (24%) | 8 (29%) | ||||
4 | 0.593 (0.122) | −0.094 (0.098) | 3 (8%) | 4 (14%) | ||||
Lesion location | 0.841 | 0.023 | 0.09 | 0.01 | ||||
foveal | 0.552 (0.045) | −0.166 (0.041) | 31 (82%) | 14 (50%) | ||||
juxta | 0.559 (0.082) | 0.001 (0.065) | 3 (8%) | 6 (21%) | ||||
extra | 0.490 (0.104) | 0.048 (0.066) | 4 (11%) | 8 (29%) | ||||
Lesion area | - | 0.301 | - | 0.039 | - | 0.138 | - | 0.298 |
Number of injections | - | <0.001 | - | 0.022 | - | 0.259 | - | 0.104 |
Neovascular Lesion Type (FA + OCT) | Mean Number of Injections per Year | |||||
---|---|---|---|---|---|---|
1st Year | 2nd Year | 3rd Year | 4th Year | 5th Year | 6th Year | |
Type 1 | 9.4 | 8.2 | 8.6 | 8.6 | 8.5 | 9.1 |
Type 2 | 8.3 | 6 | 7.8 | 7.8 | 8.1 | 8.2 |
Type 3 | 8.7 | 8 | 7.5 | 8.1 | 7.8 | 8.4 |
Type 4 (mixed) | 8.8 | 7.3 | 7.4 | 6.8 | 7.9 | 7 |
3.3. Retention Rate
3.4. Visual Results for the Entire Cohort
3.5. Visual Results by Neovascular Phenotype
Baseline Characteristics N = 88 Eyes | VA at 4 Years (logMAR) | VA Change at 4 Years (logMAR) | ≥3 Line Gain at 4 Years | ≥1 Line Loss at 4 Years | ||||
---|---|---|---|---|---|---|---|---|
Adjusted Mean (SE) | p Value | Adjusted Mean (SE) | p Value | Number (%) | p Value | Number (%) | p Value | |
Baseline VA | - | <0.001 | - | 0.002 | - | 0.001 | - | 0.384 |
6 month VA | - | <0.001 | - | 0.092 | - | 0.661 | - | 0.169 |
Total | 0.574 (0.051) | −0.090 (0.044) | 26 (30%) | 20 (23%) | ||||
Anatomic classification | 0.006 | 0.652 | 0.498 | 0.314 | ||||
1 | 0.354 (0.054) | −0.140 (0.054) | 11 (42%) | 5 (25%) | ||||
2 | 0.773 (0.185) | −0.105 (0.138) | 3 (12%) | 2 (10%) | ||||
3 | 0.599 (0.074) | −0.006 (0.073) | 7 (27%) | 9 (45%) | ||||
4 | 0.826 (0.148) | −0.114 (0.137) | 5 (19%) | 4 (20%) | ||||
Fluorescein classification | 0.573 (0.051) | 0.135 | −0.090 (0.044) | 0.839 | 0.002 | 0.831 | ||
1 | 0.442 (0.061) | −0.094 (0.048) | 10 (39%) | 9 (45%) | ||||
2 | 0.713 (0.176) | −0.194 (0.166) | 6 (23%) | 3 (15%) | ||||
3 | 0.680 (0.089) | −0.022 (0.096) | 9 (35%) | 7 (35%) | ||||
4 | 0.650 (0.178) | −0.085 (0.107) | 1 (4%) | 1 (5%) | ||||
Lesion location | 0.616 | 0.25 | 0.073 | 0.511 | ||||
foveal | 0.581 (0.061) | −0.136 (0.056) | 23 (89%) | 13 (65%) | ||||
juxta | 0.636 (0.133) | 0.022 (0.072) | 1 (4%) | 4 (20%) | ||||
extra | 0.449 (0.139) | 0.036 (0.081) | 2 (8%) | 3 (15%) | ||||
Lesion area | - | 0.592 | - | 0.043 | - | 0.049 | - | 0.085 |
Number of injections | - | 0.007 | - | 0.175 | - | 0.57 | - | 0.242 |
3.6. Multivariate Analysis
Time Point | Visual Parameter | Anatomic Classification | Number of Injections | CNV Localization | Overall Lesion Area | Age at First Injection | |
---|---|---|---|---|---|---|---|
6 months | VA | B | 0.06 | −0.05 | −0.04 | 0.01 | 0.01 |
SE | 0.03 | 0.02 | 0.04 | 0.01 | 0.00 | ||
p | 0.02 | 0.00 | 0.26 | 0.09 | 0.05 | ||
VA Change | B | −0.01 | −0.03 | 0.05 | −0.01 | 0.00 | |
SE | 0.02 | 0.01 | 0.03 | 0.00 | 0.00 | ||
p | 0.55 | 0.05 | 0.12 | 0.15 | 0.55 | ||
12 months | VA | B | 0.07 | −0.06 | −0.03 | 0.01 | 0.01 |
SE | 0.03 | 0.02 | 0.04 | 0.01 | 0.00 | ||
p | 0.01 | 0.00 | 0.50 | 0.02 | 0.06 | ||
VA Change | B | −0.01 | −0.03 | 0.06 | 0.00 | 0.00 | |
SE | 0.02 | 0.02 | 0.03 | 0.00 | 0.00 | ||
p | 0.79 | 0.03 | 0.04 | 0.67 | 0.58 | ||
24 months | VA | B | 0.06 | −0.07 | −0.02 | 0.02 | 0.01 |
SE | 0.03 | 0.02 | 0.05 | 0.01 | 0.00 | ||
p | 0.04 | 0.00 | 0.71 | 0.00 | 0.07 | ||
VA Change | B | −0.01 | −0.03 | 0.08 | 0.01 | 0.00 | |
SE | 0.02 | 0.02 | 0.04 | 0.01 | 0.00 | ||
p | 0.82 | 0.06 | 0.05 | 0.34 | 0.26 | ||
36 months | VA | B | 0.09 | −0.09 | 0.02 | 0.01 | - |
SE | 0.03 | 0.02 | 0.05 | 0.01 | - | ||
p | 0.00 | <0.001 | 0.65 | 0.05 | - | ||
VA Change | B | 0.02 | −0.03 | 0.13 | 0.00 | - | |
SE | 0.03 | 0.02 | 0.05 | 0.01 | - | ||
p | 0.47 | 0.11 | 0.01 | 0.90 | - | ||
48 months | VA | B | 0.11 | −0.11 | 0.01 | 0.00 | - |
SE | 0.04 | 0.03 | 0.07 | 0.01 | - | ||
p | 0.01 | 0.00 | 0.87 | 0.89 | - | ||
VA Change | B | 0.02 | −0.05 | 0.10 | −0.01 | - | |
SE | 0.04 | 0.03 | 0.07 | 0.01 | - | ||
p | 0.66 | 0.09 | 0.15 | 0.13 | - |
p Values | ||||||
---|---|---|---|---|---|---|
Time Point | Visual Parameter | Anatomic Classification | Number of Injections | CNV Localization | Overall Lesion Area | Age at First Injection |
6 months | VA | 0.043 | 0.016 | 0.812 | 0.564 | 0.496 |
VA Change | 0.674 | 0.445 | 0.056 | 0.291 | 0.492 | |
12 months | VA | 0.048 | 0.050 | 0.859 | 0.627 | 0.294 |
VA Change | 0.591 | 0.856 | 0.086 | 0.277 | 0.286 | |
24 months | VA | 0.024 | 0.026 | 0.976 | 0.609 | 0.193 |
VA Change | 0.367 | 0.455 | 0.110 | 0.294 | 0.202 | |
36 months | VA | 0.021 | 0.010 | 0.504 | 0.769 | - |
VA Change | 0.874 | 0.271 | 0.020 | 0.211 | - | |
48 months | VA | 0.011 | 0.002 | 0.871 | 0.887 | - |
VA Change | 0.661 | 0.090 | 0.151 | 0.127 | - |
3.7. Intraocular Pressure and Safety
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Mrejen, S.; Jung, J.J.; Chen, C.; Patel, S.N.; Gallego-Pinazo, R.; Yannuzzi, N.; Xu, L.; Marsiglia, M.; Boddu, S.; Freund, K.B. Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration. J. Clin. Med. 2015, 4, 1380-1402. https://doi.org/10.3390/jcm4071380
Mrejen S, Jung JJ, Chen C, Patel SN, Gallego-Pinazo R, Yannuzzi N, Xu L, Marsiglia M, Boddu S, Freund KB. Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration. Journal of Clinical Medicine. 2015; 4(7):1380-1402. https://doi.org/10.3390/jcm4071380
Chicago/Turabian StyleMrejen, Sarah, Jesse J. Jung, Christine Chen, Samir N. Patel, Roberto Gallego-Pinazo, Nicolas Yannuzzi, Luna Xu, Marcela Marsiglia, Sucharita Boddu, and K. Bailey Freund. 2015. "Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration" Journal of Clinical Medicine 4, no. 7: 1380-1402. https://doi.org/10.3390/jcm4071380
APA StyleMrejen, S., Jung, J. J., Chen, C., Patel, S. N., Gallego-Pinazo, R., Yannuzzi, N., Xu, L., Marsiglia, M., Boddu, S., & Freund, K. B. (2015). Long-Term Visual Outcomes for a Treat and Extend Anti-Vascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration. Journal of Clinical Medicine, 4(7), 1380-1402. https://doi.org/10.3390/jcm4071380