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Early Predictive Factors of Visual Loss at 1 Year in Neovascular Age-Related Macular Degeneration under Anti–Vascular Endothelial Growth Factor

      Purpose

      To evaluate early predictive factors of visual loss in patients treated with anti–vascular endothelial growth factor (VEGF) injections under an as-needed regimen for neovascular age-related macular degeneration (AMD).

      Design

      Post hoc analysis from the randomized controlled trial Groupe d’Evaluation Français Avastin versus Lucentis (GEFAL).

      Participants

      A total of 393 patients with neovascular AMD.

      Methods

      The present analysis is based on 1-year data from patients included in the study. Patients were separately categorized according to the best-corrected visual acuity (BCVA) change at 3 months and 1 year into 3 trajectories: (1) patients with no vision loss ≥5 letters at 3 months and 1 year (absence of loss ≥5 letters); (2) patients with no vision loss ≥5 letters at 3 months but loss ≥5 letters at 1 year (secondary loss ≥5 letters); and (3) patients with vision loss ≥5 letters at 3 months and 1 year (initial loss ≥5 letters).

      Main Outcome Measures

      The following factors were evaluated at baseline and 3 months: age, sex, BCVA, presence of fluid, central macular thickness, angiographic choroidal neovascularization (CNV) subtype, CNV area measured in disc area on fluorescein angiography, and number of intravitreal injections.

      Results

      An absence of loss ≥5 letters was found in 225 patients (57.3%), a secondary loss ≥5 letters after 3 months was found in 109 patients (27.7%), and an initial loss ≥5 letters was found in 59 patients (15%). Baseline characteristics were comparable among the 3 groups except for the total CNV area, which was larger in the initial and secondary loss groups (P = 0.0412). At 3 months, a significant association was found between presence of subretinal fluid (SRF) (P = 0.0318) and vision loss ≥5 letters, and an even stronger significant association between the presence of intraretinal fluid (IRF) (P = 0.0066) and vision loss ≥5 letters.

      Conclusions

      In the present study, we found that a large CNV area at baseline was significantly associated with initial or secondary loss of visual acuity ≥5 letters despite anti-VEGF injection. The presence of fluid, both SRF and IRF, at 3 months was found in patients with poorer trajectories.

      Keywords

      Abbreviations and Acronyms:

      AMD (age-related macular degeneration), BCVA (best-corrected visual acuity), CMT (central macular thickness), CNV (choroidal neovascularization), GEFAL (Groupe d’Evaluation Français Avastin versus Lucentis), IRF (intraretinal fluid), PRN (pro re nata), SRF (subretinal fluid), VEGF (vascular endothelial growth factor), VIEW (VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD)
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