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Invest Ophthalmol Vis Sci. 2015 Aug;56(9):5040-7. doi: 10.1167/iovs.15-16494.

Baseline Predictors for Good Versus Poor Visual Outcomes in the Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Therapy.

Author information

1
Department of Ophthalmology New York University School of Medicine, New York, New York, United States 2Vitreous Retina Macula Consultants of New York, New York, New York, United States.
2
Department of Ophthalmology New York University School of Medicine, New York, New York, United States 2Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Thr.
3
Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.
4
Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 5Department of Ophthalmology, University and Polytechni.
5
Weill Cornell Medical College, New York, New York, United States.
6
Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 7Department of Surgery, Monash University, Melbourne, A.
7
Vitreous Retina Macula Consultants of New York, New York, New York, United States 3LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States 4Edward S. Harkness Eye Institute, Columbia University.
8
Department of Ophthalmology New York University School of Medicine, New York, New York, United States.

Abstract

PURPOSE:

To examine the baseline factors associated with good (20/60 or better) versus poor (20/200 or worse) visual outcomes in eyes with treatment-naïve neovascular age-related macular degeneration (AMD) receiving intravitreal antivascular endothelial growth factor (VEGF) on a treat-and-extend regimen (TER).

METHODS:

An observational, retrospective series of patients managed with a TER, identified as having either good or poor visual outcomes, was examined. A multivariate regression analysis of baseline characteristics identified factors associated with good and poor vision at 2, 3, and 4 years. Neovascular subtypes were identified using fluorescein angiography (FA) alone and the anatomic classification system with FA and optical coherence tomography (OCT).

RESULTS:

One hundred thirty-eight patients (154 eyes) fit the inclusion criteria at 2 years, 106 patients (113 eyes) at 3 years, and 72 patients (74 eyes) at 4 years. In the multivariate analysis, type 1 lesions, according to anatomic classification, had better vision at 24 months (95% CI: [3.1, 82.7], P = 0.01), 36 months (95% CI: [1.97, 24.17], P = 0.003), and 48 months (95% CI: [2.01, 65.47], P = 0.006). Clopidogrel use was associated with poor vision at 24 months (95% CI: [0.03, 0.68], P = 0.013). Vision at 3 months was the best predictor of vision at year 4 (β = -4.277, P = 0.002).

CONCLUSIONS:

Eyes with neovascular AMD managed with a TER of anti-VEGF therapy having type 1 neovascularization at baseline were more likely to maintain good vision over 4 years, whereas clopidogrel use predicted poor vision at 2 years. Vision at 3 months was the best predictor for favorable long-term vision.

Comment in

PMID:
26237196
DOI:
10.1167/iovs.15-16494
[Indexed for MEDLINE]

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