Response to Aflibercept Therapy in Three Types of Choroidal Neovascular Membrane in Neovascular Age-Related Macular Degeneration: Real-Life Evidence in the Czech Republic
Abstract
Purpose. To present a cohort of treatment-naive patients with the neovascular form of age-related macular degeneration (nAMD) treated with aflibercept in a fixed regimen and evaluate the treatment response of three types of choroidal neovascular membrane (CNV)-occult (Type 1), classic (Type 2), and minimally classic (Type 4).
Methods. This was a multicentre, prospective, observational consecutive case series study.
Patients diagnosed with three types of CNV of nAMD were treated in a fixed regimen (3 injections every 4weeks, and then injections at 8week intervals). The follow-up period was 48weeks.
Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and spectral-domain optical coherence tomography (OCT). The measurements were taken at the baseline and then at 16, 32, and 48weeks.
Results. The treatment-naive group was composed of 135 eyes of 135 patients in the study. 61 eyes had Type 1 lesions of CNV, 50 eyes had Type 2 lesions, and 24 eyes had Type 4 lesions.
Mean baseline BCVA +/- SD for Type 1 lesions was 56.1 +/- 10.8 ETDRS letters, and then 62.2 +/- 12.9 letters, 61.2 +/- 13.7 letters, and 62.8 +/- 15.1 letters at 16, 32, and 48weeks, respectively. Mean baseline CRT +/- SD for Type 1 lesions was 442.4 +/- 194.9 mu m, and then 302.5 +/- 144.4 mu m, 299.7 +/- 128.5 mu m, and 277.7 +/- 106.5 mu m at 16, 32, and 48weeks, respectively.
Mean baseline BCVA +/- SD for Type 2 lesions was 55.6 +/- 9.9 ETDRS letters, and then 62.5 +/- 11.1 letters, 60.7 +/- 13.0 letters, and 62.5 +/- 14.2 letters at 16, 32, and 48weeks, respectively. Mean baseline CRT +/- SD.
For Type 4 lesions mean baseline BCVA +/- SD was 56.7 +/- 9.0 ETDRS letters, and then 59.1 +/- 10.6 letters, 59.5 +/- 11.4 letters, and 59.2 +/- 12.6 letters at 16, 32, and 48 weeks respectively. Mean baseline CRT +/- SD for Type 4 lesions was 492.1 +/- 187.0 mu m, and then 333.3 +/- 137.5 mu m, 354.4 +/- 175.0 mu m, and 326.7 +/- 122.4 mu m at 16, 32, and 48 weeks respectively.
All these changes were statistically significant (p<0.005). Conclusions.
The primary outcome of our study is that the treatment with aflibercept in nAMD patients led to statistically significant improvement in BCVA and to a decrease in CRT throughout the follow-up period in both occult and classic types of CNV. The minimally classic type of CNV demonstrated a poorer functional and anatomical response to treatment.