Macular atrophy after aflibercept therapy for neovascular age-related macular degeneration: outcomes of Japanese multice
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CLINICAL INVESTIGATION
Macular atrophy after aflibercept therapy for neovascular age‑related macular degeneration: outcomes of Japanese multicenter study Hideki Koizumi1,2 · Akiko Yamamoto3 · Masashi Ogasawara4 · Ichiro Maruko1 · Taiji Hasegawa1 · Kanako Itagaki4 · Tetsuju Sekiryu4 · Annabelle A. Okada3 · Tomohiro Iida1 Received: 21 August 2019 / Accepted: 26 March 2020 © Japanese Ophthalmological Society 2020
Abstract Purpose To evaluate the development and rate of growth in macular atrophy after intravitreal injections of aflibercept (IVAs) for neovascular age-related macular degeneration (AMD) over a 2-year period. Study design Retrospective, interventional, consecutive case series. Methods This study included 94 eyes of 92 patients with treatment-naïve AMD involving the foveal center treated with IVAs at 3 university hospitals in Japan. The patients underwent IVAs bimonthly after 3 initial monthly doses in the first year. The protocol was converted to a treat-and-extend regimen in the second year. The incidence and growth rate of macular atrophy were quantified based on hypoautofluorescence detected by fundus autofluorescence images. Additionally, possible background factors related to the development and rate of growth of macular atrophy were investigated. Results Of 94 eyes, 39 (41.5%) had typical AMD and 55 (58.5%) had polypoidal choroidal vasculopathy. Ten eyes (10.6%) had macular atrophy at the baseline. Of the remaining 84 eyes, 14 (16.7%) had developed new macular atrophy at 2 years, the square root of the growth rate of atrophy was 0.52 mm/year. In multivariate analyses, a poorer best-corrected visual acuity (P = 0.01) and the presence of intraretinal fluid (P = 0.04) at baseline were found to be the independent predictors for the development of macular atrophy. No factors were found that were significantly related to the growth rate of the macular atrophy. Conclusions Our study determined the incidence and rate of growth of macular atrophy after IVAs for neovascular AMD in clinical settings. Eyes with vision reduction and intraretinal fluid at the baseline develop macular atrophy more frequently after IVAs for neovascular AMD. Keywords Age-related macular degeneration · Polypoidal choroidal vasculopathy · Aflibercept · Macular atrophy · Vascular endothelial growth factor
Introduction
Corresponding Author: Hideki Koizumi * Hideki Koizumi [email protected]‑ryukyu.ac.jp 1
Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, Japan
2
Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara‑cho, Nakagami‑gun, Okinawa 903‑0125, Japan
3
Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
4
Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
Age-related macular degeneration (AMD) is a common cause of legal blindness in developed countries [1]. Various therapies are used to suppress the exudative changes produced by the choroidal neovascularization (CNV) associated with
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