Response to Aflibercept Therapy in Three Types of Choroidal Neovascular Membrane in Neovascular Age-Related Macular Degeneration: Real-Life Evidence in the Czech Republic

摘要

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 4?weeks, and then injections at 8?week intervals). The follow-up period was 48?weeks. 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 48?weeks. 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 48?weeks, respectively. Mean baseline CRT?±?SD for Type 1 lesions was 442.4?±?194.9?μm, and then 302.5?±?144.4?μm, 299.7?±?128.5?μm, and 277.7?±?106.5?μm at 16, 32, and 48?weeks, 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 48?weeks, 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 μm, and then 333.3 ± 137.5 μm, 354.4 ± 175.0 μm, and 326.7 ± 122.4 μm at 16, 32, and 48 weeks respectively. All these changes were statistically significant (p0.005). 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.