CONSEQUENCES OF LAPSES IN TREATMENT WITH VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN ROUTINE CLINICAL PRACTICE

摘要

Purpose: Evaluating outcomes in patients receiving intravitreal antivascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration whom experience a lapse in treatment. Methods: A retrospective chart review evaluating 3,304 patients >= 18 years who experienced treatment lapses >= 3 months compared with control counterparts. Demographic information, macular thickness as measured by central subfield thickness, and visual acuity were collected at baseline, the first postlapse appointment, and at 3, 6, and 12 months after the lapse for the study group. Results: Lapse (n = 241) and control patients (n = 241) had similar baseline visual acuity and central subfield thickness (Early Treatment Diabetic Retinopathy Study: 58.9 +/- 20.2 [20/63] vs. 59.2 +/- 20.1 [20/63]; central subfield thickness: 252.4 +/- 63.2 mu m vs. 259.8 +/- 66.2 mu m, P = 0.21). Analysis revealed that lapse patients experienced a significant increase in central subfield thickness after lapse when compared with controls (279.4 +/- 86.9 mu m vs. 253.7 +/- 65.9 mu m, P < 0.01), which normalized on resumption of treatment (259.1 +/- 79 mu m vs. 246.8 +/- 57.6 mu m, P = 0.06). Study patients also experienced loss in the visual acuity after lapse when compared with controls (52.9 +/- 23.6 Early Treatment Diabetic Retinopathy Study [20/100] vs. 59.9 +/- 20.8 [20/63] Early Treatment Diabetic Retinopathy Study, P < 0.01) that did not recover through 12 months of follow-up. Conclusion: Patients with neovascular age-related macular degeneration who have lapses in care are at risk for poorer outcomes. Although macular thickness normalizes on resumption of treatment, their decline in the visual acuity does not recover.