J Korean Ophthalmol Soc.  2017 Sep;58(9):1042-1049. 10.3341/jkos.2017.58.9.1042.

Fourteen Anti-vascular Endothelial Growth Factor Injections for Age-related Macular Degeneration: Ending Period and Clinical Outcome

• Han JW
• Kim JW
• Kim CG
• Lee DW
• Han JI
• Lew YJ
• Kim JH

• KMID: 2390067
• DOI: http://doi.org/10.3341/jkos.2017.58.9.1042

Abstract

PURPOSE
To evaluate the clinical course of patients who had completed 14 ranibizumab or aflibercept monocular treatments.
METHODS
Retrospective medical record analysis was performed to 24 patients who were diagnosed with monocular neovascular age-related macular degeneration and had completed 14 ranibizumab or aflibercept monocular injections, allowed by the Korean National Health Care system. Time to completion was measured along with the percentage and timing of medication switch. Best-corrected visual acuity (BCVA) was measured at the time of diagnosis, after 3-loading injections, and the time of completion. Additionally, we searched for any other factors that had influenced the time to completion.
RESULTS
The average time to completion of 14 injections was 32.3 ± 6.2 months (21-48 months). The switching was performed in 17 eyes (70.8%), and it was done after 9.4 ± 2.1 injections (4-14 injections) with prior medication. After 14 injections, the BCVA improved in 6 eyes (25.0%), unchanged in 8 eyes (33.3%), and worsened in 10 eyes (41.7%). Complete resolution of intraretinal fluid and subretinal fluid after 3 loading injections were observed in 20 eyes, and it was significantly related to time to the first recurrence and time to the completion of 14 injections (p = 0.007, r = 0.583).
CONCLUSIONS
The average time to completion of 14 injections was 32.3 months, and switching of medication was performed in 70.8%. Longer time to the first recurrence was related to longer completion time. This study will provide useful facts when informing the patients their future treatment plans under the Korean Health Care system.

Keyword

Aflibercept; Choroidal neovascularization; Macular degeneration; Ranibizumab

MeSH Terms

Choroidal Neovascularization
Delivery of Health Care
Diagnosis
Endothelial Growth Factors*
Humans
Macular Degeneration*
Medical Records
Ranibizumab
Recurrence
Retrospective Studies
Subretinal Fluid
Visual Acuity
Endothelial Growth Factors
Ranibizumab

Figure

• 

  Figure 1 Changes in best-corrected visual acuity (BCVA) (A) and central foveal thickness (B).The values were measured at the time of diagnosis (baseline), at 3 months (3M), and when the 14th anti-vascular endothelial growth factor injection was performed (at 14th inj.).

• 

  Figure 2 Proportion of patients when stratified into best-corrected visual acuity (BCVA) (n = 24). The proportion of patients with BCVA of ≥0.5 was slightly decreased, whereas the proportion in the other visual acuity groups was slightly increased during the follow-up period. At 14th inj.: When the 14th anti-vascular endothelial growth factor injection was performed.

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