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Han, Kim, Kim, Lee, Han, Lew, and Kim: Fourteen Anti-vascular Endothelial Growth Factor Injections for Age-related Macular Degeneration: Ending Period and Clinical Outcome
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(9): 1042-1049.

Published online: 12 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.9.1042

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

Jae Wook Han, MD, Jong Woo Kim, MD, Chul Gu Kim, MD, Dong Won Lee, MD, Jung Il Han, MD, Young Ju Lew, MD, Jae Hui Kim, MD

Myung-Gok Eye Resarch Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.

Address reprint requests to: Jae Hui Kim, MD. Department of Ophthalmology, Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 07301, Korea. Tel: 82-2-2671-7665, Fax: 82-2-2671-6359, kjh7997@kimeye.com

Received 29 June 2017       Revised 29 July 2017       Accepted 22 August 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Aflibercept, Choroidal neovascularization, Macular degeneration, Ranibizumab

Figures and Tables

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.).

jkos-58-1042-g001
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.

jkos-58-1042-g002
Table 1

Baseline characteristics of 24 patients (24 eyes) who completed 14 intravitreal anti-vascular endothelial growth factor injections for unilateral neovascular age-related macular degeneration

jkos-58-1042-i001

Values are presented as mean ± SD or n (%).

AMD = age-related macular degeneration; logMAR = logarithm of minimal angle of resolution.

Table 2

Comparison of characteristics and period completing 14 anti-vascular endothelial growth factor injections (n = 24)

jkos-58-1042-i002

Values are presented as mean ± SD unless otherwise indicated.

AMD = age-related macular degeneration; VEGF = vascular endothelial growth factor.

*Statistical analysis performed using Mann-Whitney U-test.

Table 3

Associations between characteristics and period completing 14 anti-vascular endothelial growth factor injections (n = 24)

jkos-58-1042-i003

BCVA = best-corrected visual acuity.

*Analysis was performed for 20 eyes in which intraretinal/subretinal fluid was completely resolved after initial 3 injections; †Analysis was performed using Pearson's correlation analysis.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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