External limiting membrane disruption predicts long‐term outcome in strict Treat‐and‐Extend Regimen in neovascular age‐related macular degeneration

• Published in: Acta ophthalmologica (Oxford, England) Vol. 100; no. S267
• Main Authors: Hoffmann, Laura, Katja, Hatz
• Format: Journal Article
• Language: English
• Published: Malden Wiley Subscription Services, Inc 01.01.2022
• Subjects: Drug therapy; Macular degeneration; Monoclonal antibodies; Patients
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/j.1755-3768.2022.235

Purpose To determine long‐term outcomes and outcome predicting factors in patients with neovascular age‐related macular degeneration (nAMD) applying a strict treat‐and‐extend regimen (TER). Methods Up to 8‐year retrospective follow‐up of treatment‐naïve subjects with nAMD starting treatment with either ranibizumab or aflibercept in a TER without loading dose but with predefined exit criteria. Spectral‐domain Optical Coherence Tomography scans were acquired in a follow‐up mode and evaluated following a standardized protocol. Results Two hundred‐eleven (211) eyes of 187 patients with a mean follow‐up of 60.3 ± 20.9 months were included. Real‐life follow‐up adherence was high (e.g. 88% at 3 years, 64% at 5 years) with the major part of discontinuations of TER being due to success. During follow‐up, 30.3% of eyes reached the predefined exit criteria, whereof 79.7% in the first five years. Mean BCVA increased from initially 63.9 ± 15.5 ETDRS letters (20/55) to 70.0 ± 14.7 (20/40) after one year (+6.1 letters, p < 0.001) and to 68.5 ± 18.1 (20/43) (+4.6 letters, p = 0.028) at 5 years. A worse BCVA (p = 0.001) and a better external limiting membrane (ELM) disruption score at baseline predicted (p = 0.019) BCVA gain at 5 years. The probability of reaching the exit criteria was significantly associated with a low central retinal thickness (CRT) (p = 0.025), a better ELM disruption score (p = 0.044) and the absence of a central pigment epithelial detachment (PED) (p = 0.05) at baseline. Conclusions Significant visual gains were sustained in a long‐term TER in a real‐world setting. Integrity of ELM at baseline predicted BCVA gain at 5 years and the potential for TER exit due to success.