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Budzinskaya M.V.

Krasnov Research Institute of Eye Diseases

Plyukhova A.A.

Krasnov Research Institute of Eye Diseases

Afanasyeva M.A.

Research Institute of Eye Diseases

Gorkavenko F.V.

Center for Healthcare Quality Assessment and Control

New criteria of effectiveness of anti-VEGF therapy in exudative age-related macular degeneration

Authors:

Budzinskaya M.V., Plyukhova A.A., Afanasyeva M.A., Gorkavenko F.V.

More about the authors

Journal: Russian Annals of Ophthalmology. 2022;138(4): 58‑66

DOI: 10.17116/oftalma202213804158

Views: 1389

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To cite this article:

Budzinskaya MV, Plyukhova AA, Afanasyeva MA, Gorkavenko FV. New criteria of effectiveness of anti-VEGF therapy in exudative age-related macular degeneration. Russian Annals of Ophthalmology. 2022;138(4):58‑66. (In Russ.)
https://doi.org/10.17116/oftalma202213804158

Подписка 2025 (Russian Annals of Ophthalmology)
 
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OBJECTIVE

To evaluate the effectiveness of anti-angiogenic therapy using fluctuation and variability in patients with exudative age-related macular degeneration (AMD).

MATERIAL AND METHODS

This study included 200 patients with types 1, 2, 3 neovascularization and polypoidal choroidal vasculopathy (PCV). All patients underwent standard ophthalmological examination, as well optical coherence tomography (OCT) and OCT angiography (OCT-A). Patients were divided into 4 quartiles based on fluctuation and variability. All patients underwent intravitreal administration of the anti-VEGF drug aflibercept (Eylea) manufactured by Bayer, Germany, using the Treat-and-Extend regimen.

RESULTS

As a result of the study, a significant increase in visual acuity was revealed on the second year of treatment in patients in the 2nd and 3rd quartiles, best corrected visual acuity (BCVA) decreased in the 1st and 4th quartiles. In the group with paracentral fluctuation, a significant increase in BCVA by the end of the second year of treatment was observed in the 1st (p=0.05) and 3rd quartiles. As a result of a 2-year follow-up, it was found that BCVA values were lower in patients with the greatest variability (2nd, 3rd, and 4th quartiles). A significant increase in BCVA was observed in the 1st quartile (p=0.047). The largest number of patients with subretinal fibrosis that had fluctuations in the central zone and peripheral fluctuations was observed in the 4th quartile, the smallest — in the 2nd quartile. Similar pattern was observed in the variability group. In the setting of anti-VEGF therapy, a significant increase in BCVA was observed in patients with the lowest variability — in the 1st quartile (p=0.047), but in patients with fluctuations the highest BCVA values were observed in the 2nd and 3rd quartiles, while in the 4th quartile BCVA decreased (p=0.0562).

CONCLUSIONS

The results of this study indicate that when treating patients with neovascular AMD, clinicians should aim for a treatment strategy that minimizes fluctuation and variability.

Keywords:

age-related macular degeneration
intraretinal fluid
subretinal fluid
retinal pigment epithelium detachment
optical coherence tomography
fluctuation
variability

Authors:

Budzinskaya M.V.

Krasnov Research Institute of Eye Diseases

Plyukhova A.A.

Krasnov Research Institute of Eye Diseases

Afanasyeva M.A.

Research Institute of Eye Diseases

Gorkavenko F.V.

Center for Healthcare Quality Assessment and Control

Received:

17.05.2022

Accepted:

17.05.2022

List of references:

  1. Fursova AZh, Derbeneva AS, Vasilyeva MA, Tarasov MS, Chubar NV, Nikulich IF. Different types localisation of retinal fluid as prognostic biomarkers in the choice of anti-VEGF therapy for age-related macular degeneration. The Russian Annals of Ophthalmology. 2020;136(6): 227-234. (In Russ.). https://doi.org/10.17116/oftalma2020136062227
  2. Mettu PS, Allingham MJ, Cousins SW. Incomplete response to Anti-VEGF therapy in neovascular AMD: Exploring disease mechanisms and therapeutic opportunities. Progr Retin Eye Res. 2020;82:100906. https://doi.org/10.1016/j.preteyeres.2020.100906
  3. Sheremet NL, Shmelkova MS, Andreeva NA, Zhorzholadze NV, Fomin AV, Krylova TD, Tsygankova PG. Characteristics of changes in retinal and optic nerve microvascularisature in Leber hereditary optic neuropathy patients seen with optical coherence tomography angiography. The Russian Annals of Ophthalmology. 2020;136(4-2):171-182. (In Russ.). https://doi.org/10.17116/oftalma2020136042171
  4. Chakravarthy U, Havilio M, Syntosi A, et al. Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD. Eye. 2021;35:2983-2990. https://doi.org/10.1038/s41433-020-01354-4
  5. Evans RN, Reeves BC, Maguire MG, Martin DF, Muldrew A, Peto T, Rogers C, Chakravarthy U. Associations of Variation in Retinal Thickness With Visual Acuity and Anatomic Outcomes in Eyes With Neovascular Age-Related Macular Degeneration Lesions Treated With Anti-Vascular Endothelial Growth Factor Agents. JAMA Ophthalmol. 2020;138(10):1043-1051. https://doi.org/10.1001/jamaophthalmol.2020.3001
  6. Singer MA, Awh CC, Sadda S, Freeman WR, Antoszyk AN, Wong P, Tuomi L. HORIZON: An open-label extension trial of ranibizumab for choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology. 2012;119(6):1175-1183. https://doi.org/10.1016/j.ophtha.2011.12.016
  7. Daniel E, Toth CA, Grunwald JE, Jaffe GJ, Martin D F, Fine SL, Huang J, Ying GS, Hagstrom SA, Winter K, Maguire MG; Comparison of Age-related Macular Degeneration Treatments Trials Research Group. Risk of scar in the comparison of age-related macular degeneration treatments trials. Ophthalmology. 2014;121(3):656-666.  https://doi.org/10.1016/j.ophtha.2013.10.019

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