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  • Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series

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Original article
Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series
  1. Livia Faes1,2,
  2. Zaria Ali3,
  3. Siegfried Wagner1,
  4. Praveen J Patel1,
  5. Dun Jack Fu1,
  6. Lucas M Bachmann4,
  7. Martin K Schmid2,
  8. Nadia Waheed5,
  9. Pearse A Keane1,
  10. Konstantinos Balaskas6
  1. 1Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Retina, Luzerner Kantonsspital, Luzern, Switzerland
  3. 3Medical Retina, Manchester Royal Eye Hospital, Manchester, UK
  4. 4Research Consultancy, medignition, Zurich, Switzerland
  5. 5Department of Ophthalmology, New England Eye Center, Boston, Massachusetts, USA
  6. 6Medical retina Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Livia Faes; l.faes{at}nhs.net

Abstract

Objective To compare clinical characteristics of patients suffering from neovascular age-related macular degeneration (nAMD) with mature and immature choroidal neovascularisation (CNV) as assessed by optical coherence tomography angiography (OCTA). To explore the effect of total anti-vascular endothelial growth factor exposure on the occurrence of mature CNV when correcting for potential confounders.

Methods and analysis In this retrospective case series, we included 40 eyes of 36 patients with nAMD with CNV assessed by OCTA at the Manchester Eye Hospital between June 2016 and June 2017. A retinal specialist masked to patient information graded CNV depicted on OCTA scans. For statistical comparisons, we used t-tests, Fisher’s exact tests and a mixed-effects logistic regression model.

Results 18 patients (20 eyes) were treatment naïve, and the mean number of intravitreal injections (IVI) in the remaining eyes was 18.4 (range 2–71). The mean duration of nAMD was 19.3 months (range 0–87.4). 25 eyes (62.5%) exhibited mature CNV. Eyes with mature CNV did not differ from those with immature CNV regarding age (+2.8 years; p=0.288) or duration of disease (+9.4 months; p=0.061). However, they had a higher number of IVIs (+3.1; p=0.035). Among eyes with best corrected visual acuity over 25 letters, there was a strong association between the number of IVIs (0 vs 1–20: OR 68.01 [95% CI 1.30 to 3546.99; p=0.036], 0 vs >20 IVI: OR 380.01 [95% CI 2.60 to 55 464.89; p=0.019]) and maturity status when correcting for potential confounders.

Conclusion Maturity status of CNV as assessed by OCTA may indicate treatment exposure of CNV in nAMD.

  • neovascularisation
  • treatment medical
  • retina

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjophth-2018-000244

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    Footnotes

    • Contributors LF, LMB: substantial contributions to the analysis and interpretation of data, drafting of the work. ZA: substantial contributions to the conception or design of the work and the acquisition of data. SW, PJP, MKS, NW, PAK: substantial contributions to the interpretation of data. KB, DJF: substantial contributions to the conception and design of the work, the acquisition and interpretation of data. All authors revised the work critically for important intellectual content and gave final approval of the version published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PAK has received speaker fees from Heidelberg Engineering, Topcon, Carl Zeiss Meditec, Haag-Streit, Allergan, Novartis and Bayer. He has served on advisory boards for Novartis and Bayer and has been an external consultant for DeepMind and Optos.

    • Patient consent for publication Not required.

    • Ethics approval The Institutional Review Board of the Manchester Royal Eye Hospital, UK has approved this study (R03712).

    • Provenance and peer review Not commissioned; externally peer reviewed.