Two-year treatment outcomes in neovascular age-related macular degeneration with type 3 macular neovascularisation.

BACKGROUND

Neovascular age-related macular degeneration (nAMD) with type 3 macular neovascularisation (MNV) carries a high risk of macular atrophy (MA) during anti-vascular endothelial growth factor (anti-VEGF) treatment. Previous studies have suggested that a greater injection burden is associated with a higher MA risk. We evaluated 2-year outcomes of patients with nAMD with type 3 MNV following the treat and extend (TAE) and pro re nata (PRN) regimens and identified the risk factors for MA.

SUBJECTS: This retrospective study included 97 eyes of 68 treatment-naïve nAMD patients with type 3 MNV. All eyes received monthly anti-VEGF injections for 3 months as a loading phase and were followed for >2 years. Analyses were performed at the eye level for clinical outcomes; for risk-factor analyses of incident MA, one eye per patient was included. Outcomes included best-corrected visual acuity (BCVA) and central macular thickness (CMT).

RESULTS

Compared with PRN, TAE achieved better BCVA at 24 months (mean difference, -0.26 logMAR; 95% CI, -0.50 to -0.02). CMT was lower with TAE at 12 months (mean difference, -47.0 µm; 95% CI, -86.1 to -8.0). Retinal haemorrhage recurrence was less frequent with TAE (16.4% vs. 52.4%; risk difference, -36.0%; 95% CI, -57.8% to -9.5%). In multivariable models, greater injection number and thinner baseline central choroidal thickness were associated with incident MA (P < 0.05), whereas regimen type itself was not.

CONCLUSIONS

Despite a higher injection burden, TAE maintained superior functional outcomes over two years relative to PRN.