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Single Injection Response to Anti-Vascular Endothelial Growth Factor Agents in Patients with wet Age related Macular Degeneration: Incidence and Characteristics.

PURPOSE
To determine the incidence of complete resolution of choroidal neovascular membrane(CNV) associated exudation with a single anti-vascular endothelial growth factor(anti-VEGF) injection in treatment naïve wet age related macular degeneration(AMD) patients and its associated characteristics.


METHODS
Retrospective, observational study of naïve wet AMD patients who received anti-VEGF therapy with ranibizumab/aflibercept and demonstrated complete resolution of retinal exudation with a single injection. Complete resolution was defined as total disappearance of the intraretinal fluid, cysts and subretinal fluid and a return of retinal thickness to <250 microns on spectral domain optical coherence tomography(SDOCT). All relevant data was collected. Follow up was scheduled on days 1, 7 and 30 postoperatively and then monthly, with at least 9 visits mandatory per year if the macula remained fluid free. Appropriate statistical analyses were performed.


RESULTS
63 patients(29 males; mean age 67.25±4.40 years) were identified. The mean baseline and final corrected distance visual acuity(CDVA) was 20/160 and 20/45 respectively. Patients completed a mean of 10.9 follow-up visits per year. Smaller CNVs(<200 microns), early presentation, better presenting CDVA, sub-foveal CNVs, absence of blood/fibrosis and use of aflibercept(2mg) favoured resolution with one injection.


CONCLUSION
A subset(13.76%; 63/458,95% confidence intervals: 10.73-17.25) of patients with treatment naïve wet AMD demonstrates resolution of CNV associated exudation with a single anti-VEGF injection, sustained over 2 years or more. This can lower therapy costs, treatments, office visits and the potential risk of geographic atrophy.