Recurrent wet AMD is common in previously stable patients who cease anti-VEGF treatment; however, predicting which patients will have a recurrence is challenging, and most of these individuals don’t have symptoms in the early stages of reactivation, new research published online in Ophthalmology Retina suggests.
The investigation enrolled 105 wet AMD patients who previously were on a treat-and-extend regimen of aflibercept injections. All subjects with a dry macula on three consecutive visits, 12 weeks apart, were eligible to participate in the study. Participants were evaluated at baseline and then monitored for disease recurrence at months four, six, eight, 10 and 12 following the last injection.
Researchers found evidence of recurrent wet AMD in 54 out of 102 patients (about 53%) after 12 months of follow-up, and disease recurrence after the last injection occurred at roughly seven months.
Looking at the impact of treatment cessation on visual acuity, BCVA decreased from 71.7 ETDRS letters at baseline to 68.1 letters at recurrence. After treatment was resumed, BCVA increased to 71.4 letters.
Pigment epithelial detachment (PED) may have also played a role in disease reoccurrence. Patients with a PED at baseline had a 74% (14 out of 19) recurrence rate compared to 48% (40 out of 83) in subjects without this finding. Additionally, about 41% (22 out of 54) of the patients with recurrent disease had symptoms of visual loss or metamorphopsia.
Long-term follow-up is important and early detection of recurrent disease can improve the chances for maintained visual function, the investigators concluded.
Aslanis S, Amrén U, Lindberg C, Epstein D. Recurrent neovascular age-related macular degeneration after discontinuation of VEGF inhibitors managed in a treat-and-extend regimen. Ophthalmol Retina. March 25, 2021. [Epub ahead of print].