Anti-VEGF treatment strategies on three subtypes of neovascular age-related macular degeneration in real-world clinical setting: A multicenter cohort study in Japan

Neovascular age-related macular degeneration (nAMD) is classified into typical AMD (tAMD), polypoidal choroidal vasculopathy (PCV), and retinal angiomatous proliferation (RAP). This study investigated clinical features of the three subtypes and visual outcome associated with real-world treatment regimens in a large cohort of nAMD patients. Retrospective multicenter cohort study Five hundred treatment-naïve nAMD (268 tAMD, 200 PCV, and 32 RAP) patients initiated with anti-VEGF agents and followed for 1 year. Medical records were reviewed to extract demographic data, best corrected visual acuity (BCVA) at baseline and 1 year after treatment initiation, spectral domain-optical coherence tomography (SD-OCT) findings, baseline fellow eye condition, systemic factors, treatment strategies, and number of intravitreal injections in the first year. Primary outcome measures were anti-VEGF treatment strategy (ranibizumab or aflibercept, anti-VEGF regimen, concomitant PDT, drug switch), BCVA at 1 year, and factors associated with VA. RAP patients were significantly older, more common in women, and had more macular lesions in fellow eye than tAMD and PCV patients. Smoking history and diabetes prevalence were not different among three subtypes. Frequencies of subretinal fluid were higher and intraretinal fluid were lower in tAMD and PCV than in RAP, while serous pigment epithelial detachment and subretinal hemorrhage were higher in PCV than in tAMD and RAP. Choice of anti-VEGF agents and treatment regimens did not differ among three subtypes. Aflibercept to ranibizumab ratio was approximately 7:3. Mean number of injections in 1 year was 5.3 ± 2.4 in nAMD overall, which was significantly less in PRN than in TAE regardless of the anti-VEGF agent. BCVA was improved in all three subtypes, although it was not significant in RAP patients. This real-world clinical study demonstrates that treatment regimens were similar in three subtypes and aflibercept was used in 70% of all patients. Approximately 5 injections were given in the first year regardless of the anti-VEGF agent, which was significantly less in PRN regimen than in TAE. VA improvement was yielded after 1-year anti-VEGF therapy in all three subtypes, but was not significant in RAP.