Incidence and risk factors of retreatment after three-monthly aflibercept therapy for exudative age-related macular degeneration

Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. In the present study, we studied 140 treatment naive eyes with typical neovascular AMD (n = 71) or polypoidal choroidal vasculopathy (PCV) (n = 69) and investigated the incidence and risk factors of retreatment after 3-monthly intravitreal aflibercept injection for exudative AMD during the 12-month period. At 12 months, best-corrected visual acuity (BCVA) improved significantly from 0.45 +/- 0.39 to 0.26 +/- 0.33 (P = 4.1 x 10(-11)). Multiple regression analysis revealed that better baseline BCVA (P = 3.6 x 10(-14)) and thicker subfoveal choroidal thickness (P = 0.039) were associated with better BCVA at 12-months. Retreatment was required in 94 out of 140 (67.1%) eyes. Multivariate logistic regression analysis revealed that older age (P = 7.2 x 10(-3)) and T-allele of ARMS2 A69S (rs10490924) variants (P = 1.9 x 10(-3)) were associated with retreatment. Cox-regression analysis revealed that older age (P = 1.0 x 10(-2)) and T-allele of the ARMS2 gene (P = 6.0 x 10(-3)) were associated with retreatment-free period. The number of retreatment episodes was significantly different among the ARMS2 genotypes (P = 8.1 x 10(-4)). These findings might be helpful for physicians when considering the optimal treatment regimen for exudative AMD.