The effects of treatment regimen on the initial management of macular neovascularization subtypes in age-related macular degeneration

OBJECTIVE: To evaluate the effect of initial treatment regimen individualization, (Pro Re nata (PRN) or Treat-and-Extend (TAE)), according to macular neovascularization (MNV) subtype, on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective is to compare the treatment burden between each MNV subtypes.METHODS: Consecutive treatment-naive nAMD patients were retrospectively included. MNV subtype was graded by 2 independent blinded investigators on multimodal imaging. Functional and anatomical outcomes were analysed according to treatment regimen and MNV subtypes.RESULTS: A total of 281 eyes from 243 patients were included in the study. According to the treatment regimen, there was no significant difference in best-corrected visual acuity gain within the 2 first year of treatment for type 1 (p=0.106) and type 3 MNV (p=0.704). Conversely, there was a significant difference in favour of TAE regimen for type 2 (p=0.017) and type 4 MNV (p=0.047). Type 1 MNV had a higher proportion of visits with subretinal fluid (p=0.0007), but not with intraretinal fluid (p=0.22). The mean interval between the last 2 injections was significantly shorter for type 1 MNV (p=0.0045).CONCLUSION: The individualization of the initial treatment protocol according to MNV subtype can improve the functional outcome and may decrease the treatment burden.

Automated summary

The study evaluates the effect of individualizing initial treatment protocol according to macular neovascularization (MNV) subtype on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective is to compare the treatment burden between each MNV subtypes. Results show that individualizing treatment regimen based on MNV subtype can improve the functional outcome and decrease the treatment burden.