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Factors associated with extended remission in neovascular age-related macular degeneration on pro re nata treatment protocol
  1. Tiezhu Lin1,2,
  2. Kunny C Dans1,
  3. Ilkay Kilic Muftuoglu1,3,
  4. Amit Meshi1,4,
  5. Manuel J Amador-Patarroyo1,5,
  6. Lingyun Cheng1,
  7. William R Freeman1
  1. 1Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, California, USA
  2. 2Ophthalmology, He Eye Hospital, He University, Shenyang, China
  3. 3Ophthalmology, Istanbul Training and Research Hospital, Istanbul, Turkey
  4. 4Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
  5. 5Ophthalmology, Escuela Superior de Oftalmologia, Instituto Barraquer de America, Bogota, Colombia
  1. Correspondence to Dr William R Freeman, Ophthalmology, Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA 92093, USA; wrfreeman{at}


Aim To show the characteristics and outcomes of patients with neovascular age-related macular degeneration (nAMD) who had extended remission (ER) while on a pro re nata (PRN) treatment protocol.

Methods This was a retrospective case–control study of a consecutive series of patients with nAMD treated with a PRN antivascular endothelial growth factor (anti-VEGF) drug regimen. ER was defined as the absence of haemorrhage, intraretinal/subretinal fluid on optical coherence tomography and leakage on fluorescein angiography for 52 weeks after cessation of anti-VEGF therapy. Matching patients with nAMD who did not achieve ER were included as control group. Cox regression analysis was fitted to identify predictors of time to achieve ER and time to recurrence. A logistic regression analysis of baseline characteristics was used to identify predictors of achieving ER.

Results Of 830 eyes treated with anti-VEGF monotherapy, 77 (9.2%) eyes achieved ER during a median follow-up of 236 weeks (range 70–525 weeks). Cox regression analysis showed that ER was achieved earlier in eyes with isolated intraretinal fluid (HR, 2.05; 95% CI 1.929 to 4.520; p=0.045) at presentation. Logistic regression analysis showed that type 3 choroidal neovascularisation (OR, 0.090; 95% CI 0.021 to 0.382; p=0.001), thinner choroid (OR, 0.993; 95% CI 0.988 to 0.998; p=0.004) and absence of macular atrophy (OR, 0.233; 95% CI 0.065 to 0.839; p=0.026) at baseline increased the likelihood of achieving ER.

Conclusion ER is achievable in 9.2% of patients under PRN therapy for nAMD. At presentation with nAMD, anatomical features on retinal imaging may predict the likelihood of achieving ER and a shorter time to achieve ER.

  • retina
  • neovascularisation
  • macula
  • imaging
  • treatment medical

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  • Contributors TL and WRF conceived of the presented idea. TL, KCD, AM and MJA-P acquired the data. KCD, IKM and LC performed the computations. LC and WRF verified the analytical methods. TL, KCD and IKM drafted the manuscript.

  • Funding The study was supported in part by a UCSD Vision Research Center Core Grant P30EY022589, an unrestricted fund from Research to Prevent Blindness, New York (WRF). The funding organisation had no role in the design or conduct of this research.

  • Disclaimer None of the authors are consultants for any of the companies that manufacture and distribute anti-VEGF drugs. The institution has received funding to conduct trials of anti-VEGF drugs and the conflicts are managed through UCSD company policy.

  • Competing interests None declared.

  • Ethics approval UCSD Institutional Review Board approval was acquired for the review and analysis of patient data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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