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Twenty-four-month outcomes of inflammatory choroidal neovascularisation treated with intravitreal anti-vascular endothelial growth factors: a comparison between two treatment regimens
  1. Alessandro Invernizzi1,2,
  2. Francesco Pichi3,4,
  3. Richard Symes2,5,
  4. Sophia Zagora2,5,
  5. Aniruddha Kishandutt Agarwal6,
  6. Phuc Nguyen2,
  7. Stefano Erba1,
  8. Alba Xhepa1,
  9. Luca De Simone7,
  10. Luca Cimino7,
  11. Mark C Gillies2,
  12. Peter J McCluskey2,5
  1. 1 Eye Clinic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
  2. 2 Save Sight Institute, The University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia
  3. 3 Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
  4. 4 Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, United States
  5. 5 Sydney Eye Hospital, Sydney, New South Wales, Australia
  6. 6 Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  7. 7 Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
  1. Correspondence to Dr Alessandro Invernizzi, Eye Clinic, Department of Clinical Science, Luigi Sacco Hospital, University of Milan, Milan 20157, Italy; alessandro.invernizzi{at}gmail.com

Abstract

Background and aim There is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV.

Methods Eyes with iCNV treated with anti-VEGF injections were divided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups.

Results Eighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 72.3 (15.8) letters in the LOADING vs 75.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p<0.001). At 24 months, there was no difference in VA between the LOADING and PRN group (87.8 (13.8) vs 90.3 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1–Q3)) than the PRN (4.5 (3–7) vs 2.5 (2–3.2), p<0.0001). The iCNV recurrences were similar in both groups.

Conclusions iCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment.

  • retina
  • neovascularisation
  • inflammation
  • drugs
  • anti-VEGF
  • treatment
  • inflammatory choroidal neovascularization
  • uveitis
  • CNV
  • regimen
  • bevacizumab
  • ranibizumab
  • aflibercept
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Footnotes

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  • Contributors AI and PJM were involved in the conception and design of the study. AI, FP, RS, SZ, AKA, SE, AX, LDS and LC were involved in the data collection. AI, MCG, PN and PJM were involved in the analysis and interpretation of the data. AI wrote the first draft of the manuscript. All authors were involved in the critical revision and final approval of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AI: Allergan (financial support), Novartis (consultant), Bayer (consultant). FP: Zeiss (consultant), Bayer (speaker), Novartis (speaker), Allergan (consultant), AbbVie (consultant). LC: Abbvie Code C (consultant), Santen Code C (consultant). MCG: Novartis (consultant), Bayer (recipient), Ophtea (consultant), Novartis (recipient), Allergan (consultant), Allergan (recipient), Bayer (consultant), Ophtea (recipient). PJM: AbbVie (financial support), AbbVie (consultant), AbbVie (recipient), Allergan (financial support), Allergan (consultant), Allergan (recipient), Shire (consultant), Shire (recipient), Zeiss (financial support).

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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