Two-year treatment outcomes after anti-vascular endothelial growth factor therapy for retinal angiomatous proliferation

Background Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration associated with a high risk of macular atrophy (MA) during anti-vascular endothelial growth factor (anti-VEGF) treatment. Previous studies have suggested that a greater injection burden is associated with a higher MA risk. We evaluated the 2-year outcomes of patients with RAP following the treat and extend (TAE) and pro re nata (PRN) regimens and identified the risk factors of MA. Subjects: This retrospective study included 97 eyes of 68 treatment-naïve patients with RAP. They received anti-VEGF injections every month for 3 months during the loading phase and were followed up for more than 2 years. Outcomes included best-corrected visual acuity (BCVA) and central macular thickness (CMT). Group comparisons were performed between TAE and PRN. Risk factors for new-onset MA were assessed using multivariable logistic regression with forward–backward stepwise selection. Results Compared with PRN, TAE achieved better BCVA and CMT at 12 and 24 months. The number of anti-VEGF injections was significantly higher for the TAE group (P < 0.01). In multivariable models, greater injection number and thinner baseline central choroidal thickness were associated with incident MA (P < 0.05), whereas regimen type itself was not. Conclusions Despite a higher injection burden, TAE maintained superior functional and anatomical outcomes over two years relative to PRN. The increased number of injections should not discourage clinicians from using the TAE regimen.