Long-term remission and incidence of recurrence of neovascularization in intravitreal injection treated exudative age-related macular degeneration.

Purpose: This study evaluates the long-term remission (LTR) rate, recurrence rate, and prognostic factors of extended remission and recurrence in macular neovascularization (MNV) eyes treated with aflibercept.

Methods: This was a retrospective cohort of treatment-naïve MNV eyes treated in Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan with intravitreal aflibercept between 2015 and 2023. Patients followed pro re nata (PRN) or Treat-and-Extend (T&E) protocols. Long-term remission (LTR) was defined as over 6 months of disease inactivity without injection. Binary logistic regression and Cox proportional hazard regression assessed associations with LTR and time to recurrence.

Results: Of 144 eyes, 68.75% achieved LTR after an average of 21.32 months after treatment, with no difference between PRN and T&E groups. Among LTR cases, 69.7% experienced recurrence after a median 15 months (range: 6 ~ 67). Firth multinomial logistic regression found younger age [OR, 0.898 (0.836 to 0.946; p = 0.032)], fewer injections per year [OR, 0 (0.000 to 0.001; p = 0.004)], polypoid choroidal vasculopathy (PCV) [OR, 6.170 (1.811 to 21.039; p = 0.033)], and retinal angiomatous proliferation (RAP) [OR, 24 450.658 (24 450.657 to 24 450.658; p < 0.001)] associated with LTR. Cox regression showed more yearly injections [HR, 7.621(0.376 to 0.972; p = 0.038)] led to earlier recurrence, while baseline subretinal fluid (SRF) [HR, 0.604 (0.376 to 0.972; p = 0.038)] delayed recurrence.

Conclusion: Implementing our exit strategies, 68.75% of eyes achieved LTR across the two injection protocols. Age, disease subtype, baseline anatomical features, and yearly injection numbers may predict sustained remission and a longer time to experience recurrence.