J Korean Ophthalmol Soc.  2018 Dec;59(12):1142-1151. 10.3341/jkos.2018.59.12.1142.

Intravitreal Anti-vascular Endothelial Growth Factor Injections to Treat Neovascular Age-related Macular Degeneration: Long-term Treatment Outcomes

Affiliations
  • 1Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ophthalmo@amc.seoul.kr

Abstract

PURPOSE
We assessed the visual and anatomical outcomes, and the safety profile of long-term intravitreal anti-vascular endothelial growth factor (VEGF) injections (aflibercept, ranibizumab, and bevacizumab) given to treat neovascular age-related macular degeneration (NAMD).
METHODS
We analyzed medical records collected over 7 years of treatment-naive NAMD patients who received outpatient clinic-based intravitreal anti-VEGF injections. All were treated employing either "treat-and-extend" or "as needed" protocols at the discretion of the retinal specialist. The number of injections, adverse events associated with injection, and measures of visual acuity (VA), central foveal thickness (CFT), and intraocular pressure (IOP) were recorded.
RESULTS
Overall, we assessed 196 eyes of 196 patients (average age 68.6 ± 9.6 years; 77 females). Patients received an average of 17.3 ± 13.5 injections over 78.0 ± 16.5 months of clinical follow-up. The initial mean VA (logMAR) was 0.75 ± 0.58 and the CFT was 349.7 ± 152.6 µm. Both parameters exhibited maximal improvements at the 6-month visit (p < 0.05). However, the clinical outcomes worsened over the 7-year clinical course; the best-corrected visual acuity (BCVA) was 0.91 ± 0.78 and the CFT was 284.5 ± 105.8 µm at 7 years. The BCVA at 7 years was significantly correlated with the initial BCVA. IOP-related events increased 11-fold and anterior chamber reactions increased 3-fold over the years, but no significant complications such as endophthalmitis were recorded.
CONCLUSIONS
The use of intravitreal anti-VEGF agents was associated with initial visual improvements over 6 months but did not prevent the worsening of NAMD over 5 years. The BCVA at the initial visit was a strong predictor of the final BCVA. A more intensive injection schedule might improve long-term outcomes.

Keyword

Age-related macular degeneration; Anti-vascular endothelial growth factor; Choroidal neovascularization

MeSH Terms

Anterior Chamber
Appointments and Schedules
Choroidal Neovascularization
Endophthalmitis
Endothelial Growth Factors*
Follow-Up Studies
Humans
Intraocular Pressure
Macular Degeneration*
Medical Records
Outpatients
Ranibizumab
Retinaldehyde
Specialization
Visual Acuity
Endothelial Growth Factors
Ranibizumab
Retinaldehyde

Figure

  • Figure 1 Temporal changes in the best-corrected visual acuity (BCVA). (A) Temporal change of mean BCVA over 7 years (in ETDRS letters; Snellen visual acuity scores were converted to ETDRS letter scores). (B) Temporal change of mean BCVA over 7 years (in ETDRS letter; converted in same manner as above graph) after imputation of missing values by the last-observation-carried-forward method (n = 37). ETDRS = early treatment diabetic retinopathy study; n = number of patients at the time of BCVA measurements.

  • Figure 2 Temporal change in central foveal thickness. The central foveal thickness improved gradually during the first 6 months, and maintained over 5 years.

  • Figure 3 Visual outcome (A), anatomical outcome (B) for different CNV subtypes in the subgroup of 65 patients who completed the 7-year follow-up. Occult CNV (n = 45), classic CNV (n = 5), PCV (n = 15). There was no significant difference between groups during follow-up periods (repeated measured ANOVA). Mean visual acuity and central foveal thickness of each group decreased over time and stabilized. CNV = choroidal neovascularization; PCV = polypoidal choroidal vasculopathy; BCVA = best-corrected visual acuity; n = number of eyes with CNV subtype; ANOVA = analysis of variance.


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