Risk for Choroidal Neovascularization in the Fellow Eye of Patients on Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration

Abstract

Purpose: : The presence of choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) is a known risk factor for the development of CNV in the fellow eye. Recent studies suggest that a small amount of systemic uptake after intraocular injection of anti-VEGF medication may have a therapeutic effect on the fellow eye. ¹ The aim, of this study was to assess the risk of developing CNV in the fellow eye of patients treated with intravitreal anti-VEGF for neovascular AMD.

Methods: : 1092 charts of patients treated with intravitreal ranibizumab or bevacizumab (Genentech Inc., CA) for neovascular AMD were reviewed. Patients with unilateral neovascular disease were selected. Visual acuity as well as lesion characteristics on fluorescein angiography, color fundus photography and optical coherence tomography (OCT) were evaluated at baseline and follow-up examinations. Cumulative risk analysis was performed using Kaplan-Meier survival statistics; associated risk factors were analyzed using a chi-square test.

Results: : 222 patients (82 male, 140 female; mean age = 80 years) were included in this study. The mean follow-up time was 11.43 months (range = 1 - 29). Patients received an average of 5.82 injections (range = 1-17) of anti-VEGF medication. The cumulative risk of developing CNV in the fellow eye was 4.8% at 12 months and 11.5% at 24 months. Patients were more likely to develop CNV if the fellow eye had additional risk factors such as soft indistinct drusen and/or pigment hyperplasia. The neovascular subtype and lesion composition in the treated eye did not reach statistical significance as independent risk factors.

Keywords: age-related macular degeneration • choroid: neovascularization • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials