Long-term Outcomes of Neovascular Age-related Macular Degeneration Treated with As Needed Anti-Vascular Endothelial Growth Factor Agents

Abstract

Purpose : Although clinical trials showed that anti-VEGF therapy have greatly improved the visual prognosis of neovascular age-related macular degeneration (wet AMD), most trials are limited to observations over 1 to 2 years. No studies have evaluated patients receiving PRN dosing over time greater than five years. The aim of current study was to present the 5-10 year visual outcomes in wet AMD eyes treated with PRN anti-VEGF agents.

Methods : This single center retrospective study included 34 eyes of 33 patients with neovascular AMD patients receiving PRN intravitreal anti-VEGF treatment and consecutively followed-up for 5-10 years. Eyes with other macular diseases or received any other forms of treatments such as laser, photodynamic therapy, vitrectomy or intravitreal steroids were excluded. A standardized optical coherence tomography and fluorescein angiography guided PRN protocol was followed. Visual acuity was measured with ETDRS charts and recorded at baseline and at each follow-up examination.

Results : The mean follow-up time was 6.3±1.3years (range 5-10 years). The mean number of intravitreal injections was 23.0±13.0 (range 4-52) during the follow-up period. The median visual acuity improved from 65 letters (Snellen 20/50) at baseline to 70 letters (20/40) at the final visit. 83.9% of the study eyes maintained or improved vision during the follow-up period. At the final visit, 52.9% of eyes were 20/40 or better, 32.4% between 20/40 and 20/200 and 14% below 20/200. Better baseline visual acuity was significantly associated with a good visual outcome at the final visit (P<0.001). More recurrences were associated with more vision loss with eyes with 4 or more recurrences having a loss of 15.1 letters versus a loss of 0.3 letters in eyes with 3 or fewer recurrences (P=0.009), which remained significant (P=0.03) after controlling follow-up period.

Conclusions : Good long-term visual outcomes were achieved in eyes with AMD treated with PRN intravitreal anti-VEGF treatments for up to ten years using a standardized protocol and careful imaging. Good baseline visual acuity, and fewer recurrences predicted a better visual outcome at the final visit.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Annual injection frequency for wet AMD treated with PRN anti-VEGF therapy.

 

Mean visual acuity (ETDRS letters) change during the follow-up in eyes with wet AMD treated with PRN anti-VEGF therapy.