Purchase this article with an account.
Thomas Wecker, Christoph Ehlken, Anima Buehler, Clemens Lange, Hansjürgen Agostini, Daniel Boehringer, Andreas Stahl; Anti-VEGF injection patterns and five year functional outcomes in patients with choroidal neovascularization or macular edema. Invest. Ophthalmol. Vis. Sci. 2016;57(12):546.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The introduction of anti-VEGF (vascular endothelial growth factor) revolutionized the treatment of patients with exsudative age-related macular degeneration (AMD), diabetic macular edema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularisation (CNV). The need for repeated intravitreal injections, however, still poses a major challenge for patients, physicians and health-care providers. In this monocentric retrospective study we analyzed long-term injection patterns and associated best-corrected visual acuity (BCVA) changes for up to five years of treatment.
After Ethics Board approval we analzyed all patients with AMD, DME, RVO or myopic CNV who were treated at our hospital between 2009 and 2014 and had at least one year of follow-up data available. All patients were treated using pro-re-nata (PRN) regimens. In total, 2,536 eyes of 2,034 patients (863 male and 1,171 female, mean age: 73.9 ± 11.7 years) qualified for analysis. AMD accounted for 1,661 eyes, DME for 479, RVO for 351 and myopic CNV for 45 eyes. The total number of injections for all eyes was 33,187. BCVA (extracted from medical reports) was available for 2,069 eyes from 1,682 patients. Outcome measures were change of BCVA, injection frequencies and cumulative injections over time. Statistical assessment was performed using Spearman’s correlation.
In year one, AMD patients received a median of 6 injections per eye (4-9, quartiles), 6 (3-9) for DME, 5 (3-8) for myopic CNV and 6 (3-8) for RVO. During the following years, median injection frequencies declined for all indications resulting in 3 (0.3 – 5.0) for AMD, 1.75 (0-4) for DME, 1 (0-3) for myopic CNV and 2 (0-4.8) for RVO. Proportion of patients gaining more than 15 letters was highest in RVO (30.2%). AMD patients, in contrast, showed the highest proportion of patients with more than 15 letters loss (25.3%). In all groups, between 75 and 83 % of patients remained either stable or gained vision.
Our real world VA data differ from the one- and two-year data reported from clinical trials, emphasizing the fact that (especially in AMD) initial VA gain cannot always be maintained long-term. Furthermore, this study provides information on expected treatment duration, injection frequencies and cumulative injection numbers that may be useful for counseling patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only