Long-term visual and anatomical outcomes in treatment naïve neovascular age-related macular degeneration (nAMD) patients treated with anti-VEGF agents

Abstract

Purpose : To assess long-term visual and anatomic outcomes in treatment naïve nAMD patients treated with intravitreal injections of anti-VEGF agents.

Methods : Screening of nAMD patients seen by a co-author between January and December 2014 identified 274 eyes of 233 patients with ≥6 month follow up; out of which 136 eyes of 120 patients had subfoveal (SF) choroidal neovascularization (CNV) treated with injections of an anti-VEGF agent. Eyes with geographic atrophy, subretinal (SR) fibrosis, and large SR hemorrhage were excluded.

Results : Mean follow-up duration was 3.6±0.3 (0.6 to 5.4) years. Baseline visual acuity (VA) was ≥20/40, 20/50-20/160, or ≤20/200 in 51.5%, 43.4%, 5.1% patients. The percentage of patients with final VA ≥20/40, 20/50-20/160, or ≤20/200 was 64.0, 26.5, 9.5. Change from baseline VA at final visit was a gain ≥6, ≥3, ≥2, ≥1 lines in 1 (0.7%), 21 (15.4%), 39 (28.7%), 58 (42.6%), no change in 31 (22.8%), and loss of ≥1, ≥2, ≥3, ≥6 lines in 47 (34.6%), 25 (18.4%), 19 (14.0%), 12 (8.8%) patients. Mean baseline and final central subfield thickness (CST) was 321.0±6.8µm and 251.1±6.8µm respectively, with a mean decrease of -69.9±7.5µm at final visit. The rate of anti-VEGF injections per year was 5.7±0.3. Final VA was significantly correlated with baseline VA (r=0.559, p<0.001), rate of injection per year (r=0.219, p<0.01), and change in CST (r=0.221, p<0.01).

At final visit, 26.5% eyes had intraretinal (IR) fluid, 27.9% had SR fluid and 12.5% had both IR and SR fluid. Seven (5.1%) eyes had outer retinal tubulations. Height of pigment epithelial detachment increased in 34.6% and decreased in 44.9% at final visit. Four (0.3%) eyes had non-fibrotic SR hyper-reflective material in the fovea, 10 (7.4%) eyes had SF fibrosis, and 22 (16.2%) eyes had SF atrophy at final visit. Atrophy at final visit was negatively correlated with rate of anti-VEGF injections per year (r= -0.190, p=0.027). A significant correlation was noted between baseline VA with atrophy (r= -0.194, p=0.023) and SR fibrosis (r= -0.235, p=0.006) at final visit.

Conclusions : In nAMD patients, long-term frequent anti-VEGF injections provide good visual and anatomic outcomes. There is an association of good outcomes with better baseline VA, higher change in CST, and higher rate of anti-VEGF injections per year where fewer patients receiving frequent anti-VEGF developed atrophy.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.