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Karsten Ulrich Kortuem, Thushanthi Ramakrishnan, Katrin Fasler, Reena Chopra, NIKOLAS PONTIKOS, Siegfried Wagner, Laxmi Raja, Hasaneen Al Janabi, Farid Afshar, Ella Preston, Praveen Patel, Adnan Tufail, Konstantinos Balaskas, Pearse Keane; Visual outcomes after 50 or more intravitreal anti-VEGF injections for neovascular age-related macular degeneration at a large tertiary ophthalmic hospital. Invest. Ophthalmol. Vis. Sci. 2018;59(9):838. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
After approval of intravitreal ranibizumab as first Anti-VEGF drug for neovascular AMD (nAMD) already in 2006, an increasing number of patients have received more than 50 injections per eye. While the benefits of anti-VEGF agents are well-reported, the long-term implications of repeated injections are unknown. In many countries, funding of Anti-VEGF drugs for intravitreal delivery remains a challenge due to costs. We report on the demographics, presenting features, and visual outcomes of patients, who have undergone more than 50 injections for nAMD at an UK tertiary ophthalmic hospital.
The Moorfields Eye Hospital Electronic Medical Record system was queried for patients who had received 50 or more intravitreal injections to the same eye due to a choroidal neovascularization secondary to nAMD between 2007-2017. Patients were treated with either aflibercept or ranibizumab, depending on the standard of care when injection happened. Visual acuity was recorded in ETDRS format. Data was manually checked to populate missing visual acuities. Statistical analysis was carried out using SPSS version 23.
One-hundred and eight eyes of 77 patients (66.2% female) with a mean baseline age (SD) of 77 (±7.4) years had 50 or more anti-VEGF injections. The mean maximal (SD) injection number was 60 (±7). Mean (SD) follow-up time was 7.4 (±1) years and mean time (SD) to injection number 50 was 6.2 years (±0.8). Of the eyes included, 1 (1%) patient had received over 50 ranibizumab injections, and 107 (99%) had switched from ranibizumab to aflibercept and had received 50 or more injections in total . Fifty-five (71.4%) patients were White, 8 (10.4%) were Asian, 1 (1.3%) was Chinese, and 13 (16.9%) were mixed/other or unknown. Mean (SD) baseline visual acuity was 61.4 (±12) letters. Mean (SD) visual acuity after 50 injections was 62.7 (±16) letters.
Of those patients, who received more than 50 Anti-VEGF injections due to nAMD, VA after more than 50 injections was on average still more than one letter better than on baseline VA. It shows, that a long-term Anti-VEGF treatment is possible and leads to stabilization of VA over a long period. Higher VA value correlate with higher quality of life and less depression. However, funding, especially in emerging countries, remains a challenge as costs for these intensive treatments are high.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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