Abstract
Purpose :
Quarterly dosing with intravitreal anti-vascular endothelial growth factor (VEGF) injections (QD) is a common approach to managing eyes with neovascular age related macular degeneration (nAMD). Prospective treat-and-extend trials report that 22-40% of patients achieve an interval of >10 weeks between retreatments. The current study retrospectively evaluated outcomes of QD for nAMD.
Methods :
Records of 6,809 nAMD patients receiving injections from 2005 through 2017 within a large, urban retina practice were reviewed to identify those who received ≥5 consecutive injections intentionally at intervals of 11 to 15 weeks, defined as QD. Documented reason(s) for transition to and from QD were collected along with visual acuity (VA) in Snellen fractions at date of nAMD diagnosis, initiation and termination of QD, and final visit. VA was converted to approximate Early Treatment Diabetic Retinopathy Study (ETDRS) letter equivalent, and changes in VA were analyzed using Student’s T-tests and ANOVA.
Results :
162 eyes from 145 patients received a mean 9.8 injections (range 5-29) over a mean of 29 months (range 12-98) during QD. Mean VA increased from nAMD diagnosis to initiation of QD (51 to 55 letters), then decreased to final visit or termination of QD (55 to 51 letters), with no significant change in VA from diagnosis to final visit or termination of QD (p=0.03). 99 (61%) eyes were maintained on QD through the final visit, while 63 (39%) stopped receiving QD and were either treated more frequently (41 eyes, 65%) most commonly due to increased exudative disease activity, or intentionally stopped receiving treatment (22 eyes, 35%) most commonly due to apparent disease inactivity. Of the 22 eyes observed following QD for a mean of 30 months of follow-up, 8 (36%) eyes had recurrent exudative activity after a mean of 23 months (range 6-58) and were re-initiated on anti-VEGF treatment following a mean 8-letter loss relative to VA at the time of QD termination (p=0.03).
Conclusions :
In the current, real-world analysis of QD for 162 eyes with nAMD, 39% of patients stopped receiving QD, most (65%) transitioned to more frequent dosing due to increased exudative disease activity. While 22 stopped QD due to disease inactivity, 36% of these re-initiated anti-VEGF dosing due to eventual recurrent disease activity. Patients managed with quarterly anti-VEGF intravitreal treatments require consistent long-term clinical care.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.