July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Anatomical outcomes of patients receiving 50 or more intravitreal anti-VEGF injections for neovascular age-related macular degeneration
Author Affiliations & Notes
  • Cristina Arpa
    Moorfields Eye Hospital London, Cabiate, CO, Italy
    Eye Unit, IRCCS Policlinico San Matteo, Pavia, Italy
  • Gabriella Moraes
    Moorfields Eye Hospital London, Cabiate, CO, Italy
  • Katrin Fasler
    Moorfields Eye Hospital London, Cabiate, CO, Italy
    Department of Ophthalmology, University Hospital, Zurich, Switzerland
  • Dun Jack Fu
    Moorfields Eye Hospital London, Cabiate, CO, Italy
  • Siegfried Karl Wagner
    Moorfields Eye Hospital London, Cabiate, CO, Italy
  • Konstantinos Balaskas
    Moorfields Eye Hospital London, Cabiate, CO, Italy
  • Pearse Andrew Keane
    Moorfields Eye Hospital London, Cabiate, CO, Italy
  • Footnotes
    Commercial Relationships   Cristina Arpa, None; Gabriella Moraes, None; Katrin Fasler, Alfred Vot Stipendium (F), Google Deepmind (C), Novartis (C), Schweizerischer Fonds zur Verhutung und Bekampfung der Blindheit (F); Dun Jack Fu, None; Siegfried Wagner, None; Konstantinos Balaskas, Alimera (F), Allergan (F), Bayer (F), Heidelberg (F), Novartis (F), Topcon (F); Pearse Keane, Allergan (F), Bayer (F), Carl Zeiss Meditec (F), Deepmind (C), Haag-Streit (F), Heidelberg Engineering (F), Novartis (F), Optos (C), Topcon (F)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 116. doi:
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      Cristina Arpa, Gabriella Moraes, Katrin Fasler, Dun Jack Fu, Siegfried Karl Wagner, Konstantinos Balaskas, Pearse Andrew Keane; Anatomical outcomes of patients receiving 50 or more intravitreal anti-VEGF injections for neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2019;60(9):116.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The aim of this study was to analyze optical coherence tomography (OCT) scans of patients receiving long-term anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD) by comparing anatomical features at start of treatment to the time of their 50thinjection.

Methods : This is a retrospective cohort study with data extracted from the Moorfields Eye Hospital Electronic Medical Record system with inclusion criteria being eyes receiving ≥ 50 injections for choroidal neovascularization secondary to nAMD between 2008-2017. Either ranibizumab or aflibercept was used as anti-VEGF therapy. Both baseline and the 50thinjection OCT were analyzed. Morphometric analysis was performed manually to obtain central retinal thickness (CRT), measured from inner retinal surface to Bruch’s membrane. Comparative analyses of paired, non-parametric data and categorical data were carried out with Wilcoxon Signed Rank test and Chi-squared proportional testing, respectively. Distribution of data was tested for normality using the Shapiro-Wilk test and level of statistical significance set at 0.05.

Results : One-hundred eyes had ≥ 50 anti-VEGF injections. Of these, 33% had central intraretinal fluid (IRF) and 75% had central subretinal fluid (SRF) at presentation. At the 50thinjection, these values decreased to 27% (p-value 0.396) and 42% (p<0.001), respectively. Both drusen (88% at both time points) and pigment epithelial detachment (PED) (88% at baseline and 87% at 50thinjection) persisted in the majority of eyes. Ill-defined subretinal hyperreflective material (SHRM) was detected in 20% of the eyes at baseline and 3% at 50thinjections (p-value 0.002). In contrast, well-defined SHRM was detected in 7 and 6 eyes at the two time points, respectively. Presence of vitreomacular adhesion causing central deformation was similar at presentation and at 50th injections, while epiretinal membrane increased from 3% to 8% of eyes. Mean CRT decreased from 372.2±220.68μm (standard deviation) at baseline to 283.96±154.6μm at 50thinjections (p<0.001).

Conclusions : Characterizing long-term morphological sequelae is crucial to understand treatment efficacy and response. Repeated anti-VEGF injections for nAMD induces significant reduction in SRF and overall central retinal thickness. IRF and PED were comparable at baseline and at the 50thinjection.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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