Abstract
Purpose :
To determine outcomes of eyes with neovascular age-related macular degeneration (nAMD) lost to follow-up (LTFU) after intravitreal injection with anti-vascular endothelial growth factor (anti-VEGF).
Methods :
Retrospective study of eyes that received intravitreal bevacizumab, ranibizumab, and aflibercept for nAMD and were LTFU for >6 months. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) measurements and OCT paramaters such as presence of subretinal fluid, intraretinal fluid, and central foveal thickness were taken at the visit before LTFU, return visit, and final visit.
Results :
Ninety-three eyes were included in the analysis. Mean duration from date of LTFU to return visit was 346 (±122) days. There was a significant change in the median LogMAR VA from 0.60 [0.40-2.00] at the visit before LTFU, to 1.00 [0.48-2.00] at the return visit (p<0.001), and to 1.00 [0.54-2.00] at the final visit (p<0.001). There was a significantly greater worsening in mean logMAR VA in eyes that received bevacizumab and eyes that received ranibizumab compared to aflibercept at the final visit, (0.32 vs 0.003 p=0.04) and (0.28 vs 0.003 p=0.03), respectively. There was no significant difference in initial logMAR VA by anti-VEGF agent, no significant difference in mean number of injections after return from LTFU, and no significant difference in mean number of days between return from LTFU and final visit, among the three agents. There was a significant increase in mean CFT from 201 (±106) µm the visit before LTFU to 240 (±183) at the return visit (P=0.004). However, there was no significant difference between the mean CFT at the visit before LTFU and the final visit [183 (±101)] (p=0.16). There was no significant difference in the number of eyes with intraretinal fluid when comparing eyes that received either bevacizumab or ranibizumab to aflibercept at the visit before LTFU (p=0.48, p=0.29), the return visit (p=0.053, p=0.08) and the final visit (p=0.61, p=0.23).
Conclusions :
Eyes with nAMD receiving intravitreal anti-VEGF that were LTFU experience significant VA decline at the return visit that persists on final follow-up. Among the three agents evaluated, aflibercept had the least worsening of visual acuity when a patient is lost to follow-up.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.