Abstract
Purpose :
To evaluate the long-term functional and anatomical outcomes of neovascular age-related macular degeneration (nvAMD) eyes treated with intravitreal anti-vascular endothelial growth factors (VEGF) compounds for up to 10 years and to identify associated factors.
Methods :
Retrospective evaluation of consecutive nvAMD naïve eyes initially treated with intravitreal bevacizumab and switched to ranibizumab or aflibercept if required using a treat and extend protocol. Data were collected from the electronic medical records including demographics, clinical, and optical coherence tomography findings. Genotyping for the CFH (rs1061170), HTRA1 (rs1200638), and C3 (rs2230199) major risk single nucleotide polymorphisms for AMD were collected.
Results :
A total of 206 patients (n=276 eyes) commenced anti-VEGF therapy ≥8 years, and 66 (32.0%) patients (n=80 eyes, 29.0%) remained in follow-up ≥8 years and were included in this study. The mean number of anti-VEGF injections (±SD) was 73.3±28.0 over 10 years. Mean best-corrected visual acuity (BCVA) (LogMAR±SD) improved from 0.55±0.53 at baseline to 0.42±0.41 (p<0.0005) at 24 months, but deteriorated to 0.81±0.71 at 8 years (p<0.03) and 1.00±0.73 at 10 years (p<0.0005, compared with baseline). Baseline central point thickness (CPT) and central subfield thickness (CST; microns±SD) were 410.9±208.1 and 415.8±162.1, respectively. Both values decreased to 294.7±135.9 and 323±113.6 (p<0.0005 in each case), respectively, after 3 monthly injections, and remained lower than baseline values until the end of follow-up. BCVA and intraretinal fluid at baseline, macular atrophy and thinning at end of follow-up were associated with the visual outcome after 10 years. Carriers of the CFH and C3 risk alleles had a smaller reduction of CST at follow-up compared with none-carriers. Thinning of CST correlated negatively with the number of CFH/C3 risk alleles borne by a patient. (Pearson rho= -0.246, and -0.608; p=0.040, and 0.003 at 8 and 10 years, respectively).
Conclusions :
nvAMD patients under anti-VEGF therapy for over 10 years encounter a substantial mean vision loss that is influenced by the presence of IRF at baseline and by atrophy rather than re-thickening of the macula at follow-up. Major complement risk alleles for AMD are associated with a lesser reduction in baseline macula thickness in the long-term.
This is a 2021 ARVO Annual Meeting abstract.