Abstract
Purpose :
Patients with neovascular AMD often require high treatment burden with first-line management using anti-VEGF injections. Lesions primarily located away from the central macula may be amenable to initial treatment with injections, reducing lesion size, followed by thermal laser destruction to maintain control of the disease with a reduced injection burden.
Methods :
A retrospective electronic chart review was conducted on a series of 27 patients who had choroidal neovascularization (CNV) related to wet AMD and were treated initially with anti-VEGF injections and subsequently with thermal laser treatment. Demographics, lesion characteristics, clinical course, and outcomes were recorded. Patients were treated with laser if the lesions were relatively small in size and favorably positioned to minimize short-term and long-term risk of vision loss related to treatment.
Results :
Chart review assembled 27 patients who were treated with anti-VEGF injections followed by thermal laser (24 peripapillary, 3 extrafoveal). 74% of patients had ceased injections following laser treatment at patient’s last follow-up. Mean age was 80 years old (range 63-94). Average time without treatment following laser was 25.26 months (range 3-53 months): 4 patients had recurrent CNV and 3 developed new CNV during follow-up period. 89% of patients had stable or improved visual acuity. 3 patients had improved vision (gain of 2 lines or more), 20 had stable vision (VA within 1 line +/- of baseline acuity), 3 patients had worsened vision (vision loss of 2 lines or greater: 2 GA, 1 new CNV). No patients had reduced acuity due to laser. 33% (9 patients) had fovea involving disease of the fellow eye with reduced vision or need for anti-VEGF injections.
Conclusions :
Carefully selected patients with appropriate lesion size and location may benefit from anti-VEGF treatment followed by thermal laser photocoagulation with a high percentage of patients maintaining vision without need for continued injections. A substantial number of patients can experience recurrent or new CNV and many have significant bilateral disease.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.