Different Clinical Courses on Long-Term Follow-Up of Age-Related Macular Degeneration Patients Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections

Ophthalmologica. 2017;238(4):217-225. doi: 10.1159/000479437. Epub 2017 Sep 20.

Abstract

Purpose: To assess the long-term outcome of neovascular age-related macular degeneration (AMD) treated with multiple intravitreal anti-vascular endothelial growth factor (VEGF) injections.

Methods: All patients treated with over 30 intravitreal anti-VEGF injections for neovascular AMD between 2007 and 2014 were retrospectively reviewed.

Results: A total of 67 eyes received 2,960 (mean 45 ± 9.1 per eye) anti-VEGF injections. Eyes with good final visual acuity (VA) had better initial VA (p = 0.020) and maintained it. Patients with moderate-to-poor final VA improved significantly after the first 3 monthly injections, and thereafter deteriorated consistently, mostly during the third (p = 0.019) and fourth (p = 0.006) years. Eyes with worse final VA had more intraretinal fluid (p = 0.05) and subretinal fibrosis (p = 0.04).

Conclusion: Two distinct clinical courses were identified: good final VA was associated with initial and long-term stability of good VA; eyes with worse final VA had worse initial VA, progressive deterioration following the initial improvement, and more scarring and intraretinal fluid. This probably underscores the long-term benefits of early detection and treatment.

Keywords: Age-related macular degeneration; Anti-vascular endothelial growth factor; Bevacizumab; Long-term follow-up.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage
  • Bevacizumab / administration & dosage*
  • Female
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Ranibizumab / administration & dosage*
  • Retrospective Studies
  • Time Factors
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Visual Acuity*
  • Wet Macular Degeneration / diagnosis
  • Wet Macular Degeneration / drug therapy*

Substances

  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A
  • Bevacizumab
  • Ranibizumab