LONG-TERM USE OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Abstract Purpose: While pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD), there is a paucity of clinical data about the long term (>5 years) treatment. Methods: Retrospective analysis of all patients with nAMD who were actively treated, had received >40 anti-VEGF injections, and were followed for ≥5 years. Snellen corrected visual acuity (SCVA), initial drug choice, and times elapsed between treatment were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated. Results: A total of 88 patients (162 eyes) met the inclusion criteria: the average patient was 86.3 years with an average follow up period of 7.6 years. The average total number of injections per eye was 69 (18.0 std dev); a total of 11,208 injections were given throughout the study period and 6 (0.05%) cases of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average SCVA at injections #2,#3, #4, #5, #6, #10 and #20, as compared with baseline (p=0.03, p<0.01, p=0.02, p<0.01, p=0.01, p=0.01, p<0.01, respectively). Patients in the SCVA 20/20-20/40 subgroup maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage. Conclusions: The nAMD cohort herein received on average 8 anti-VEGF injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their VA while eyes with worse SCVA (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endo11phthalmitis was low.