The fate of eyes with wet AMD beyond four years of anti-VEGF therapy.

Garweg, Justus G.; Zirpel, Johanna J; Gerhardt, Christin; Pfister, Isabel B (2018). The fate of eyes with wet AMD beyond four years of anti-VEGF therapy. Graefe's archive for clinical and experimental ophthalmology, 256(4), pp. 823-831. Springer 10.1007/s00417-018-3907-y

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PURPOSE

Real-life studies on long-term functional outcome of anti-VEGF treatment for wet age-related macular degeneration (wAMD) are limited. We therefore assessed the 10-year outcomes in our patients.

METHODS

In this retrospective study, all patients with newly diagnosed wAMD that had received minimally three intravitreal injections between 2007 and 2012 and a follow-up of ≥48 months were included. Primary outcome measure was the evolution of best-corrected visual acuity (BCVA) over time. For qualitative, quantitative and longitudinal data, Pearson's chi test, the Mann-Whitney U-test and Wilcoxon's signed-rank test were applied at a significance level of p < 0.05.

RESULTS

Of 267 eyes (219 patients) with newly diagnosed wAMD treated during this period, 104 eyes (104 patients) had been followed for at least 48 months and were included. Fifty-nine eyes (57.8%) after 7 years were still under active treatment, 29 eyes (25.0%) had interrupted treatment [mean follow-up 7.5 years (4.0-10.1; SD 1.6)], whereas 16 patients had died. BCVA stabilized at -7.3 to -11.9 letters after 3-10 years of follow-up with a mean of 2.8 injections (median; 3.0, SD 1.0; 1-5) and 5.1 visits per year. In two thirds of eyes, treatment was switched to aflibercept or corticosteroid combinations without bearing on functional outcomes. Thirty-seven percent (37%) of eyes maintained driving vision for up to 10 years.

CONCLUSIONS

Beyond 3 years of treatment, functional stability was maintained for up to 10 years. Further improvement of long-term outcomes might have required a more intensive treatment in the early phase.

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