Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Abstract

Purpose Single center, noninterventional cohort study to assess 10-year visual and anatomical outcomes following initiation of treatment with antivascular endothelial growth factor (anti-VEGF) agents in neovascular age-related macular degeneration (AMD) patients. Neovascular AMD patients initiated on intravitreal anti-VEGF injections in 2008–2009 and continued to be followed up for at least 10 years were included in this study. Methods The Moorfields OpenEyes database was searched for all patients who were initiated on anti-VEGF therapy for neovascular AMD in 2008–2009 and the visual acuity (VA) in Early Diabetic Retinopathy Study (ETDRS) letters and injection records were analyzed for those who have had at least 10-year follow-up. The spectral-domain optical coherence tomography (SD-OCT) scans, color fundus photos, and fundus fluorescein angiography (FA) were graded by two retinal physicians. The outcomes were also compared between those with good and poor VA outcomes based on pre-defined criteria. The primary end point was change in VA at 10 years; secondary outcomes included percentage with VA of 20/40 or better, 20/70 or better, VA gains and losses, anatomic outcomes and number of injections. Results After a mean of 10.04 years after initiation of anti-VEGF therapy, the mean decline in VA from baseline was −2.1 ETDRS letters (SD 19.9, p = 0.65). One hundred eyes (67.1%) achieved a VA threshold of 20/70 or better, 33.5% achieved a VA of 20/40 or better, and 76.5% eyes maintained VA defined as a loss of less than 15 letters. Fourteen percent of study eyes had VA of 20/200 or worse and 23.5% declined by 15 letters or more. 87.5% of eyes were switched from ranibizumab to aflibercept during the course of 10 years and the eyes received a mean of 52.2 (SD 18.1) injections over 10 years. From this cohort, 87 (58.3%) eyes are having on-going treatment. On OCT, 34.9% had persistent fluid at the last visit, 6.7% patients showed new onset atrophy compared to baseline, and 43.7% had increased area of macular atrophy. The mean area of atrophy at the final visit was 4.15 mm 2 . Comparison between the good and worse visual outcome groups showed lower baseline VA, fovea-involving atrophy and final area of atrophy had a statistically significant negative effect on the final visual outcome ( p < 0.05). Conclusions Regular monitoring and anti-VEGF treatment over 10 years reduce the risk of visual loss of 15 letters or more in patients with neovascular AMD. The most common cause of substantial visual decline was macular atrophy.

RNA sequencing reveals BMP4 as a basis for the dual-target treatment of diabetic retinopathy

“…Anti-VEGF drugs have gradually become an effective way to assist the treatment of PDR due to their significant effect on neovascular and exudative lesions [13]. However, a large number of studies have found that anti-VEGF drug therapy can lead to increased expression of fibrotic factors and aggravate the fibrotic process [19,20]. Previous studies have found that CTGF expression in the proliferative membrane of PDR patients treated with anti-VEGF drugs was significantly decreased, but fibrotic factor expression was significantly upregulated [21].…”

“…Cells were treated with different concentrations of 4HNE (5,10,20,40,80, and 100 µM), of CoCl 2 (10,25, 50, 100, and 200 µM),, or of AGEs (100, 150, 200, 250, or 300 µg/ml) for 24 hours.…”

Ten-Year Real-World Outcomes of Anti-Vascular Endothelial Growth Factor Therapy in Neovascular Age-Related Macular Degeneration

“… 11 Chandra et al reported 149 eyes completing 10-year follow-up for nAMD with 76.5% of eyes losing ≤15 letters and 67.1% of eyes achieving VA threshold of 20/70 (57 letters on 2 m ETDRS) letters at the end of 10 years. 12 …”

Ten-year survival trends of neovascular age-related macular degeneration at first presentation

“…This study offers one of the longest reports on anti-VEGF treatment for nAMD and one of the first UK-based studies on patients followed-up for 10 years. [18] By analysing results for the first-affected eye and accounting second eye involvement , we offer a realistic insight of disease burden and visual prognosis. Encouragingly, among those who completed the follow-up, approximately one out of two patients was able to maintain a BCVA ≥ 70 letters in the better-seeing eye while only 5.4% of the patients were accounted as legally blind at 10 years.…”