gms | German Medical Science

Background: To analyse the long-term outcome of flexible anti-VEGF treatment in patients with wet AMD.

Methods: A retrospective institutional case series analysis of 104 eyes (104 patients, mean age 77.6+/-7.3, (mean+/-1 SD)), with a median baseline best corrected logMAR visual acuity (BCLMVA) of 0.7, was performed. Only eyes meeting the inclusion criteria of the MARINA/ANCHOR studies were selected. Initial treatment consisted of 3 monthly ranibizumab injections. Patients were examined monthly during year 1 (Y1), and further on according to an individualized PRN regimen.

Results: All patients continued observation until the end of Y1, 86 (83 %) until end of Y4, 55 (53%) until Y7, and 30 (29%) until the end of Y10. In 24 eyes (23% of all included) therapy was transiently or permanently switched from ranibizumab to aflibercept between Y5 and Y10. Median BCLMVA improved by +1.3 lines during the loading phase and was +0.94 lines at Y1, +0.0 lines at Y4, +0.0 lines at Y7, and -0.05 lines at Y10 visit. 12 (40%) of 30 patients reaching Y10 evaluation had presented active disease within the last year, indicating treatment. The total number of injections was 2091 (ranibizumab: 1847 (88.3%), aflibercept: 244 (11.7%)).The total number of injections was 608 in Y1, 205 in Y4, 133 in Y7 and 55 in Y10. The average number of injections per enrolled eye within 10 years was 0.17/month, 2.0/eye/year, and totally 20.1/eye. The mean number of cumulative injections/observed eye was 5.8+/-2.3 in Y1, 14.2+/-8.4 at the end of Y4, 22.9+/-16.4 after Y7 and 28.6+/-20.9 towards end of Y10. Eyes with active disease received 15.0+/-5.8 injections until the end of Y4, 29.9+/-13.6 until Y7, and 37.2+/-19.6 injections until the end of Y10. The average number of injections/year for eyes with active disease was nearly identical through follow-up (5.8+/-2.3 in Y1, 4.8+/-2.4 in Y4, 4.8+/-2.2 in Y7 and 4.6+/-3.6 in Y10).

Conclusions: Results of this study demonstrate that anti-VEGF therapy of wet AMD can result in long-term functional stabilization at baseline level, well above the natural course of the disease. A stable level was achieved following year 4 with a relatively low number of injections. A considerable percentage of eyes presented persistence of active and treatable disease even in year 10 of care.