An 8-year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration.
PURPOSE
To investigate long-term visual results of treatment with anti-vascular endothelial growth factor (VEGF) agents for neovascular age-related macular degeneration (nAMD) following a treat-and-extend regimen.


METHODS
Retrospective review of 155 patients who initiated treatment with bevacizumab for nAMD in one eye. At the final 8-year visit, 40 patients (26%) remained for follow-up. Mean change in best-corrected visual acuity (BCVA) was calculated compared to baseline values.


RESULTS
Mean BCVA improved significantly from baseline during the first year of treatment, with -0.11 logMAR units equivalent to 6.1 approximate Early Treatment Diabetic Retinopathy Study (approxETDRS) letters (p = <0.001). Mean BCVA was still significantly improved after 4 years of treatment for the entire group of patients and after 6 years of treatment for the subgroup of 40 patients who remained at the final 8-year visit. Thereafter, BCVA gradually declined and at 8 years, there was a mean change of 0.05 logMAR units equivalent to 2.1 approxETDRS letters below baseline (p = 0.530). Mean number of injections during the first year was 6.1 ± 2.8 and during year 8 was 5.4 ± 3.5. At 5 years, fundus autofluorescence showed some degree of macular atrophy in all eyes. At the final 8-year visit, 87.5% of the eyes had stable neovascular lesions with no fluid on optical coherence tomography (OCT).


CONCLUSION
In an everyday clinical setting, treatment of nAMD patients with a treat-and-extend modality provided improvement and stability of vision for several years. After 8 years of follow-up, there was a decline in visual acuity (VA) that could be explained by macular atrophic development.
['Berg|Karina|K|http://orcid.org/0000-0001-7536-3760', 'Roald|Anca B|AB|', 'Navaratnam|Jesintha|J|', 'Bragadóttir|Ragnheiður|R|']
D020533:Angiogenesis Inhibitors D000068258:Bevacizumab D005260:Female D005451:Fluorescein Angiography D005500:Follow-Up Studies D005654:Fundus Oculi D006801:Humans D058449:Intravitreal Injections D008297:Male D000069579:Ranibizumab D012189:Retrospective Studies D013997:Time Factors D041623:Tomography, Optical Coherence D016896:Treatment Outcome D042461:Vascular Endothelial Growth Factor A D014792:Visual Acuity D057135:Wet Macular Degeneration
treat-and-extend bevacizumab AMD aflibercept ranibizumab