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

  • Medical Ophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

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 chi2 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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Acknowledgements

None of the authors announces any conflict of interest in the context of the data presented herein.

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Authors and Affiliations

  1. Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, CH-3012, Bern, Switzerland

    Justus G. Garweg, Christin Gerhardt & Isabel B. Pfister

  2. University of Bern, Bern, Switzerland

    Justus G. Garweg, Johanna J. Zirpel, Christin Gerhardt & Isabel B. Pfister

Authors
  1. Justus G. Garweg
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  2. Johanna J. Zirpel
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  3. Christin Gerhardt
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  4. Isabel B. Pfister
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Corresponding author

Correspondence to Justus G. Garweg.

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Competing interests

JGG advises several pharmaceutical companies (Alcon, Allergan, Bayer, Novartis) and participates in a number of international, multicentre clinical studies that are sponsored by a few of these (Novartis, Bayer) in the fields of AMD and diabetic retinopathy. These activities had no bearing on the study that gave rise to the submitted article, for which JGG received neither direct nor indirect financial support; nor has he conflicts of interest with any of the presented data. The other two authors have no potential conflicts of interest.

Financial disclosure

This study did not receive any external funding.

Ethical approval

Though formal consent is not required for this type of retrospective study, ethical approval was received by the Institutional Ethics Board (Kantonale Ethikkommission Bern, University of Bern, registration number KEK 99/15).

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Garweg, J.G., Zirpel, J.J., Gerhardt, C. et al. The fate of eyes with wet AMD beyond four years of anti-VEGF therapy. Graefes Arch Clin Exp Ophthalmol 256, 823–831 (2018). https://doi.org/10.1007/s00417-018-3907-y

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  • DOI: https://doi.org/10.1007/s00417-018-3907-y

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