Change in Therapy of Neovascular Age-Related Macular Degeneration, Diabetic Maculopathy and Macular Edema after Retinal Vein Occlusion

Abstract

Therapy of neovascular age-related macular degeneration, diabetic maculopathy and macular edema after retinal vein occlusion has changed fundamentally since the introduction of anti-VEGF therapy more than 10 years ago. With the technological progress in ocular coherence tomography (OCT) functional criteria have been replaced by more morphological criteria. Contract law and administrative problems have been improved but not solved totally. In a retrospective study, 207 eyes of 157 patients who presented between January 2007 and October 2013 with neovascular age-related macular degeneration, diabetic maculopathy or macular edema after retinal vein occlusion were analyzed. Baseline visual acuity (VA) was 0.25 (median). After initial anti-VEGF upload, there was a significant increase in VA from 0.25 to 0.32 (p < 0.001). Patients with bad VA profited most (p = 0.004). Patients with more intravitreal injections had a larger increase in VA (p = 0.002). In the mainly VA-controlled group of the first years, VA decreased to 0.05 after one year and 3.49 intravitreal injections in the mean. In the OCT-controlled group of the later years, the initial increase in VA could be held after one year and 5.03 intravitreal anti-VEGF applications in the mean. There was a significant difference in the course of VA between the two groups (p = 0.001). Mean interval between indication and start of therapy was 25.34 days in the early years, and 5.40 days in the later years. Mainly VA-based criteria in the anti-VEGF therapy of the early years seem to be inferior to morphological criteria of the later years. Contract law and administrative problems have delayed the time between indication and start of therapy and, thereby, contributed to undersupply and worsening functional results.