Abstract
PurposeTo investigate the outcomes of a suspension of anti-vascular endothelial growth factor (anti-VEGF) treatments in the eyes with neovascular age-related macular degeneration (nAMD).MethodsThis was a retrospective study that examined eyes having no exudation for 48 weeks while undergoing intravitreal anti-VEGF injections every 12 to 16 weeks. The rate and time of recurrences, best-corrected visual acuity (BCVA), central subfield thickness (CST), number of visits, and reactivity to anti-VEGF were determined after the suspension of the anti-VEGF treatments.ResultsIn 34 eyes of 34 patients, 17 eyes (50.0%) had a recurrence during the 24-month follow-up period. The median time of a recurrence was 10 months. The BCVA was maintained for 24 months after the suspension regardless of the development of any recurrences. In 41.7% of the eyes that resumed treatment, the duration of exudation suppression by the anti-VEGF therapy was shorter than 12 weeks during the 12 months after restarting the anti-VEGF treatments. There was a significant increase in the number of visits during the first year after beginning the suspension versus during the 1 year before the suspension (non-recurrence group; P = 0.007, recurrence group; P = 0.001).ConclusionAlthough one-half of the eyes had a recurrence within 24 months after a suspension of anti-VEGF treatment, the BCVA was maintained after a resumption of the anti-VEGF treatments. However, the number of hospital visits increases regardless of the recurrences and the lesion stability is altered by the anti-VEGF suspension. Clinicians should explain both the advantages and disadvantages of anti-VEGF suspension to nAMD patients.
Highlights
Materials and methodsAge-related macular degeneration (AMD) is a major cause of vision reduction in the elderly, and it is feared that the number of cases will increase worldwide in the near future [1]
The purpose of this study was to evaluate the rate of recurrences and the degree of exudations in eyes with neovascular AMD (nAMD) which matched the antiVEGF suspension criteria, regardless of any past intravitreal injection treatment history
Our study was designed for real-world clinical conditions, and the findings showed that the rate of recurrences of exudation was 38.2% for 12 months and 50.0% for 24 months after the treatment suspension
Summary
Materials and methodsAge-related macular degeneration (AMD) is a major cause of vision reduction in the elderly, and it is feared that the number of cases will increase worldwide in the near future [1]. Several early nAMD clinical trials have shown that monthly or bimonthly injections of anti-VEGF agents were effective in improving and maintaining the visual acuity [4,5,6]. Treat and extend (TAE) regimen, in which the treatment interval is changed depending on the status of the retinal lesions, can reduce the burden on patients by decreasing the cost, number of injections, and hospital visits, with an improvement in the visual acuity [7, 8]. To reduce the burden of the intravitreal injections, guidelines for the suspension of the anti-VEGF injections in eyes with nAMD with milder lesion activity have been proposed [9, 10]. This study examined the visual and anatomical outcomes and the changes in the number of hospital visits after the suspension of the antiVEGF treatments
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