Abstract
To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for treatment of neovascular age-related macular degeneration (nAMD) in vitrectomized eyes. The medical records were reviewed of nAMD patients treated with anti-VEGF agents who previously underwent pars plana vitrectomy (PPV). PPV was performed with complete posterior vitreous detachment induction. A total of 44 eyes from 44 patients were included. The mean central foveal thickness (CFT) was 478.50 ± 156.93 μm at baseline, 414.25 ± 143.55 μm (86.6% of baseline) at 1 month after first injection (P < 0.001), and 386.75 ± 141.45 μm (80.8% of baseline) after monthly multiple injections (2.30 ± 1.07; range, 1-5) (P < 0.001). The mean logarithm of the minimum angle of resolution best-corrected visual acuity visual acuity (BCVA) was 0.85 ± 0.57 at baseline, 0.86 ± 0.63 after the first injection, and 0.84 ± 0.64 after monthly multiple injections. BCVA improved in 39.5% at 1 month after first injection and 45.2% at 1 month after monthly multiple injections. In the subgroup analysis, CFT of eyes with the posterior capsule decreased significantly to 85.8% and 79.8% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively. CFT of eyes without the posterior capsule decreased to 91.6% and 87.4% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively, without statistical significance. Monthly injections of Intravitreal anti-VEGF agents induced favorable anatomical improvement and vision maintenance in vitrectomized eyes with nAMD.
Highlights
Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness worldwide [1]
The advent of intravitreal anti-vascular endothelial growth factor (VEGF) injection led to a paradigm shift of treatment for neovascular AMD [2,3]
Bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA, USA), ranibizumab (Lucentis; Genentech, Inc.), and aflibercept (Eylea; Regeneron Pharmaceuticals, Tarrytown, NY, USA) are anti-VEGF agents used for the treatment of neovascular AMD (nAMD), for which favorable results in non-vitrectomized eyes were reported through clinical trials [4,5,6]
Summary
Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness worldwide [1]. The advent of intravitreal anti-vascular endothelial growth factor (VEGF) injection led to a paradigm shift of treatment for neovascular AMD (nAMD) [2,3]. Patients who undergo vitrectomy may need intravitreal anti-VEGF injections for the treatment of nAMD. Previous studies reported controversial findings on the pharmacokinetics of intravitreal anti-VEGF agents after vitrectomy in animal eyes [13,14,15,16,17]. Several clinical studies reported on the effect of intravitreal anti-VEGF in vitrectomized eyes, but these were only small case series (nAMD, 4 eyes), cohorts of patients with pathologies other than nAMD (macular edema due to diabetic retinopathy or retinal vein occlusion), or cases of patients who underwent core rather than total vitrectomy [18,19,20,21,22,23]
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