Long-term results (60 months) of anti-VEGF therapy of macular diseases in real clinical practice. Part 2.

Abstract

Purpose: to study long-term results of anti-VEGF therapy for macular diseases of patients followed up for 60 months in real clinical practice. Materials and methods. The research group included 57 patients (43 women, 14 men; median age 62 years) who received antiVEGF therapy (ranibizumab, aflibercept) and remained under regular observation for 60 months. Of these, 24 patients had “wet” agerelated macular degeneration (wAMD), 20 had myopic choroidal neovascularization (mCNV), 10 had macular edema due to retinal vein occlusions (MERVO), and 3 patients had diabetic macular edema (DME). Statistical analysis of demographic indicators and treatment results was carried out using STATISTICA 13.3 software: conditions of normality for variables, nonparametric and parametric criteria were determined, and rank analysis of variance was carried out. The characteristics of the study group are given in the first part of this article [ROJ, 2022; 15 (3): 11–17]. Results. Over the research period, the best corrected visual acuity (BCVA) increased from 0.29 0.35 0.42 to 0.47 0.54 0.61 (p < 0.00001); 91.2 % of patients maintained the indicator or improved it with regard to the baseline. The proportion of subjects with BCVA ≥ 0.5 ranged from 61.4 to 73.7 % during the research period. The average number of intravitreal injections (IVI) received by the patients was 8.93 10.84 12.75. We revealed a tendency towards a gradual decrease in the intensity of treatment and confirmed it (p < 0.00001). The proportion of patients who received 4 IVI or more over 12 months of treatment decreased from 57.9 % in the first year to 12.3 % in the fifth year, and the proportion of cases where anti-VEGF therapy did not need to be resumed before the end of the year of treatment increased from 28.1 % (in the second year of research) to 49.1 % (in the fifth year). The need for IVI anti-VEGF drugs in wAMD and DME was significantly greater than in MERVO and mCNV. Conclusion. The results confirm high efficiency of anti-VEGF therapy. To solve the issue of ill-timed or insufficient treatment, it is necessary to start the therapy as early as possible, use the most effective (proactive) regimens, apply individualized approach to the treatment, take organizational measures aimed at facilitation of access to specialized care, and, generally, to change the attitude of the professional community.