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BCVA in wet AMD decreased over long term with as-needed anti-VEGF treatment
There were significant functional and morphological benefits in patients with neovascular age-related macular degeneration over the first year of treatment with intravitreal bevacizumab, but best corrected visual acuity decreased by the third year, according to a study.
“The maintenance of an initial gain/stabilization during long-term therapy in a standard clinical setting remains a significant challenge,” the study authors said.
The prospective interventional case series examined 181 eyes of 160 consecutive patients with active wet AMD treated with Avastin (bevacizumab, Genentech). BCVA and central retinal thickness were the main outcome parameters. All patients followed a realistic pattern of care in which they were diagnosed and treated at an expert center until their condition stabilized and were then transferred to the primary referring ophthalmologist for continued care. As-needed treatment was based on parameters recommended in the PRONTO study.
Sixty-seven eyes that had undergone previous photodynamic therapy plus intravitreal triamcinolone were analyzed separately from 114 treatment-naïve eyes.
After 3 years, overall BCVA decreased from 0.23 ± 0.16 to 0.16 ± 0.21 (P = .002). BCVA in treatment-naïve eyes had a clinically significant reduction from 0.24 ± 0.21 to 0.17 ± 0.21 (P = .03), while the reduction in eyes that had undergone previous therapy, from 0.22 ± 0.19 to 0.16 ± 0.21, was not significant.
Central retinal thickness increased in all subjects from 291 ± 92 µm to 319 ± 110 µm (P = .01).
“Despite the primarily promising inclusion characteristics and an initial stabilization of function and morphology, the therapeutic benefit was lost during long-term follow-up,” the authors said. “A monthly follow-up and re-treatment based on OCT morphology and clinical and vision outcomes would improve the long-term morphologic and functional outcomes in these patients.”