Long-Term Effect of Anti-VEGF Agents on Intraocular Pressure in Age-Related Macular Degeneration

AimsTo evaluate the long-term functional and anatomical outcomes of neovascular age-related macular degeneration (nvAMD) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) for up to 10 years, and to identify associated risk factors.MethodsClinical and optical coherence tomography findings were retrieved for nvAMD cases treated with intravitreal anti-VEGF compounds using a treat-and-extend protocol. In addition, the major risk alleles for AMD in the CFH (rs1061170), HTRA1 (rs1200638) and C3 (rs2230199) genes were genotyped.ResultsFrom 276 eligible eyes in 206 patients, 80 eyes (29%) in 66 patients (32.0%) had a follow-up period of ≥8 years and were included in this study. Over a 10-year period, 73.3±28.0 (mean±SD) anti-VEGF injections were administered. Best-corrected visual acuity (BCVA; LogMAR) deteriorated from 0.55±0.53 at baseline to 1.00±0.73 at 10 years (p<0.0005). Central subfield thickness (CST) decreased from 415.8±162.1 µm at baseline to 323±113.6 µm (p<0.0005) after three monthly injections and remained lower than baseline throughout the follow-up period. Visual outcome was associated with BCVA and intraretinal fluid (IRF) at baseline, macular atrophy, and macular thinning at follow-up. The decrease in CST was inversely correlated with the number of CFH and/or C3 risk alleles carried by the patient (Pearson’s r: −0.608; p=0.003).ConclusionsPatients with nvAMD who received anti-VEGF therapy for 10 years developed substantial vision loss associated with the presence of IRF at baseline and macular atrophy. Major risk alleles for AMD in two complement genes were associated with a reduced long-term reduction in macular thickness.

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A Case of Sustained Intraocular Pressure Elevation after Multiple Intravitreal Injection of Ranibizumab and Aflibercept for Neovascular Age-Related Macular Degeneration

Case Reports in Ophthalmology ◽

10.1159/000446016 ◽

2016 ◽

Vol 7 (1) ◽

pp. 230-236 ◽

Cited By ~ 4

Author(s):

Hisashi Matsubara ◽

Ryohei Miyata ◽

Maki Kobayashi ◽

Hideyuki Tsukitome ◽

Kengo Ikesugi ◽

...

Keyword(s):

Intraocular Pressure ◽

Macular Degeneration ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Intravitreal Injections ◽

Multiple Injections ◽

Anti Vegf ◽

Age Related ◽

Intravitreal Aflibercept ◽

Iop Elevation

Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents are widely used to treat neovascular age-related macular degeneration (nAMD). Although these treatments are effective, multiple injections have recently been recommended to ensure that there is a good long-term prognosis. However, sustained intraocular pressure (IOP) elevations have been reported to develop after multiple injections of anti-VEGF agents. We present our findings of a case of uncontrolled and persistent IOP elevation after switching from intravitreal ranibizumab injections to intravitreal aflibercept injections. A 74-year-old Japanese man without a history of glaucoma underwent 22 ranibizumab injections for nAMD and suddenly developed an elevated IOP after the 22nd injection. Although the subsequent medical treatment led to normalization of his IOP, the subretinal fluid under the central fovea remained even after the 25th injection of ranibizumab. Thus, ranibizumab treatment was switched to bimonthly intravitreal aflibercept injections in conjunction with glaucoma medications. His IOP recovered to within the normal range; however, after the 11th aflibercept injection, there was a sudden elevation of his IOP in spite of the continued glaucoma medications. Due to this sustained IOP elevation, his aflibercept injections were suspended for 16 weeks. Because his IOP could not be normalized by a full glaucoma medication regimen, the patient underwent trabeculotomy, which resulted in a lowering of the IOP to normal levels. We conclude that patients who receive serial intravitreal injections of anti-VEGF agents need to be closely monitored because severe and sustained ocular hypertension can develop.

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Treatment for neovascular age-related macular degeneration: reasonable expectations of physicians and patients

Clinical ophthalmology ◽

10.32364/2311-7729-2021-21-3-169-174 ◽

2021 ◽

Vol 21 (3) ◽

pp. 169-174

Author(s):

A.B. Durasov ◽

◽

...

Keyword(s):

Macular Degeneration ◽

Treatment Outcomes ◽

Randomized Clinical Trials ◽

Patient Characteristics ◽

Age Related Macular Degeneration ◽

Strict Adherence ◽

Treat And Extend ◽

Anti Vegf ◽

Age Related

Neovascular age-related macular degeneration (nAMD) is a progressive chronic multifactorial disease requiring long-term, lifelong anti- VEGF therapy. Treatment outcomes are not always in line with the results of randomized clinical trials and do not meet the expectations for therapy whose success is assessed differently by patients and physicians. Good functional and anatomical results are expected from antivasoproliferative therapy under certain conditions, e.g., accurate evaluation of some patient characteristics (baseline visual acuity, type of choroidal neovascularization, comorbidities, status of retinal fluid and its differentiation), timely (as early as possible) treatment initiation after verifying diagnosis, and strict adherence to a proactive personalized "Treat-and-Extend" (T&E) regimen that implies a required number of injections with individual intervals. Poor adherence to treatment (non-compliance or nonpersistence of anti-VEGF therapy) significantly affects treatment outcomes in real-world clinical practice. This paper reviews criteria which predict the response to antivasoproliferative therapy and improving treatment adherence. The authors describe four fundamental principles to be met by an ideal regimen of anti-VEGF therapy for nAMD. Keywords: neovascular age-related macular degeneration, nAMD, "Treat-and-Extend", T&E, adherence, nonpersistence, anti-VEGF. For citation: Durasov A.B. Treatment for neovascular age-related macular degeneration: reasonable expectations of physicians and patients. Russian Journal of Clinical Ophthalmology. 2021;21(3):169–174 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-169-174.

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Morphological characteristics of eyes with neovascular age-related macular degeneration and good long-term visual outcomes after anti-VEGF therapy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319602 ◽

2021 ◽

pp. bjophthalmol-2021-319602

Author(s):

Mengyuan Fang ◽

Karntida Chanwimol ◽

Jyotsna Maram ◽

Ghazala A Datoo O'Keefe ◽

Charles C Wykoff ◽

...

Keyword(s):

Macular Degeneration ◽

Retinal Pigment ◽

Morphological Characteristics ◽

Age Related Macular Degeneration ◽

Neovascular Amd ◽

Poor Vision ◽

Anti Vegf ◽

Age Related ◽

Good Vision

PurposeTo analyse the morphological characteristics of eyes with neovascular age-related macular degeneration (AMD) with good long-term visual acuity after anti-VEGF (vascular endothelial growth factor) therapy.MethodsRetrospective, observational study of 175 patients with neovascular AMD with >5 years of follow-up after initiating anti-VEGF therapy. Spectral-domain optical coherence tomography images were assessed for thickness of pigment epithelial detachment (PED), subretinal hyper-reflective material (SHRM), subretinal fluid and subfoveal choroidal, as well as the integrity of the outer retinal bands.ResultsThe final analysis cohort included 203 eyes (175 patients) followed for a mean of 7.84±1.70 years (range: 5–11). The maximum PED thickness in the foveal central subfield (FCS) was significantly lower (p<0.001) in the poor vision group (13.11 μm) compared with the intermediate (86.25 μm) or good (97.92 μm) vision groups, respectively. In contrast, the maximum thickness of SHRM in the FCS was significantly thicker (p<0.001) in eyes with poor vision (149.46 μm) compared with eyes with intermediate vision (64.37 μm) which in turn were significantly thicker (p<0.001) than eyes with good vision (9.35 μm). The good vision group also had better continuity of all outer retinal bands (external limiting membrane, ellipsoid zone, and retinal pigment epithelium) compared with the other two groups (all p<0.001).ConclusionA thicker PED and thinner SHRM were correlated with better vision in eyes with neovascular AMD following long-term anti-VEGF therapy. If replicated in future prospective studies, these findings may have implications for design of optimal anatomic endpoints for neovascular AMD treatment.

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