PRN Treatment of Neovascular AMD with Cycles of Three Monthly Injections

Abstract

Purpose: To report the one and two year outcome of cycles of three, monthly anti-VEGF injections given upon reactivation of the disease in eyes with neovascular age-related macular degeneration (nAMD).

Methods: Retrospective study of naïve nAMD cases with more than one year of follow-up, treated with a protocol of cycles of three monthly injections of anti-VEGF drugs upon reactivation. Visual acuity (VA) and central macular thickness (CMT) are the main outcome measures.

Results: Twenty-six patients with a mean age of 78.15 $\pm$ 9.29 years (57.7% female) were included. The mean follow-up was 30.89 $\pm$ 6.95 months. Treatment started with bevacizumab in all patients but in six patients was switched to aflibercept due to inadequate response to intravitreal bevacizumab injection. The mean VA at baseline and at 12 and 24 months was 53.87 $\pm$ 21.84, 60.54 $\pm$ 21.13, and 53.68 $\pm$ 27.16 ETDRS letters, respectively. Patients gained a mean of 6.67 $\pm$ 13.7 (p = 0.013, 95% CI= 0.60 to 12.65) and 0.77 $\pm$ 15.21 (p = 0.4, 95% CI: -5.65 to 7.2) letters at 12 and 24 months. CMT at baseline, 12, and 24 months was 403.55 $\pm$ 147.59, 323.95 $\pm$ 79.58, and 298.59 $\pm$ 77.161 µm, respectively. The number of injections in the first and second years were 7.65 $\pm$ 2.64 and 5.52 $\pm$ 3.01, respectively. Three eyes (12.5%) lost $>$ 15 letters at 24 months.

Conclusion: This protocol can stabilize or improve vision in 87.5% of nAMD patients and can reduce the number of visits.

Keywords: Anti-VEGF; Naïve; Neovascular; Real World; Age-related Macular Degeneration.

Figure 1

Changes in logMAR visual acuity and central macular thickness at baseline and 12 and 24 months.