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. 2023 Dec 25;13(1):111.
doi: 10.3390/jcm13010111.

Anatomical and Functional Outcomes with Prompt versus Delayed Initiation of Anti-VEGF in Exudative Age-Related Macular Degeneration

Assaf Gershoni  1   2 , Edward Barayev  1   2 , Rabeea H Daood  1 , Maureen Yogev  1 , Orly Gal-Or  1   2 , Olga Reitblat  1   2 , Maria Tsessler  1 , Michal Schaap Fogler  1   2 , Raimo Tuuminen  3   4 , Rita Ehrlich  1   2
Affiliations

Anatomical and Functional Outcomes with Prompt versus Delayed Initiation of Anti-VEGF in Exudative Age-Related Macular Degeneration

Assaf Gershoni et al. J Clin Med. .

Abstract

Purpose: To investigate the correlation between time from diagnosis of treatment-naïve exudative age-related macular degeneration (AMD) to the introduction of anti-VEGF treatment and anatomical and functional outcomes.

Design: Retrospective cohort study.

Methods: Included were treatment-naïve exudative AMD patients who presented to a single tertiary medical center between 2012 and 2018. All patients were treated within the first 30 days of their diagnosis with three monthly intravitreal injections of bevacizumab. Patients were divided into three groups: group 1 (prompt anti-VEGF) were injected with bevacizumab within ten days, group 2 (intermediate anti-VEGF) within 11-20 days, and group 3 (delayed anti-VEGF) within 21-30 days from diagnosis. Baseline characteristics and clinical outcomes were compared up to two years from treatment.

Results: 146 eyes of 146 patients were included. Sixty-eight patients were in the prompt anti-VEGF group, 31 in the intermediate anti-VEGF group, and 47 in the delayed anti-VEGF group. Following the induction phase of three intravitreal bevacizumab injections, the mean central subfield macular thickness (328.0 ± 115.4 µm vs. 364.6 ± 127.2 µm vs. 337.7 ± 150.1 µm, p = 0.432) and the best-corrected visual acuity (0.47 ± 0.38 vs. 0.59 ± 0.48 vs. 0.47 ± 0.44 logMAR units, p = 0.458) were comparable between the prompt, intermediate and delayed anti-VEGF groups. Anatomical and functional outcomes, treatment burden, number of relapses and eyes with second-line anti-VEGF therapy were comparable between the groups at both 1-year and 2-year timepoints.

Conclusions: Our real-world evidence data emphasize that even if anti-VEGF induction cannot be initiated promptly within ten days from diagnosis of naïve exudative AMD, the visual and anatomical prognosis of the patients may not worsen if the treatment is started within one month of diagnosis.

Keywords: anti-VEGF; bevacizumab; central subfield macular thickness; exudative age-related macular degeneration; intravitreal treatment; treatment-naïve.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Anatomical and functional outcomes in treatment-naïve exudative AMD patients with prompt, intermediate and delayed anti-VEGF treatment. (A) CSMT reduction and (B) BCVA gain at 1 year and 2 years in prompt, intermediate and delayed anti-VEGF treatment groups in treatment-naïve exudative AMD patients. BCVA; best-corrected visual acuity, CSMT; central subfield macular thickness.
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