A new study suggests a link between the frequency of anti-VEGF injections and the development and progression of geographic atrophy (GA) for people with neovascular age-related macular degeneration (nAMD). While this treatment method is responsible for preventing vision loss in 90% of patients, it also comes with its risks: in addition to sometimes causing rare complications such as endophthalmitis, vitreous hemorrhage and retinal tears, studies are now revealing a clear relationship between the anti-VEGF intravitreal injections and GA.
The researchers performed a meta-analysis of 31 studies representing 4,501 patients and 4,609 eyes, 9.7% of which had GA at baseline. The study eyes received a mean 17.7 injections over 35.2 months. Patients included in the study were not using any other treatment modalities other than anti-VEGF. The results revealed a positive correlation between the number of injections and the incidence of GA at the patient’s final follow-up appointment.
Researchers also found that patients receiving monthly injections were more likely to develop GA than those who sought treatment less frequently. On average, there was a 0.94% increase in GA incidence for each additional injection administered. However, it’s possible that those receiving injections more frequently had more aggressive nAMD, which puts them at a higher risk for GA. Still, patients receiving anti-VEGF treatment may be more susceptible to developing GA if they also have preexisting risk factors, which include GA in the fellow eye, retinal angiomatous proliferation, drusen and reticular pseudodrusen.
“At present, intravitreal injections of anti-VEGF agents are the most effective treatment to preserve vision in eyes with nAMD. However, strategies should be employed for those at high risk of GA to limit the number of injections whenever possible while preserving visual acuity gains and maintaining close follow-up,” the researchers said in their paper.
Further studies are needed to determine how much these results and the increased incidence of GA following anti-VEGF injections are explained by the natural occurrence of GA in patients with nAMD over time. Studies will also be necessary to link anti-VEGF injections with worsened visual acuity, as that observation could be attributed to natural disease progression as well.
Eshtiaghi A, Issa M, Popovic MM, et al. Geographic atrophy incidence and progression following intravitreal injections of anti-vascular endothelial growth factor agents for age-related macular degeneration: a meta-analysis. Retina. October 2020. [Epub ahead of print].