Anti-VEGF agents are the therapy of choice for wet AMD, yet this treatment can be costly, require strict follow-up and cause psychological and physical side effects, not to mention the heightened risk of geographic atrophy (GA). A recent study published in Retina suggests that at least some wet AMD patients may experience complete resolution of CNV for at least two years following a single anti-VEGF injection.
The retrospective, observational investigation included 458 treatment-naïve patients (194 males) who received therapy for wet AMD. Of these, 63 patients (14%) showed complete resolution of fluid for up to three years after the first injection of ranibizumab/aflibercept.
Complete resolution was defined as total disappearance of intraretinal fluid, cysts and subretinal fluid and a return of retinal thickness to less than 250μm as seen on SD-OCT. Follow-up occurred on days one, seven and 30 postoperatively and then monthly, with at least nine mandatory visits per year if the macula remained fluid-free. Participants were about 67 years old, and baseline and final corrected distance VAs were 20/160 and 20/45, respectively.
Younger patients, smaller subfoveal membranes, early presentation, use of aflibercept and presence of exudates all favored complete resolution with a single injection. Looking at visual acuity, 63% of patients showed a 15-letter gain, and 47% maintained a 10-letter gain at the end of the follow-up period of at least three years. Only seven patients needed multiple injections after a treatment-free interval of at least 24 months.
If sustainable, achieving favorable outcomes with a single injection can lower therapy costs, treatments, office visits and the potential risk of GA, the study authors concluded.
Bilgic A, Kodjikian L, Mathis T. Single injection response to anti-vascular endothelial growth factor agents in patients with wet age related macular degeneration: incidence and characteristics. Retina. January 4, 2021. [Epub ahead of print].