First Author: M.Grinton UK
Co Author(s): M. McKenna S. Pushpoth P. Severn
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The introduction of anti-vascular endothelial growth factor drugs has revolutionised the treatment of exudative age-related macular degeneration. Most improvement in mean visual acuity (VA) is seen in the first 3-6 months of treatment but studies have shown that the mean VA decreases from the second year onwards despite ongoing anti-VEGF treatment. The exact cause and processes responsible for the decrease in vision is unknown however may be related to ongoing wet AMD activity, the development of geographic atrophy and fibrotic scar formation. This study aims to provide more information on the morphological outcomes in patients treated with anti-VEGF.
James Cook University Hospital, NHS, Middlesbrough, Teeside, UK.
Case series study of patients treated for exudative AMD with intravitreal Aflibercept and ranibizumab at James Cook University Hospital.
234 patients were treated with intravitreal anti-VEGF. The mean age was 79 years old. 31% of patients before starting treatment had VA of 6/12 (20/40) or better (n=234). At 1 year 26% had VA of 6/12 or better (n=92). Mean central macular thickness (CMT) at presentation was 333um (n=230). After 2 years of treatment mean CMT was 233um (n=96). At presentation all patients showed evidence of intraretinal, subretinal or sub-RPE fluid; 1% showed evidence of geographic atrophy and 4% showed evidence of fibrotic scar. Post loading of anti-VEGF (after 3 monthly injections) 24% of patients showed no fluid on OCT, 9% had evidence of geographic atrophy and 9% showed evidence of fibrotic scar (n=206). At between 1 and 2 years after starting treatment, 28% of patients had no fluid on OCT, 17% had evidence of geographic atrophy and 14% a fibrotic scar (n=127).
The study provides more evidence of efficacy of anti-VEGF in the maintenance of vision in patients with exudative macular degeneration. The most improvement in resolution of fluid on OCT was within the loading phase of anti-VEGF with a less marked benefit in the subsequent 1-2 years after this. The study also illustrates the increasing prevalence of both geographic atrophy and fibrotic scar formation in the 2 years after diagnosis and commencement of treatment although further studies are required to investigate the aetiology of this.