Long-Term Follow-up of Patients with Exudative Age-Related Macular Degeneration Treated with Intravitreal AntieVascular Endothelial Growth Factor Injections

Purpose: To determine the long-term visual outcomes and intravitreal injection burden of patients with exudative age-related macular degeneration (AMD) treated with intravitreal antievascular endothelial growth factor (VEGF) injections. Design: Retrospective cohort study. Participants: Patients with exudative AMD treated with intravitreal anti-VEGF injections with annual office visits for at least 7 years. Methods: Snellen visual acuity was measured at baseline and then annually until the last year of follow-up. The number of injections was recorded on an annual basis during each year of follow-up. Main Outcome Measures: The change in the frequency of injections over time along with the change in visual acuity each year from the baseline visit through 7 years. Results: During this period, 533 eyes of 429 patients were treated for exudative AMD. Of these, 391 eyes (73%) met the inclusion criteria of annual office visits and received a mean of 5.8 +/- 2.5 intravitreal injections per year. The baseline mean visual acuity was 0.6 +/- 0.5 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/80), and the 7-year visual acuity was 0.8 +/- 0.6 logMAR (Snellen equivalent, 20/126; P < 0.0001). When compared with the 142 eyes that did not undergo an office visit for a continuous 12-month period, eyes with annual office visits showed similar baseline mean visual acuity (0.7 logMAR vs. 0.6 logMAR; P = 0.2102), but more injections per year (P < 0.0001). Of the 533 total eyes, 124 eyes (23%) maintained better than 20/40 visual acuity at 7 years. These eyes received more injections overall per year (6.5 vs. 5.5 injections per year; P = 0.0007). Conclusions: In a real-world setting, eyes that maintained consistent, long-term follow-up received significantly more intravitreal injections per year than eyes with inconsistent follow-up. Eyes with 20/40 or better vision at study conclusion received more injections per year than eyes with worse than 20/40 vision. (C) 2020 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology