Real-world outcomes of intravitreal antivascular endothelial growth factors for neovascular age-related macular degeneration in Taiwan: A 4-year longitudinal study

PURPOSE: The purpose of the study is to report the long-term efficacy of patients with neovascular age-related macular degeneration (nAMD) treated with antivascular endothelial growth factor (VEGF) in Changhua Christian Hospital in Taiwan. MATERIALS AND METHODS: Retrospective case series of patients with nAMD who were treated with intravitreal injection (IVI) of anti-VEGF and had a minimum follow-up of 48 months. Every patient was initially treated with three loading doses of either bevacizumab or ranibizumab, followed by a loose treat and extend regimen. Eyes were divided into two groups according to whether aflibercept was later used as a rescue therapy (Group 2) or not (Group 1). Patients underwent best-corrected visual acuity (BCVA) testing, optical coherence tomography, and ophthalmic examination at baseline and all the scheduled follow-up visits. RESULTS: Seventy eyes in 63 patients were included (mean age 70.54 ± 9.18 years). The mean number of IVIs per year was 5.28 ± 1.36. The mean BCVA in logarithm of the minimal angle of resolution (logMar) improved from 0.89 ± 0.45 to 0.72 ± 0.49 for all patients (P = 0.004). Significant visual improvement was noted in Group 1 (P = 0.01) at 4 years of follow-up, but not in Group 2 (P = 0.16). Patients with initial poor BCVA (LogMar visual acuity >1.0), and older age (>70 years) had significant visual improvement, in contrast to no significant visual changes in patients with younger age and initial better BCVA. CONCLUSION: Under a loose treat and extend protocol and rescue therapy of aflibercept, BCVA improvement was maintained for 4 years in patients with nAMD, especially in the older population (Registration Number: NCT03324542).