Intravitreal anti-VEGF therapy for extrafoveal macular neovascularisation secondary to age-related macular degeneration: five-year results in a tertiary centre

TL;DR

This study shows that anti-VEGF therapy for a type of macular degeneration helps about half of patients maintain or improve vision, but overall vision declines over five years due to retinal changes.

Contribution

The study provides five-year data on anti-VEGF therapy for extrafoveal macular neovascularisation, highlighting long-term visual and morphological outcomes.

Findings

46% of patients had stable or improved vision after five years of anti-VEGF therapy.

Mean visual acuity declined significantly over five years despite treatment.

Foveal atrophy was linked to worse visual outcomes in the long term.

Abstract

To assess the long-term efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy on best-corrected visual acuity (BCVA) and foveal morphology in patients with extrafoveal macular neovascularisation (MNV) secondary to age-related macular degeneration (AMD) over five years.

A total of 104 eyes with treatment-naïve extrafoveal MNV treated with intravitreal anti-VEGF injections were analysed retrospectively. BCVA was assessed at baseline and annually for five years. Central foveal thickness (CFT), intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachments (PED), subretinal hyperreflective material (SHRM), and foveal atrophy (incomplete/complete retinal pigment epithelium and outer retinal atrophy (iRORA/cRORA))—were documented.

After five years, 46% of the eyes had unchanged or improved vision by one or more lines, whereas mean BVCA declined from 0.28 ± 0.20 logMAR at baseline to 0.50 ± 0.49 logMAR after five years (p = 0.016). CFT, and the prevalence of IRF and SRF decreased significantly (p < 0.001), while iRORA (p = 0.041), and cRORA (p < 0.001) increased by year five. Presence of cRORA was associated with worse five-year BCVA (p < 0.001).

Anti-VEGF therapy for extrafoveal MNV secondary to AMD stabilised or improved BCVA in approximately half of the patients; however, mean BCVA declined after five years. Long-term functional benefits were limited due to morphological changes in the macula, such as subfoveal atrophy.

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