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Klin Monbl Augenheilkd 2016; 233(04): 471-474
DOI: 10.1055/s-0041-111835
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Long-term Results of Intravitreal Anti-VEGF Injections in Wet AMD: A Meta-Analysis

Langzeitergebnisse der intravitrealen anti-VEGF-Injektionstherapie bei feuchter altersabhängiger Makuladegeneration: Eine Meta-Analyse
H. Gerding
1   Augenzentrum Klinik Pallas, Olten, Switzerland (Director: Prof. Dr. med. Heinrich Gerding F. E. B. O.)
2   Department of Ophthalmology, University of Münster, Münster, Germany (Chairman: Prof. Dr. med. Nicole Eter)
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Publication History

Publication Date:
26 April 2016 (online)

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Abstract

Background: Although intravitreal anti-VEGF medications are widely used in age-related macular degeneration, no systematic data analysis is available on the long-term prognosis of this relatively new therapeutic approach. Material and Methods: A meta-analysis was performed on available Medline literature. 13 relevant clinical studies (14 case series) could be identified, covering 10 247 treated eyes. The majority of available reports originate from single centre retrospective real-life environments. Results: The mean improvement in average visual gain was 0.9 ± 0.5 (mean ± 1 standard deviation, median; 0.8 lines) at year 1, 1.2 ± 1.1 (median: 1.1) letters at year 2, 0.7 ± 1.0 (median: 0.7) letters at year 3, and 0.2 ± 0.8 (median: 0.5), 0.4 ± 0.4 (median: 0.5) at years 4 and 5. The drop-out rates in these studies was relatively high. At the end of year 3, the average percentage of observed eyes was 44.3 ± 18.4 % (mean ± 1 standard deviation), at the end of year 4 23.5 ± 23.9 % and after years 6 and 7 below 10 % (8.2 and 7.9 %). The mean treatment frequency of injections in all available studies was highest in year 1 (6.4 ± 1.2, 6.1 – mean ± SD; median), followed by relatively consistent mean values of 4.1 and 5.1 (year (Y)2: 4.4, Y3: 4.3, Y4: 4.7, Y5: 4.1, Y6: 5.1, Y7: 4.7) injections per year. Conclusions: The results of this meta-analysis clearly indicate that intravitreal anti-VEGF injection therapy is capable of maintaining visual acuity on a long-term basis of at least 4–5 years.

Zusammenfassung

Hintergrund: Obschon die Anwendung intravitrealer anti-VEGF-Medikamente bei der altersabhängigen Makuladegeneration weit verbreitet ist, sind bislang keine systematischen Analysen zur Langzeitprognose verfügbar. Material und Methoden: In einer Meta-Analyse (Medline) wurden 13 relevante Studien (14 Fallserien) mit insgesamt 10 247 behandelten Augen identifiziert. Die Mehrzahl dieser Artikel beschreibt monozentrische, retrospektive Fallserien. Ergebnisse: Der mittlere Visusgewinn betrug 0.9 ± 0.5 (Mittelwert ± 1 Standardabweichung; Median + 0.8 Linien) nach 1 Jahr, 1.2 ± 1.1 (Median: 1.1) Linien nach 2, 0.7 ± 1.0 (Median: 0.7) Linien nach 3 und 0.2 ± 0.8 (Median: 0.5), 0.4 ± 0.4 (Median: 0.5) Linien nach 4 und 5 Jahren. Bei hoher Ausfallrate waren nach 3 Jahren nur 44.3 ± 18.4 %, nach 4 23.5 ± 23.9 % und nach 6–7 Jahren unter 10 % (8.2 & 7.9 %) der Patienten unter Beobachtung. Die mittlere Injektionsfrequenz betrug im 1. Jahr 6.4 ± 1.2 (Median: 6.1) Injektionen und dann relativ konstant zwischen 4.1 und 5.1 (Jahr (J)2: 4.4, J3: 4.3, J4: 4.7, J5: 4.1, J6: 5.1, J7: 4.7). Schlussfolgerungen: Die Ergebnisse dieser Meta-Analyse zeigen, dass durch anti-VEGF-Injektionen über 4–5 Jahre eine langzeitige Visusstabilisierung erreicht werden kann.

Key words

age related macular degeneration - AMD - wAMD - nAMD - anti-VEGF - ranibizumab - aflibercept - bevacizumab - retina - macula - meta-analysis - review

Schlüsselwörter

altersabhängige Makuladegeneration - AMD - wAMD - nAMD - anti-VEGF - Ranibizumab - Aflibercept - Bevacizumab - Retina - Makula - Meta-Analyse - Review
 

  • References

  • 1 Peden MC, Suner IJ, Hammer ME et al. Fixed-interval dosing of anit-vascular endothelial growth factor agents for wet age-related macular degeneration. Ophthalmology 2015; 122: 803-808
    CrossrefPubMedSearch in Google Scholar
  • 2 Lala C, Framme C, Wolf-Schnurrbusch UEK et al. Three-year results of visual outcome with disease activity-guided ranibizumab algorithm for the treatment of exsudative age-related macular degeneration. Acta Ophthalmologica 2013; 91: 526-530
    CrossrefPubMedSearch in Google Scholar
  • 3 Beykin G, Grunin M, Averbukh E et al. Bevacizumab treatment for neovascular age-related macular degeneration in the setting of a clinic: “real life” long-term outcome. BMC Ophthalmology 2015; 15: 39
    CrossrefPubMedSearch in Google Scholar
  • 4 Borooah S, Jeganathan VS, Ambrecht AM et al. Long-term visual outcomes of intravitreal ranibizumab treatment for wet age-related macular degeneration and effect on blindness rates in south-east Scotland. Eye (Lond) 2015; 29: 1156-1161
    CrossrefPubMedSearch in Google Scholar
  • 5 Gillies MC, Campain A, Barthelmes D et al. Long-term outcomes of treatment of neovascular age-related macular degeneration. Ophthalmology 2015; 122: 1837-1845
    CrossrefPubMedSearch in Google Scholar
  • 6 Buckle M, Donachie PHJ, Johnston RL. Long-term outcomes of intravitreal ranibizumab for neovascular are-related macular degeneration in a well defined region of the UK. Br J Ophthalmol 2016; 100: 240-245
    CrossrefPubMedSearch in Google Scholar
  • 7 Frennesson CI, Nilsson SEG. A three-year follow-up of ranibizumab treatment of exsudative AMD: impact on the outcome of carrying forward the last acuity observation in drop-outs. Acta Ophthalmologica 2014; 92: 216-220
    CrossrefPubMedSearch in Google Scholar
  • 8 Pushpoth S, Sykakis E, Merchant K et al. Measuring the benefit of 4 years of intravitreal ranibizumab treatment for neovascular age-related macular degeneration. Br J Ophthalmol 2012; 96: 1469-1473
    CrossrefPubMedSearch in Google Scholar
  • 9 Rasmussen A, Bloch SB, Fuchs J et al. A 4-year longitutinal study of 555 patients treated with ranibizumab for neovascular age-related macular degeneration. Ophthalmology 2013; 120: 2630-2636
    CrossrefPubMedSearch in Google Scholar
  • 10 Zhu M, Chew JK, Broadhead GK et al. Intravitreal ranibizumab for neovascular age-related macular degeneration in clinical practice: five-year treatment outcome. Graefes Arch Clin Exp Ophthalmol 2015; 253: 1217-1225
    CrossrefPubMedSearch in Google Scholar
  • 11 Mrejen S, Jung JJ, Chen C et al. Long-term visual outcome for a treat and extend anti-vascular endothelial growth factor regimen in eyes with neovascular age-related macular degeneration. J Clin Med 2015; 4: 1380-1402
    CrossrefPubMedSearch in Google Scholar
  • 12 Rofagha S, Bhisitkul RB, Boyer DS et al. Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON. A multicenter cohort study (SEVEN-UP). Ophthalmology 2013; 120: 2292-2299
    CrossrefPubMedSearch in Google Scholar
  • 13 Silva R, Axer-Siegel R, Eldem B et al. The SECURE Study. Long-term safety of ranibizumab 0.5 mg in neovascular age-related macular degeneration. Ophthalmology 2013; 120: 130-139
    CrossrefPubMedSearch in Google Scholar
  • 14 Amstutz CA, Fleischhauer J, Zweifel S et al. Langzeit-Verlauf bei Patienten mit intravitrealer anti-VEGF Therapie für neovaskuläre AMD. Klin Monatsbl Augenheilkd 2015; 232: 533-537
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Boulanger-Scemama E, Querques G, About F et al. Ranibizumab for exsudative age-related macular degeneration: A five year study of adherence to follow-up in a real-life setting. J Fr Ophthalmol 2015; 38: 620-627
    CrossrefPubMedSearch in Google Scholar
  • 16 Shah AR, Del Priore LV. Natural history of predominantely classic, minimally classic, and occult subgroups in exsudative age-related macular degeneration. Ophthalmology 2009; 116: 1901-1907
    CrossrefPubMedSearch in Google Scholar
  • 17 Gerding H. Treatment of wet AMD with less than 12 injections of ranibizumab per year. Klin Monbl Augenheilk 2010; 227: 294-297
    PubMedSearch in Google Scholar
  • 18 Gerding H, Loukopoulos V, Riese J et al. Results of flexible ranibizumab in age-related macular degeneration and search for parameters with impact on outcome. Graefes Arch Clin Exp Ophthalmol 2011; 249: 653-662
    CrossrefPubMedSearch in Google Scholar
  • 19 Gerding H. Ranibizumab treatment in age-related macular degeneration: a meta-analysis of one-year results. Klin Monbl Augenheilk 2014; 231: 427-431
    PubMedSearch in Google Scholar