Effects of treatment interruption on anatomical and functional status of eyes with neovascular age-related macular degeneration receiving anti-VEGF therapy

AIM: To study anatomical and functional changes in eyes with neovascular age-related macular degeneration (AMD) receiving anti-VEGF therapy and experienced treatment interruption during COVID pandemic.

MATERIAL AND METHODS: This retrospective study included 58 eyes (49 patients, 34 males and 15 females with a mean age of 73.2 ± 9.4 years) with nAMD. Eyes in the first-year treatment group (18 eyes) received up to 7 intravitreal aflibercept injections, eyes in the second-year treatment group (21 eyes) were treated with pro re nata regimen. The treatment interruption period in the first and second-year treatment group was 5.5 ± 0.7 and 5.5 ± 1.0 months, respectively.

RESULTS: Over the treatment interruption period, the first-year treatment group showed no statistically significant differences in best-corrected visual acuity (BCVA) and central retinal thickness (CRT), p = 0.25 and p = 0.09, respectively. At the same time, the second-year treatment group showed a statistically significant decrease in BCVA (p = 0.0004) and an increase in CRT (p = 0.002). Baseline BCVA was positively associated with BCVA at the end of treatment interruption (r = 0.82; p < 0.0001). Presence of sub- and intraretinal fluid (p = 0.015 and p = 0.007, respectively), low BCVA (p < 0.0001), high CRT (p = 0.019), alteration of the ellipsoid zone (p < 0.001) were negatively associated with BCVA at the end of treatment interruption. Age (p = 0.8), gender (p = 0.41), and the number of intravitreal injections (p = 0.5) showed no association with changes in BCVA.

CONCLUSIONS: NAMD patients of the second year of anti-VEGF therapy appear to have a higher risk of functional loss during treatment interruption. Higher CRT and lower BCVA, as well as sub- and intraretinal fluid before treatment interruption, are associated with poorer functional status at the end of the interruption period.