AGE-RELATED MACULAR DEGENERATION CURRENT INVESTIGATIONS AND TREATMENTS

agerelatedmaculardeg774enerationkapak

LONG-TERM OUTCOMES OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT

Nurettin Bayram1
Cemal Özsaygılı2

1Ankara Etlik City Hospital, Department of Ophthalmology, Ankara, Türkiye
2Kayseri City Hospital, Department of Ophthalmology, Kayseri, Türkiye

Bayram N, Özsaygılı C. Long-Term Outcomes of Anti-Vascular Endothelial Growth Factor Treatment. In: Çıtırık M, Şekeryapan Gediz B, editors. Age-Related Macular Degeneration: Current Investigations and Treatments. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.195-208.

ABSTRACT

Wet age-related macular degeneration (AMD) is the leading cause of irreversible and severe central vision loss among elderly individuals worldwide. It is mainly classified into dry AMD and wet AMD. Wet AMD is characterized by the growth of new blood vessels in and beneath the retina. These abnormal vessels often leak, causing fluid and/or blood to accumulate in or under the retina, which leads to significant vision loss. Diagnosis is based on clinical examination and imaging techniques such as optical coherence tomography and fluorescein angiography.

Vascular endothelial growth factor (VEGF) stimulates the proliferation of vascular endothelial cells, resulting in neovascularization and increased vascular leakage. Both processes are essential components of neoangiogenesis, along with the leakage associated with wet AMD. Intravitreal anti-VEGF therapy is the gold standard among current treatment options for preserving vision and improving outcomes. The short-term outcomes of intravitreal anti-VEGF agents, using fixed, pro re nata, and treat-and-extend regimens, are remarkably impressive. The clinical trials’ results clearly indicate that a higher number of injections is associated with improved visual acuity. However, each injection is a surgical procedure that carries potential complications related to its application and also involves extra costs. The ophthalmologist and the patient should work together to find the most appropriate regimen.

Since intravitreal anti-VEGF agents have a relatively short duration of action and do not cure AMD but only control it, they are used for long-term treatment. Three anti-VEGF agents—bevacizumab, ranibizumab, and aflibercept—are well-known drugs for intravitreal injection in the treatment of wettype AMD. Therefore, these agents have been used for a long time and have long-term outcomes. While cross-trial comparisons involve inherent risks due to differences in initial visual acuity and patient populations, long-term evidence from the literature, including ten-year results, indicates that more injections are associated with improved vision. Current studies also suggest that beginning treatment earlier may enhance long-term vision results. The existing literature does not adequately support discontinuing anti-VEGF treatment for wet AMD. These results highlight the necessity for accessible anti-VEGF therapy for wet AMD. If clinicians decide to discontinue treatment after a long period, careful selection of patients is crucial. Patients should be provided with comprehensive counseling and monitoring, and they should have the opportunity for retreatment if visual symptoms return.

Keywords: Age-related macular degeneration; Bevacizumab, ranibizumab; Aflibercept; Vascular endothelial growth factor

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