Careful observation is needed after suspending anti-VEGF injections

This study examines the implications of suspending VEGF inhibitors for neovascular AMD when lesions have been inactive for 3 months.

Study design

The authors performed an observational study using data from patients enrolled in the Fight Retinal Blindness! Registry. Eyes were considered to have suspended treatment if they had a 3 month or longer documented period of inactivity of the choroidal neovascular lesion with no further treatments unless the lesion reactivated.

Outcomes

A total of 434 eyes were tracked for at least 12 months after treatment was suspended. The estimated percentage of eyes reactivating in the first year after treatment suspension was 41%, increasing to 79% by the fifth year. The 275 eyes that showed reactivation lost a mean of 4.2 letters (P<0.001) from the time of the last injection to the time of reactivation; 206 eyes resumed treatment for at least 12 months and recovered a mean of 1.2 letters (P=0.133), resulting in a net loss of 3.3 letters (P<0.001) compared with vision at treatment suspension.

Limitations

This is an observational study that included data from a relatively small group of patients.

Clinical significance

Less than half of eyes in which treatment was suspended reactivated within the first year, but most reactivated by the fifth year. Care should be taken to avoid suspending treatment prematurely. If treatment is suspended, close monitoring is recommended.