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  • Recurrence of neovascular AMD is common when treatment is suspended

    Retina/Vitreous

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    Review of: Recurrent neovascular age-related macular degeneration after discontinuation of vascular endothelial growth factor inhibitors managed in a treat-and-extend regimen

    Aslanis S, Amrén U, Lindberg C, et al. Ophthalmology Retina, January 2022

    Investigators in Sweden conducted a prospective cohort study to evaluate recurrence of active macular revascularization and visual outcomes in patients who previously underwent anti-VEGF treatment for neovascular AMD (nAMD).

    Study design

    All 102 study participants had been treated for nAMD with 3 monthly aflibercept injections upon diagnosis, and were then followed up in a treat-and-extend regimen, with extensions by 2 weeks at a time if no signs of disease activity were noted (including intraretinal macular edema, hemorrhage, or subretinal fluid seen on OCT). For patients with stable disease spanning 3 subsequent 12-week intervals in the treat-and-extend regime, treatment was stopped and they were monitored for recurrent disease requiring resumption of anti-VEGF injections. The primary outcome was recurrent disease after 12 months of follow-up.

    Outcomes

    At 12 months after the last injection, evidence of recurrent nAMD was seen in 52.9% of patients. The mean time to recurrence was 6.7 months. In patients who had recurrent disease, best-corrected visual acuity increased from 68.1 Early Treatment Diabetic Retinopathy Study (ETDRS) letters to 71.4 ETDRS letters following resumption of treatment, which was not significantly different from what was noted at study baseline (71.0 ETDRS letters).

    Limitations

    The biggest limitation of the study is the relatively small sample size, which could have masked baseline disease differences that made recurrence more or less likely.

    Clinical significance

    Recurrent nAMD is common in previously stable patients whose anti-VEGF treatments are suspended. Notably, in this study only 41% of the patients with recurrent disease showed symptoms of visual loss or metamorphopsia. Therefore, long-term follow-up is important, as early detection of recurrent nAMD can improve the chances of preserving good visual function.