Outcomes of 16-week extension of anti-VEGF therapy in neovascular age-related macular degeneration.

OBJECTIVE: To determine the outcomes of extending anti-VEGF injection intervals to 4 months in neovascular age-related macular degeneration (nAMD).

DESIGN: A prospective cohort study.

PARTICIPANTS: Patients undergoing injections with standard-dose anti-VEGF (aflibercept, ranibizumab) with documented disease stability at 3-month injection intervals for ≥2 years.

METHODS: The injection interval was extended to 4 months. The primary outcome of disease stability was defined as no clinical evidence of lesion growth, blood, or intraretinal or new subretinal fluid seen on ocular coherence tomography (OCT). Demographic data, visual acuity, exam findings, and OCT data were collected.

RESULTS: This study included 88 eyes (83.4 ± 7.3 years, 64.8% female) with nAMD extended to injection intervals of 4 months (56 eyes with aflibercept and 32 with ranibizumab). The recurrence rate was 10.2% (9/88). Four eyes recurred after the first 4-month extension interval, 2 eyes at the 8-month follow-up, 2 eyes at 16 months, and 1 eye at 22 months. In eyes with a recurrence (n = 9), there was no significant difference (p > .05) between mean visual acuity prior to recurrence (0.18 ± 0.13 [20/30]) and at final follow-up postrecurrence (0.21 ± 0.17 [20/30]). All but 1 case returned to within 1 Snellen line of visual acuity at final follow-up. All eyes were able to regain stability at 3- or 4-month injection intervals.

CONCLUSIONS: In nAMD patients with disease stability at 3-month injection intervals for at least 2 years, the majority remained stable when extended to 4 months. Recurrences were able to achieve stability again with shorter injection intervals, without a persistent decline in visual acuity.