Klin Monbl Augenheilkd 2016; 233(04): 471-474
DOI: 10.1055/s-0041-111835
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Long-term Results of Intravitreal Anti-VEGF Injections in Wet AMD: A Meta-Analysis

Langzeitergebnisse der intravitrealen anti-VEGF-Injektionstherapie bei feuchter altersabhängiger Makuladegeneration: Eine Meta-Analyse
H. Gerding
1   Augenzentrum Klinik Pallas, Olten, Switzerland (Director: Prof. Dr. med. Heinrich Gerding F. E. B. O.)
2   Department of Ophthalmology, University of Münster, Münster, Germany (Chairman: Prof. Dr. med. Nicole Eter)
› Author Affiliations
Further Information

Publication History

Publication Date:
26 April 2016 (online)

Abstract

Background: Although intravitreal anti-VEGF medications are widely used in age-related macular degeneration, no systematic data analysis is available on the long-term prognosis of this relatively new therapeutic approach. Material and Methods: A meta-analysis was performed on available Medline literature. 13 relevant clinical studies (14 case series) could be identified, covering 10 247 treated eyes. The majority of available reports originate from single centre retrospective real-life environments. Results: The mean improvement in average visual gain was 0.9 ± 0.5 (mean ± 1 standard deviation, median; 0.8 lines) at year 1, 1.2 ± 1.1 (median: 1.1) letters at year 2, 0.7 ± 1.0 (median: 0.7) letters at year 3, and 0.2 ± 0.8 (median: 0.5), 0.4 ± 0.4 (median: 0.5) at years 4 and 5. The drop-out rates in these studies was relatively high. At the end of year 3, the average percentage of observed eyes was 44.3 ± 18.4 % (mean ± 1 standard deviation), at the end of year 4 23.5 ± 23.9 % and after years 6 and 7 below 10 % (8.2 and 7.9 %). The mean treatment frequency of injections in all available studies was highest in year 1 (6.4 ± 1.2, 6.1 – mean ± SD; median), followed by relatively consistent mean values of 4.1 and 5.1 (year (Y)2: 4.4, Y3: 4.3, Y4: 4.7, Y5: 4.1, Y6: 5.1, Y7: 4.7) injections per year. Conclusions: The results of this meta-analysis clearly indicate that intravitreal anti-VEGF injection therapy is capable of maintaining visual acuity on a long-term basis of at least 4–5 years.

Zusammenfassung

Hintergrund: Obschon die Anwendung intravitrealer anti-VEGF-Medikamente bei der altersabhängigen Makuladegeneration weit verbreitet ist, sind bislang keine systematischen Analysen zur Langzeitprognose verfügbar. Material und Methoden: In einer Meta-Analyse (Medline) wurden 13 relevante Studien (14 Fallserien) mit insgesamt 10 247 behandelten Augen identifiziert. Die Mehrzahl dieser Artikel beschreibt monozentrische, retrospektive Fallserien. Ergebnisse: Der mittlere Visusgewinn betrug 0.9 ± 0.5 (Mittelwert ± 1 Standardabweichung; Median + 0.8 Linien) nach 1 Jahr, 1.2 ± 1.1 (Median: 1.1) Linien nach 2, 0.7 ± 1.0 (Median: 0.7) Linien nach 3 und 0.2 ± 0.8 (Median: 0.5), 0.4 ± 0.4 (Median: 0.5) Linien nach 4 und 5 Jahren. Bei hoher Ausfallrate waren nach 3 Jahren nur 44.3 ± 18.4 %, nach 4 23.5 ± 23.9 % und nach 6–7 Jahren unter 10 % (8.2 & 7.9 %) der Patienten unter Beobachtung. Die mittlere Injektionsfrequenz betrug im 1. Jahr 6.4 ± 1.2 (Median: 6.1) Injektionen und dann relativ konstant zwischen 4.1 und 5.1 (Jahr (J)2: 4.4, J3: 4.3, J4: 4.7, J5: 4.1, J6: 5.1, J7: 4.7). Schlussfolgerungen: Die Ergebnisse dieser Meta-Analyse zeigen, dass durch anti-VEGF-Injektionen über 4–5 Jahre eine langzeitige Visusstabilisierung erreicht werden kann.

 
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