Efficacy of Intravitreal Anti-Vegf Therapy In Age-Related Macular Degeneration: A Comparative Study

Abstract

Background: Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment in older people. Intravitreal anti-VEGF therapy has revolutionized management and markedly improved functional and anatomical outcomes. Nevertheless, the comparative real-world evidence for different anti-VEGF agents remains scarce. For the optimization of treatment selection and the appropriate allocation of resources, understanding the evidence regarding the outcomes of efficacy and safety is essential.

Objectives: Evaluate and compare the outcomes in functional best-corrected visual acuity BCVA, anatomical (central macular thickness [CMT]), and safety parameters and injection frequency after 12 months as well as the efficacy of various intraocular anti-VEGF agents.

Study Design: A comparative observational study.

Place and duration of study:  Department of Ophthalmology Bacha Khan Medical College Mardan from Jan 2024 to June 2024

Methods:130 treatment-naïve neovascular AMD patients. Like patients received intravitreal ranibizumab, aflibercept, or bevacizumab in a fixed loading and PRN schedule. Several outcome variables were evaluated which included BCVA in ETDRS letters, CMT measured by OCT, frequency of injections, and occurrence of adverse events. Extraction and statistical analysis of study data were conducted by AD using SPSS v24.0 and ANOVA/Chi-square tests. A value of 0.05 was set as the cut-off for statistical significance.  

Results: 130 eyes Mean age 69.2 ± 7.4 years. At the end of the 12-month period, there was an overall improvement of BCVA of 8.5 ± 9.8 letters (ranibizumab +7.9, aflibercept +9.4, bevacizumab +8.2, p=0.39). CMT also improved (mean change of -115 ± 102 CMT, group difference, p=0.28). The proportion of eyes that register a gain of 15 letters or more were 33.1% (ranibizumab 30.7%, aflibercept 35.2%, bevacizumab 33.3%, p=0.62). Median injections decreased were 7 (IQR 6–8), with aflibercept needing less than ranibizumab and bevacizumab (p=0.04). The adverse events were rare and there were no observed cases of endophthalmitis.

Conclusion: After 12 months, all anti-VEGF agents assessed showed considerable improvements functionally and anatomically in the case of neovascular AMD, and no significant differences in efficacy were observed. Aflibercept showed a modest reduction in burden of injections as compared to ranibizumab and bevacizumab. This indicates the degree of clinical flexibility present with anti-VEGF agents, and emphasizes the need to monitor closely in order to maintain optimal vision outcomes.