Jornal de Ensaios Clínicos
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Complications after Anti-Vascular Endothelial Growth Factor Treatment of Patients with Wet Age-Related Macular Degeneration

Christina Vidinova*, Dafina Antonova, Kalin Vidinov

Anti-Vascular Endothelial Growth Factor (VEGF) therapy is the leading treatment strategy for Age-related Macular Degeneration (AMD). Although this treatment generally improves VA of the affected patients, its prolonged application can lead to serious complications.

Purpose: The purpose of our study is to outline the possible long term complications of anti-VEGF treatment in AMD patients and to outline eventual ways to avoid some of them.

Methods: In our prospective study 42 patients with wet AMD were enrolled. They all underwent a complete ophthalmological examination including Visual Acuity (VA), fundus photography, structural Optical Coherence Tomography (OCT) (Revue, Optovue) and OCT-A (Angiophlex, Zeiss). All of the patients were treated with aflibercept (Eylea)-in the Treat and Extend regiment for a period of 2 years. The mean number of injections was 15 ± 2. All patients were evaluated for possible complications after the 2 year period.

Results: The long term complications we encounter can be summarized in percentage % as follows:

• Tachyphylaxis to the treatment drug-20%

• RPE Tear-10 %

• Retinal fibrosis and scar formation-32%-35%

• Retinal atrophy 25%

In 20% of the patients a tachyphylaxis developed after the first year, which leads to lower effect of the drug on the course of treatment. Discontinuation of the treatment or change to another drug helped against that complication. In 10% of the cases Retinal Pigment Epithelial (RPE) tear developed usually in cases with RPE detachment, large in area and height. Retinal fibrosis was the most serious complication. In our study it developed mainly in patients with lower VA at baseline, with macular hemorrhages or intraretinal cysts. Retinal fibrosis developed usually after the 8 intravitreal injection. In 25% retinal atrophy developed

Conclusion: Complications of anti-VEGF therapy are relatively rare but leading to devastating results. The stronger the action of the anti-VEGF drug the more frequent the complications, especially fibrosis. Early recognition of the risk factors such as low vision at the beginning. Intraretinal cysts, macular hemorrhages and large area of CNV are a prerequisite for a successful prophylaxis of the possible complication.