Effectiveness of treatment of exudative age-related macular degeneration with anti-vascular endothelial growth factor drugs

Melo, Raquel Coelho de Souza Lima; Souza, Carolina Costa da Silva; Ledo, Iasmin Cardoso; Amorim, Ester; Oliveira, Dayse Cury de Almeida; Boa-Sorte, Ney

doi:10.37039/1982.8551.20240039

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Revista Brasileira de Oftalmologia

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Original Article • Rev. bras.oftalmol. 83 • 2024 • https://doi.org/10.37039/1982.8551.20240039 copy

Effectiveness of treatment of exudative age-related macular degeneration with anti-vascular endothelial growth factor drugs

Efetividade do tratamento da doença macular relacionada à idade exsudativa com drogas antifactor de crescimento endotelial vascular

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To characterize the effectiveness of anti-vascular endothelial growth factor drugs in exudative age-related macular degeneration.

Methods:

Retrospective longitudinal study of 54 patients with age-related macular degeneration receiving bevacizumab or aflibercept. Demographic data, visual acuity, and central retinal thickness measurements were collected. Improvement/stability of visual acuity and reduction in retinal thickness configured satisfactory responses.

Results:

Among the 60 eyes studied, there was no difference (p = 0.262) in satisfactory response when using bevacizumab (48.5%) or aflibercept (63.0%). Snellen’s visual acuity, letter gain, and retinal thickness showed improvement or maintenance in 55.0%, 32.8%, and 78.3% of cases, respectively. The percentage of improvement/maintenance was higher in eyes with an initial visual acuity of < Snellen 20/400 (70.0% versus 40.0%; p = 0.002).

Conclusion:

A higher percentage of improvement/stabilization of visual acuity and macular thickness was observed in patients with age-related macular degeneration, with better response in patients with visual acuity worse than Snellen 20/400.

Keywords:
Retina; Macular degeneration; Bevacizumab; Visual acuity; Effectiveness

Features
Sex
	Male	20 (35.9)
	Female	34 (64.1)
Age (at first anti-VEFG injection), years old
	Under 60	3 (5.6)
	60-70	15 (27.8)
	70-80	20 (37.0)
	Over 80	16 (29.6)
Economic activity
	Retired	22 (40.7)
	Housewife	1 (1.9)
	Work activity	4 (7.4)
	Not informed	27 (50.0)
	Hypertension present	30 (55.6)
	DM present	15 (27.8)
	Previous pan-retinal photocoagulation	4 (7.4)
Associated ophthalmic changes
	Glaucoma	8 (14.8)
	Cataract	20 (40.8)
	Use of FACO during treatment	5 (9.3)
	Use of eye drops	9 (16.7)
	Ocular hypotensive	7 (77.7)
	Lubricant	1 (11.1)
	Dimethylpolysiloxane	1 (11.1)

Visual acuity^* * Classification according to I Brazilian Consensus on Low Vision.(14)		All	Aflibercept	Bevacizumab
Mild disability or no visual impairment (0)		9 (15.0)
	20/30	3 (5.0)	–	3 (100.0)
	20/60	1 (1.7)		1 (100.0)
	20/70	5 (8.3)	2 (40.0)	3 (60.0)
Moderate visual impairment (1)		21 (35.0)
	20/80	1 (1.7)	–	1 (100.0)
	20/100	4 (6.7)	1 (25.0)	3 (75.0)
	20/200	16 (26.7)	7 (43.8)	9 (56.2)
Severe visual impairment (2)		3 (5.0)
	20/400	3 (5.0)	–	3 (100.0)
Blindness (3)		27 (45.0)
	20/600	2 (3.3)	1 (50.0)	1 (50.0)
	20/800	2 (3.3)	1 (50.0)	1 (50.0)
	20/1000	8 (13.3)	4 (50.0)	4 (50.0)
	20/1200	15 (25.1)	11 (73.3)	4 (26.7)

Initial visual acuity^* * Classification according to I Brazilian Consensus on Low Vision.(14)		Final visual acuity^* * Classification according to I Brazilian Consensus on Low Vision.(14)
		N(%)	Light DV (0)	DV Mod (1)	Severe DV (2)	Blindness (3)	Blindness (4)
Mild disability or no visual impairment (0)		9 (15.0)	3 (33.3)	2 (22.2)	1 (11.1)	3 (33.3)	0
	20/30	3 (5.0)	2 (66.7)	–	1 (33.3)	–	–
	20/60	1 (1.7)	–	1 (100.0)	–	–	–
	20/70	5 (8.3)	1 (20.0)	1 (20.0)	–	3 (60.0)	–
Moderate visual impairment (1)		21 (35.0)	5 (23.8)	8 (38.1)	1 (4.8)	6 (28.6)	1 (4.8)
	20/80	1 (1.7)	–	1 (100.0)	–	–	–
	20/100	4 (6.7)	1 (25.0)	1 (25.0)	–	2 (50.0)	–
	20/200	16 (26.7)	4 (25.0)	6 (27.5)	1 (6.25)	4 (25.0)	1 (6.25)
Severe visual impairment (2)		3 (5.0)	1 (33.3)	–	1 (33.3)	1 (33.3)	–
	20/400	3 (5.0)	1 (33.3)	–	1 (33.3)	1 (33.3)	–
Blindness (3)		27 (45.0)	2 (7.4)	5 (18.5)	1 (3.7)	15 (55.6)	4 (14.8)
	20/600	2 (3.3)	–	–	–	2 (100.0)	–
	20/800	2 (3.3)	–	1 (50.0)	–	–	1 (50.0)
	20/1000	8 (13.3)	1 (12.5)	1 (12.5)	–	5 (62.5)	1 (12.5)
	20/1200	15 (25.0)	1 (6.7)	3 (20.0)	1 (6.67)	8 (52.3)	2 (13.3)

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[1] Corresponding author: Ney Boa-Sorte Av. Dom João VI, 275, Brotas 40290-000, Salvador, BA, Brazil E-mail: neyboasorte@bahiana.edu.br