Long-term follow-up of vascular endothelial growth factor inhibitor therapy for neovascular age-related macular degeneration

Curr Opin Ophthalmol. 2013 May;24(3):190-6. doi: 10.1097/ICU.0b013e32835fefee.


Purpose of review: To discuss the most recent literature regarding the long-term use (≥52 weeks of follow-up) of antivascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (NVAMD).

Recent findings: Intravitreal ranibizumab has been demonstrated to provide outstanding vision outcomes relative to the standard therapy in patients with NVAMD. The VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD studies showed that patients managed with intravitreal aflibercept achieved visual acuity and anatomic improvements similar to individuals managed with monthly ranibizumab while receiving an average of five fewer injections during the first 12 months of treatment. In the Comparison of AMD Treatment Trials, intravitreal bevacizumab dosed monthly met noninferiority to ranibizumab monthly, as well as noninferiority to ranibizumab dosed as-needed with respect to change in visual acuity 1 year after the treatment initiation. Furthermore, patients switched to as-needed regimens in their second year of follow-up from monthly dosing during the first year demonstrated an incremental loss of visual acuity during the second year of follow-up irrespective of the drug used. To date, trials evaluating anti-VEGF therapy for NVAMD demonstrate a low incidence of serious ocular or systemic adverse events. However, the potential for deleterious effects of long-term (beyond 2 years) pan-VEGF blockade remains unknown.

Summary: Patients with NVAMD enjoy heretofore unprecedented vision gains when managed with anti-VEGF therapy, and the limited body of evidence to date regarding long-term anti-VEGF treatment shows these vision gains can be maintained through 2 years. Further investigation is needed to explore the effects of long-term anti-VEGF therapy beyond 2 years.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Bevacizumab
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections
  • Ranibizumab
  • Receptors, Vascular Endothelial Growth Factor / adverse effects
  • Receptors, Vascular Endothelial Growth Factor / therapeutic use
  • Recombinant Fusion Proteins / adverse effects
  • Recombinant Fusion Proteins / therapeutic use
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Visual Acuity / physiology
  • Wet Macular Degeneration / drug therapy*
  • Wet Macular Degeneration / physiopathology


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Recombinant Fusion Proteins
  • Vascular Endothelial Growth Factor A
  • aflibercept
  • Bevacizumab
  • Receptors, Vascular Endothelial Growth Factor
  • Ranibizumab