Background: Neovascular (wet) age-related macular degeneration (wAMD) is a progressive and degenerative retinal disease. This study reports the real-life use in Germany of the standard anti-vascular endothelial growth factor (VEGF) therapy for wAMD as an intravitreal operative drug application.
Patients and methods: Within the framework of an international retrospective study the medical records of patients with wAMD who were first treated with ranibizumab between 1 January and 31 August 2009 were evaluated. Data were collected until the end of treatment and/or monitoring or until 31 August 2011. The primary objective was to evaluate changes in visual acuity after the start of anti-VEGF therapy. Secondary outcomes included determining real-life anti-VEGF treatment regimens and disease-monitoring practices.
Results: Out of 2227 patients who received ≥ 1 anti-VEGF injection with a baseline visual acuity assessment and ≥ 1 post-baseline visual acuity assessment for the treated eye, 420 were included in the German cohort. Visual acuity improved until about day 90 but these gains in visual acuity were not maintained. The mean changes in visual acuity scores from baseline to years 1 and 2 were 1.1 ± 15.7 and - 0.8 ± 17.2 letters, respectively. Patients received a mean of 4.3 ± 1.9 and 1.3 ± 2.2 injections in years 1 and 2, respectively. The majority of visits ( 98.6 %) were conducted irregularly and outside the time frame recommended at the time of the study, with an average of 47.7 ± 36.7 days between visits. More frequent visits and injections were associated with greater improvements in visual acuity.
Conclusion: Treatment intensity was not sufficient to maintain the initial improvement in visual acuity by ranibizumab treatment. Real-life results for visual acuity and injection frequency in the German cohort were worse at that time than in other countries. Regular follow-up visits as well as timely retreatment in the presence of signs of disease activity are required to achieve optimal results in wAMD when applying a pro re nata-based strategy.