Purpose: To assess the long-term visual outcome and incidence of recurrence of neovascular age-related macular degeneration (NAMD) treated with intravitreal anti-VEGF injections (IVAI).
Methods: One hundred and thirty-two consecutive eyes treated with IVAI for NAMD based on an as-needed regimen with a follow-up ≥5 years (mean 7.55, range 5-9.67) were retrospectively reviewed. Main outcome measures included visual acuity, yearly number of IVAI, and occurrence of a long-term remission, defined as no recurrence of NAMD for ≥12 consecutive months.
Results: Mean baseline visual acuity was 20/100. Mean final visual acuity change was -3.41 letters. Mean overall IVAI number was 22.8 ± 17.4 (range 2-71), decreasing from 4.6 during Year 1 to 2.21 during Year 8. A significant positive correlation was found between the number of IVAI during the first year of treatment and the overall number of IVAI during 5 years, 6 years, 7 years, or 8 years follow-up (r = 0.67-0.70, P <0.0001). Long-term remission occurred at least once in 83/132 eyes (63%) and was associated with a better visual outcome (-1.04 vs. -7.43 letters, P = 0.034). Incidence of yearly remission of NAMD increased from 28% during Year 2 to 59% during Year 8, fitting along a single straight line (+5.231%/year, R = 0.9511).
Conclusion: The incidence of recurrence of treated NAMD decreases slowly but steadily during follow-up. The number of years of follow-up is the main factor to assess the proportion of treated eyes at remission at a given moment. Incidence of recurrence of neovascularization during year 1 and length of follow-up are significant factors when tailoring an optimal long-term follow-up regimen.