title: Vision-threatening lesions developing with longer-term follow-up after treatment of neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To assess the development of vision-threatening lesions at least 3.5 years after initiating anti-vascular endothelial growth factor (VEGF) for choroidal neovascularization (CNV) in eyes with age-related macular degeneration (AMD).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 75 patients (81 eyes) with CNV secondary to AMD who received intravitreous anti-VEGF treatment and were followed for at least 3.5 years after initiating treatment.
  
  
  METHODS
  Retrospective record review of patients initiating anti-VEGF treatment between November 2005 and June 2008 at a university-based institution for whom at least 3.5 years of follow-up was available at the same institution.
  
  
  METHODS
  Predominantly hemorrhagic lesions or geographic atrophy (GA).
  
  
  RESULTS
  Among 75 patients (81 eyes; 59% were women; median age, 78 years), mean follow-up was 4.9 years and at least 6 years for 40%. Median visual acuity (VA) was 20/80 (interquartile range [IQR], 20/50-20/100) initially, 20/63 (IQR, 20/40-20/160) at 2 years, 20/80 (IQR, 20/40-20/200) at 3.5 years, and 20/63 (IQR 20/32-20/200) at 6 years. Six eyes (7%) had predominantly hemorrhagic lesions initially, whereas this developed in an additional 3 eyes (4%, 95% confidence interval [CI], 1% to 10%) in 3.5 years and in 1 additional eye (1%, 95% CI, 0.03% to 7%) at more than 3.5 years of follow-up. Initially, GA within or overlapping the boundary of the entire CNV was present in 4 eyes (5%) and outside this boundary in 8 eyes (10%). Geographic atrophy enlarged in each eye over time. The only eyes that developed GA outside the CNV boundary were those that had GA outside the lesion at baseline. Additional atrophy within the boundary of CNV defined at baseline, termed "atrophic disciform scars," developed in 5 eyes (6%), all within 4 years of treatment initiation.
  
  
  CONCLUSIONS
  Longer-term follow-up of neovascular AMD managed with anti-VEGF therapy suggests that predominantly hemorrhagic lesions may develop within 3.5 years of initiating therapy and more than 3.5 years after initiating therapy. In contrast, new areas of GA beyond the boundaries of the CNV lesion as defined at initiation of anti-VEGF therapy seem unlikely to develop if there is no GA outside of the CNV lesion initially.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Erika
authors.initials: E
authors.lastname: Tanaka
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Voraporn
authors.initials: V
authors.lastname: Chaikitmongkol
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Bressler
authors.affiliation: Retina Division, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. Electronic address: nmboffice@jhmi.edu.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Bressler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D000068258:Bevacizumab; D015331:Cohort Studies; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D057092:Geographic Atrophy / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D012166:Retinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000139:chemically induced* / Q000175:diagnosis; D014792:Visual Acuity / Q000187:drug effects; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab