title: Five-year visual acuity outcomes and injection patterns in patients with pro-re-nata treatments for AMD, DME, RVO and myopic CNV.
abstract: Anti vascular endothelial growth factor (VEGF) therapy is an established treatment for various retinal diseases. Long-term data on injection frequencies and visual acuity (VA), however, are still rare.
  
  
  
  Five-year analysis of real-life VA developments and injection patterns from 2072 patients (2577 eyes; 33 187 injections) with chronically active disease undergoing pro-re-nata treatment for age-related macular degeneration (AMD), diabetic macular oedema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularisation (CNV).
  
  
  
  Maximum mean VA gain in year 1 was+5.2 letters in AMD, +6.2 in DME, +10 in RVO and+7.2 in myopic CNV. Over 5 years, however, VA in patients with AMD declined. By year 5, 34% of patients with AMD had experienced VA loss of >15 letters, 56% had remained stable and 10% had gained >15 letters. Long-term VA developments in DME and RVO were more favourable with 81% of DME and 79% of patients with RVO gaining or maintaining vision at 5 years. In AMD, median injection frequency was six in year 1 and between four and five in consecutive years. In DME and RVO, median injection frequency was six in year 1 but lower compared with AMD in consecutive years. Injection frequency in DME was weakly associated with patient age (rs=0.1; p=0.03).
  
  
  
  In AMD, the initial VA gain was not maintained long term despite higher injection numbers compared with DME, RVO and myopic CNV. The presented real-world data provide a peer-group-based estimate of VA developments and injection frequencies for counselling patients undergoing long-term anti-VEGF therapy.
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wecker
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ehlken
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Anima
authors.initials: A
authors.lastname: Bühler
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Lange
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Hansjürgen
authors.initials: H
authors.lastname: Agostini
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Böhringer
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stahl
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000188:drug therapy; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000188:drug therapy; D000069579:Ranibizumab / Q000008:administration & dosage; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D012164:Retinal Diseases / Q000188:drug therapy* / Q000503:physiopathology; D012170:Retinal Vein Occlusion / Q000188:drug therapy; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Angiogenesis; Macula; Neovascularisation; Retina