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EVALUATION OF ANTI-VEGF THERAPY IN AGE-RELATED MACULAR
DEGENERATION
Jalalova Dilfuza Zuhridinovna
Scientific supervisor.
Department of Ophthalmology, Samarkand State Medical University
Kasimov Turdali
Samarkand State Medical University, Department of Ophthalmology,
2st year clinical ordinator.
https://doi.org/10.5281/zenodo.17584019
Annotation.
Age-related macular degeneration (AMD) is a leading cause of irreversible
central vision loss among the elderly, profoundly impacting quality of life and independence. The
advent of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy revolutionized
the management of neovascular (wet) AMD, shifting treatment goals from mere stabilization of
vision to meaningful visual improvement. This study evaluates the long-term clinical efficacy,
safety, and outcomes of anti-VEGF therapy in patients with various stages of neovascular AMD.
Data from 230 patients treated over a 24-month period were analyzed, focusing on best-
corrected visual acuity (BCVA), central retinal thickness (CRT), and frequency of injections.
Results revealed significant improvement in BCVA and reduction in CRT within the first year,
followed by a plateau phase with maintenance dosing. Anti-VEGF agents, including ranibizumab,
aflibercept, and bevacizumab, demonstrated comparable safety profiles with minimal adverse
effects. The findings emphasize the necessity of individualized treatment regimens, adherence to
follow-up schedules, and early intervention to maximize therapeutic outcomes.
Keywords
: Age-related macular degeneration, anti-VEGF, ranibizumab, aflibercept,
bevacizumab, intravitreal injection, visual acuity, retinal thickness, neovascular AMD,
ophthalmology.
Introduction
Age-related macular degeneration is a chronic, progressive retinal disorder
primarily affecting the macula, the central region responsible for sharp, detailed vision. It is a
multifactorial disease associated with aging, oxidative stress, genetic predisposition, and
environmental influences such as smoking and poor nutrition. The disease manifests in two main
forms: the dry (atrophic) type, characterized by drusen deposits and retinal pigment epithelium
(RPE) atrophy, and the wet (neovascular) type, which involves abnormal choroidal
neovascularization leading to fluid leakage, hemorrhage, and rapid central vision loss. Before the
introduction of anti-VEGF therapy, treatment options were limited to photodynamic therapy and
laser photocoagulation, both of which offered limited efficacy and risked collateral retinal damage.
VEGF, a key mediator of angiogenesis, plays a central role in the pathogenesis of neovascular
AMD. Inhibition of VEGF signaling has proven effective in reducing vascular permeability and
neovascular growth, thereby preserving retinal integrity. Anti-VEGF agents, such as ranibizumab,
aflibercept, and off-label bevacizumab, are now the standard of care, offering significant
improvements in visual outcomes and quality of life.
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This study aims to evaluate the efficacy and safety of these agents through longitudinal
assessment of anatomical and functional parameters, emphasizing evidence-based optimization of
dosing strategies and individualized patient management.
Materials and Methods
The study included 230 patients (124 females, 106 males) aged
55–87 years with clinically and angiographically confirmed neovascular AMD. Inclusion criteria
were treatment-naïve patients with active choroidal neovascularization and baseline BCVA
ranging between 20/40 and 20/400. Exclusion criteria included other retinal vascular disorders,
diabetic macular edema, uveitis, and history of intraocular surgery within six months. Patients
were divided into three groups based on the anti-VEGF agent used: Group A received
ranibizumab (0.5 mg/0.05 ml), Group B received aflibercept (2.0 mg/0.05 ml), and Group C
received bevacizumab (1.25 mg/0.05 ml). All injections were administered intravitreally under
sterile conditions following a treat-and-extend protocol after an initial loading phase of three
monthly injections. Comprehensive ophthalmologic evaluation, including BCVA using ETDRS
charts, spectral-domain optical coherence tomography (SD-OCT), fundus fluorescein angiography
(FFA), and intraocular pressure measurement, was performed at baseline and every three months
thereafter. The primary outcome measures were change in BCVA and CRT over 24 months.
Safety assessments included intraocular inflammation, endophthalmitis, retinal detachment,
and systemic vascular events. Statistical analyses were conducted using paired t-tests and
ANOVA, with p-values <0.05 considered significant.
Results
Significant improvement in BCVA was observed in all treatment groups at three
months, with mean gain of +8.9 letters in Group A (ranibizumab), +9.3 in Group B (aflibercept),
and +8.4 in Group C (bevacizumab). Mean CRT reduction after the first three injections was 134
μm, 145 μm, and 128 μm, respectively. At 12 months, 78% of patients maintained or improved
vision, and 42% gained ≥15 ETDRS letters. Visual and anatomical improvements were sustained
through 24 months with a mean injection frequency of 7.5 per year. No significant differences in
visual outcomes were detected between treatment groups (p>0.05). Adverse events were rare, with
mild subconjunctival hemorrhage (12%), transient intraocular pressure rise (5%), and isolated
cases of mild anterior uveitis (2%). No instances of endophthalmitis or retinal detachment
occurred. Patients receiving consistent follow-up demonstrated better visual preservation
compared to those with irregular attendance (p<0.01). Long-term OCT monitoring revealed
stabilization of retinal structure, resolution of intraretinal and subretinal fluid, and restoration of
foveal contour in responsive cases.
Discussion
The study confirms that anti-VEGF therapy remains the gold standard for
managing neovascular AMD, offering sustained visual and anatomical benefits with acceptable
safety. Ranibizumab, aflibercept, and bevacizumab demonstrate equivalent efficacy when
administered under structured regimens. The observed early improvement in BCVA and CRT
reduction underscores the significance of early diagnosis and prompt treatment initiation.
Individual response variability suggests that tailored dosing strategies, such as treat-and-extend
and PRN protocols, optimize therapeutic efficacy while minimizing patient burden and healthcare
costs. Aflibercept’s longer binding affinity to VEGF may allow for extended dosing intervals,
enhancing patient adherence. Regular OCT monitoring is essential for guiding retreatment
decisions and detecting subclinical recurrence.
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Although anti-VEGF therapy primarily targets vascular proliferation, future directions
include combination therapy with anti-inflammatory or neuroprotective agents to address the
multifactorial nature of AMD. Long-term management requires a holistic approach, including
nutritional support, smoking cessation, and genetic counseling. The minimal adverse event rate
observed supports the long-term safety of intravitreal anti-VEGF injections when performed under
aseptic conditions.
Conclusion
Anti-VEGF therapy significantly improves and stabilizes vision in patients
with neovascular AMD, reducing retinal thickness and preventing further visual deterioration. The
study demonstrates comparable efficacy and safety among ranibizumab, aflibercept, and
bevacizumab, highlighting the value of individualized treatment regimens and regular monitoring.
Early intervention, adherence to therapy, and lifestyle modifications remain critical for
long-term visual preservation. Continuous evaluation of real-world data and incorporation of
emerging therapeutic strategies will further refine AMD management and patient outcomes.
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