Anti-VEGF injections and macular atrophy progression in patients with neovascular age-related macular degeneration in remission

Aims To determine the effect of continuing anti-vascular endothelial growth factor (VEGF) injections on the progression of macular atrophy (MA) during remission of neovascular age-related macular degeneration (nAMD). Methods In this retrospective cohort study, 59 eyes with nAMD with at least 6-month remission (disease inactivity) were analysed and were grouped into two. In group 1, anti-VEGF injections were stopped after remission (holiday). In group 2, injections were continued despite inactivity (maintenance). Using blue autofluorescence images via Heidelberg Spectralis, MA area was measured at initial injection, remission onset and the latest available remission point. The absence of subretinal haemorrhage, intraretinal fluid, subretinal fluid or subretinal hyper-reflective material associated with fluid on serial spectral domain optical coherence tomography scans was used to confirm the inactivity of the disease (remission). The rate of progression of MA during the period of remission was measured for the two groups. Results In group 1, 30 eyes received a mean of 16.97 injections over 39.2 months, followed by 21 months of drug holiday. In group 2, 29 eyes received a mean of 27.1 injections over 62.16 months, followed by a mean of 11.59 injections over 19.32 months for maintenance. The MA in the maintenance group progressed faster than the holiday group during remission (p=0.03). Conclusions Maintenance injections for nAMD in remission significantly increase progression of MA. Data are available on reasonable request. Data are available on reasonable request to WRF.