Intravitreal Anti-Vascular Endothelial Growth Factor Agents in Patients with Neovascular Age-Related Macular...

The purpose of this systematic review and meta-analysis is to evaluate the outcomes of continuing versus discontinuing intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment at various follow-up time-points in neovascular age-related macular degeneration (nAMD) patients who developed retinal pigment epithelium (RPE) tears following anti-VEGF therapy.

Relevant publications were identified through a systematic search in the PubMed and EMBASE databases. The standardized mean differences (SMD), with their 95% confidence intervals (95% CI), were estimated using random effects models (DerSimonian-Laird), as appropriate. Meta-regression analysis was also performed.

Thirty studies (including 479 eyes with RPE tear) were eligible for the systematic review and meta-analysis. These studies examined the outcomes in patients who continued anti-VEGF treatment post-tear and those who discontinued it, with comparisons made separately for different timepoints in each group. In patients who continued anti-VEGF treatment, the pooled best-corrected visual acuity (BCVA) showed no statistically significant difference compared to baseline at any time-point of the follow-up. The pooled central subfield thickness (CST) improved at 12 months, but did not reach a significant level (SMD -0.45; 95% CI: -0.99, 0.10, I² = 49.5%, p = .159). Long-term follow-up indicated a decrease in the presence of subretinal and intraretinal fluid. In patients who discontinued intravitreal anti-VEGF treatment, there was a non-significant improvement in BCVA within the first 3 months; however, BCVA fluctuated or worsened over time, and fibrosis development was observed.

This systematic review and meta-analysis found that intravitreal injections of anti-VEGF do not significantly impact visual acuity in patients with RPE tears at various follow-up timepoints, but may provide anatomical improvement.