Real-world safety and efficacy of Anti-VEGF treatment in Brazil

This retrospective study evaluated the safety and efficacy of real-world antiangiogenic therapy for ocular conditions in the private healthcare sector in southern Brazil.

Medical records from patients who underwent intravitreal anti-vascular endothelial growth factor injections over the past 12 years were reviewed retrospectively. Data collection included the primary diagnoses, drugs administered, injection techniques, adverse effects, and treatment efficacy. Efficacy was assessed by comparing preand posttreatment visual acuity and central subfield thickness in eyes with followup exceeding 2 years.

A total of 1,024 patients, 1,310 treated eyes, and 11,377 injections were analyzed. The injections included aflibercept (6,833), ranibizumab (3,692), bevacizumab (843), and brolucizumab (9), administered either bilaterally (3,696) or unilaterally (7,681). The most common diagnoses were diabetic macular edema, exudative age-related macular degeneration, retinal vein occlusion related macular edema, and proliferative diabetic retinopathy. No endophthalmitis cases were reported. Vitritis with transient visual acuity loss occurred in two cases following aflibercept injections. One retinal detachment case was successfully treated with vitrectomy. The median number of injections per patient was 6 (IQR [interquartile range], 3-13). Among 445 eyes from 328 patients with followup over 2 years (median, 4.05 years; IQR, 2.89-6.29), there was a significant improvement in best-corrected visual acuity from 0.3 to 0.4 (Snellen) (p<0.001) and a reduction in central subfield thickness from 361 to 267 microns (p<0.001). CST comparisons included patients with age-related macular degeneration, diabetic macular edema, and retinal vein occlusion related macular edema.

This real-world study, the largest of its kind in Brazil, confirms the safety and efficacy of antiangiogenic therapies in the southern Brazilian private healthcare system. The findings highlight a low incidence of severe adverse events and outcomes consistent with global studies, supporting the ongoing use of antiangiogenic agents as effective and well-tolerated treatments for various ocular conditions in developing countries.