Ophthalmology ReportsOphthalmology Reports1998-71022412-5423Eco-Vector5996610.17816/OV59966Research ArticleEffects of treatment interruption on anatomical and functional status of eyes with neovascular age-related macular degeneration receiving anti-VEGF therapyKharakozovAlexandr S.<p>graduated</p>kharakozoff@mail.ruhttps://orcid.org/0000-0003-4598-0826KulikovAlexey N.<p>MD, PhD, Dr. Sci. (Med.)</p>alexey.kulikov@mail.ruhttps://orcid.org/0000-0002-5274-6993MaltsevDmitrii S.<p>MD, PhD</p>glaz.med@yandex.ruhttps://orcid.org/0000-0001-6598-3982S.M. Kirov Military Medical Academy0906202114135420302202121032021Copyright © 2021, Kharakozov A.S., Kulikov A.N., Maltsev D.S.2021<p><em>AIM:</em> To study anatomical and functional changes in eyes with neovascular age-related macular degeneration (AMD) receiving anti-VEGF therapy and experienced treatment interruption during COVID pandemic.</p>
<p><em>MATERIAL AND METHODS: </em>This retrospective study included 58 eyes (49 patients, 34 males and 15 females with a mean age of 73.2 9.4 years) with nAMD. Eyes in the first-year treatment group (18 eyes) received up to 7 intravitreal aflibercept injections, eyes in the second-year treatment group (21 eyes) were treated with <em>pro re nata </em>regimen. The treatment interruption period in the first and second-year treatment group was 5.5 0.7 and 5.5 1.0 months, respectively.</p>
<p><em>RESULTS:</em> Over the treatment interruption period, the first-year treatment group showed no statistically significant differences in best-corrected visual acuity (BCVA) and central retinal thickness (CRT), <em>p</em> = 0.25 and <em>p</em> = 0.09, respectively. At the same time, the second-year treatment group showed a statistically significant decrease in BCVA (<em>p</em> = 0.0004) and an increase in CRT (<em>p</em> = 0.002). Baseline BCVA was positively associated with BCVA at the end of treatment interruption (<em>r</em> = 0.82; <em>p</em> 0.0001). Presence of sub- and intraretinal fluid (<em>p</em> = 0.015 and <em>p</em> = 0.007, respectively), low BCVA (<em>p</em> 0.0001), high CRT (<em>p</em> = 0.019), alteration of the ellipsoid zone (<em>p</em> 0.001) were negatively associated with BCVA at the end of treatment interruption. Age (<em>p</em> = 0.8), gender (<em>p</em> = 0.41), and the number of intravitreal injections (<em>p</em> = 0.5) showed no association with changes in BCVA.</p>
<p><em>CONCLUSIONS:</em> NAMD patients of the second year of anti-VEGF therapy appear to have a higher risk of functional loss during treatment interruption. Higher CRT and lower BCVA, as well as sub- and intraretinal fluid before treatment interruption, are associated with poorer functional status at the end of the interruption period.</p>neovascular age-related macular degenerationanti-VEGF therapyafliberceptoptical coherence tomographyCOVID-19возрастная макулярная дегенерацияантиангиогенная терапияафлиберцептоптическая когерентная томографияCOVID-19[Regillo CD, Busbee BG, Ho AC, et al. Baseline predictors of 12-Month treatment response to ranibizumab in patients with wet age-related macular degeneration. Am J Ophthalmol. 2015;160(5):1014–1023. DOI: 10.1016/j.ajo.2015.07.034][Hayashi H, Yamashiro K, Tsujikawa A, et al. Association between foveal photoreceptor integrity and visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol. 2009;148(1):83–89. DOI: 10.1016/j.ajo.2009.01.017][Kharakozov AS, Kulikov AN, Maltsev DS. Predictors of functional outcome of antiangiogenic therapy in neovascular age-related macular degeneration. Ophthalmology Journal. 2020;13(4):7-13. (In Russ.)] DOI: 10.17816/OV46198][Ou WC, Brown DM, Payne JF, et al. Relationship between visual acuity and retinal thickness during anti-vascular endothelial growth factor therapy for retinal diseases. Am J Ophthalmol. 2017;180:8–17. DOI: 10.1016/j.ajo.2017.05.014][Boiko EV, Maltsev DS. Quantitative optical coherence tomography analysis of retinal degenerative changes in diabetic macular edema and neovascular age-related macular degeneration. Retina. 2018;38(7):1324–1330. DOI: 10.1097/IAE.0000000000001696][Kulikov AN, Sosnovskii SV, Berezin RD, et al. Vitreoretinal interface abnormalities in diabetic macular edema and effectiveness of anti-VEGF therapy: an optical coherence tomography study. Clin Ophthalmol. 2017;11:1995–2002. DOI: 10.2147/OPTH.S146019][American Academy of Ophthalmology. Alert: Important coronavirus updates for ophthalmologists. March 23, 2020. Available at: https://www.aao.org/headline/alert-important-coronavirus-context. Accessed: 25.03.2021.][Antaki F, Dirani A. Treating neovascular age-related macular degeneration in the era of COVID-19. Graefes Arch Clin Exp Ophthalmol. 2020;258(7):1567–1569. DOI: 10.1007/s00417-020-04693-w][Wong DHT, Mak ST, Yip NKF, et al. Protective shields for ophthalmic equipment to minimise droplet transmission of COVID-19. Graefes Arch Clin Exp Ophthalmol. 2020;258(7):1571–1573. DOI: 10.1007/s00417-020-04683-y][Sacconi R, Borrelli E, Vella G, et al. TriPla regimen: A new treatment approach for patients with neovascular age-related macular degeneration in the COVID-19 “era”. Eur J Ophthalmol. 2020;7:1120672120963448. DOI: 10.1177/1120672120963448][The Royal College of Ophthalmologists (2020) Medical retinal management plans during COVID-19. Available at: https://www.rcophth.ac.uk/wp-content/uploads/2020/03/Medical-Retinal-Management-Planduring-COVID-19-UPDATED-300320-1-2.pdf. Accessed 25.03.2021.]