EVALUATION OF ANTI-VEGF THERAPY IN AGE-RELATED MACULAR DEGENERATION

Аннотация

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. 104 Noyabr, 2025-Yil 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). Adverse events were rare, with mild subconjunctival hem