Discontinuing Anti-VEGF Therapy in Patients with Neovascular Age-Related Macular Degeneration That Remains Inactive with Treatment at the Maximum Injection Interval

Günhal Şatırtav,1 Monica Karin Lövestam-Adrian,2 Woohyok Chang,3 Martín Charles,4 Lee-Jen Chen,5 Chui Ming Gemmy Cheung,6,7 Laurent Kodjikian,8,9 Masahito Ohji,10 Martin Zinkernagel,11 Sebastian Wolf11 1Department of Ophthalmology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey; 2Department of Ophthalmology, Lund University Hospital, Lund, Sweden; 3Chang’s Retina Center, Daegu, South Korea; 4Charles Centro Oftalmológico, Buenos Aires, Argentina; 5Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan; 6Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; 7Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; 8Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; 9University of Lyon 1, UMR5510 MATEIS, CNRS, INSA Lyon, Villeurbanne, France; 10Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan; 11Department of Ophthalmology, Inselspital, University of Bern, Bern, SwitzerlandCorrespondence: Günhal Şatırtav, Department of Ophthalmology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey, Email [email protected]: This review aims to provide guidance on the management of patients with neovascular age-related macular degeneration (nAMD) whose disease becomes inactive on anti-vascular endothelial growth factor (VEGF) treatment. The Vision Academy’s membership of international retinal disease experts reviewed the literature and developed consensus recommendations and an algorithm to determine the appropriate timing of treatment suspension and a post-treatment follow-up strategy for appropriate patients with nAMD who achieve a good response to anti-VEGF therapy. Patients with inactive disease (defined as absence of both intraretinal and subretinal fluid, absence of deterioration in vision, and absence of new retinal hemorrhage) for at least three consecutive maximum treatment intervals as outlined in the clinic’s protocol may be considered for treatment exit. However, in patients with stable disease that remains active and those with only one good seeing eye and a history of disease recurrence, treatment continuation may be preferred. An appropriate interval for continued monitoring with optical coherence tomography and visual acuity testing should be decided following discussion with the patient and consideration of patient-specific factors. This article presents consensus guidelines for nAMD management in patients who respond well to anti-VEGF therapy, and for the discontinuation of treatment in cases of success.Keywords: intravitreal injections, inactive disease, treatment discontinuation, treatment success