Long-Term Observational Data on Neovascular Age-related Macular Degeneration: A 10-Year Follow-up Study

Long-Term Observational Data on Neovascular Age-related Macular Degeneration: A 10-Year Follow-up Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Long-Term Observational Data on Neovascular Age-related Macular Degeneration: A 10-Year Follow-up Study Feyza Cukurova, Belgin İzgi, Zafer Cebeci, Nur Kır This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6169313/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in International Ophthalmology → Version 1 posted 9 You are reading this latest preprint version Abstract AIM: To report real-life data of eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors for an average of 10 years. METHODS: Anti-VEGF naïve eyes with nAMD and had at least 7-year follow-up at a tertiary center were evaluated. The primary outcome was a change in best-corrected visual acuity (BCVA) at 10 years; secondary outcomes included anatomical outcomes, number of injections, and examinations. RESULTS: The study included 102 eyes of 82 patients, with a mean initial age of 69.2 ± 9.7 years. The average follow-up duration was 116.19 ± 24.98 months, and the mean number of injections was 37.42 ± 15.81. Initial mean BCVA was 59.0 ± 18.3 letters, increasing to 70.55 ± 12.72 in the first year, then gradually declining to 60.44 ± 17.55 by the tenth year. Patients had an average of 6.13 ± 1.72 exams in the first year and 4.61 ± 2.60 in the last year, with 6.02 ± 1.70 injections in the first year and 3.18 ± 2.17 in the tenth year. Patients were classified as increasing, decreasing, or stable based on changes in VA by 2 lines or 10 letters. Significant variables among the groups included age (p=0.018), baseline BCVA (p=0.001), prior photodynamic therapy (PDT) (p=0.025), and retinal hemorrhage due to macular neovascularization (MNV) (p=0.049). CONCLUSION: Eyes with nAMD maintained their initial BCVA after treatment with VEGF inhibitors for 10 years. With regular and prompt treatment, functional vision can be achieved over a long period of time in nAMD. age related macular degeneration intravitreal anti-VEGF long term Synopsis In this study, mean VA was maintained from baseline to 10 years. Age, baseline VA, prior PDT, retinal hemorrhage significantly influenced visual outcomes. Regular follow-up and consistent anti-VEGF treatment can preserve vision long-term in nAMD. Introduction Age-related macular degeneration (AMD) accounts for 8% of the causes of blindness worldwide and is the most common cause of blindness in individuals over 60 years of age, particularly in developed countries( 1 ). It is expected that its prevalence will increase with an aging population. Clinically, AMD is classified as early (retinal pigment epithelial change and medium-sized drusen) to late stage (neovascular and atrophic)( 2 ). Although the dry type is more common, the wet type accounts for 90% of AMD-related blindness( 3 ). AMD is a multifactorial disease, and dysregulation of complement factors, lipid levels, and vascular, inflammatory, and extracellular matrix pathways contributes to its pathogenesis. More than 50 gene locations have been identified, with CFH and ARMS2 being the most important genes. Among non-genetic risk factors, the most important are smoking, ultraviolet radiation exposure, and a diet low in antioxidants( 2 , 4 ). The course of nAMD changed dramatically in 2006 when intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGF) was accepted as the first-line treatment. Within the first year of onset, the disease worsens and results in central vision loss, if left untreated. ( 5 ). Phase 3 and short- to medium-term observational studies have demonstrated the success of anti-VEGFs( 6 ). The 8- to 10-year follow-up results for anti-VEGF agents have recently been published in several retrospective cohort studies. These studies have shown that visual acuity cannot be preserved over the long term. The underlying reasons for this have been reported to be macular atrophy or fibrosis, which vary in frequency according to studies( 7 – 9 ). The reasons for the progression of the underlying disease should be investigated to guide the treatment of patients with nAMD. Therefore, further long-term studies are required to confirm this finding. In this study, we aimed to reveal real-life data of patients who received intravitreal anti-VEGF treatment for nAMD and were followed-up for an average of 10 years. Methods Study design The research followed the tenets of the Declaration of Helsinki and the STROBE reporting guidelines. The requirement for informed consent was waived because of the retrospective nature of the study, and a waiver was granted by the Institutional Review Board of the Istanbul University( 04.01.2023–1536721) . Patients who received intravitreal anti-VEGF treatment for nAMD diagnosis at a University Hospital between June 2006 and September 2022 and were followed up for at least seven years were included in the study, and their files were retrospectively assessed. The follow-up duration was calculated from the first injection to the final visit. Patients lost to follow-up were excluded from the study; all participants in our study cohort attended their scheduled examinations until the study's endpoint. Exclusion criteria for the study were previous anti-VEGF treatment, other ophthalmological pathologies (diabetic retinopathy, retinal vascular occlusions, inflammatory diseases, etc.), pathologies that may cause macular neovascularization (MNV), such as high myopia, angioid streaks, and previous intraocular surgery other than cataract surgery. Patients who underwent photodynamic therapy (PDT) in addition to anti-VEGF treatment were included in the study. When there was no anti-VEGF treatment in our country, some patients were treated with PDT and continued with anti-VEGF treatment. PDT was administered to patients with polypoidal choroidal vasculopathy (PCV), in addition to anti-VEGF injections when necessary. Data collected from the files included patient age, sex, systemic disease, number of injections and examinations, any complications, best-corrected visual acuity (Snellen VA converted to Early Treatment Diabetic Retinopathy Study (ETDRS) letters), anterior segment findings (such as cataract), intraocular pressure values, glaucoma presence, and fundus examination findings. Baseline fundus fluorescein angiography (FA), indocyanine green angiography (ICG) (if any), and OCT images were graded by two ophthalmologists (NK and FC) according to the Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data (CONAN)( 10 ). PCV diagnosis was confirmed using ICG. Atrophy progression was analyzed using the baseline and final red-free pictures of the eyes. This study adhered to the tenets of the Declaration of Helsinki and was approved by the Clinical Effectiveness Committee of the hospital. Treatment protocol Treatment protocol All patients received three consecutive loading anti-VEGF injections and were referred for monthly check-up BCVA measurement and biomicroscopic and fundus examination, and OCT screening was performed at each visit. Patients with no complaints during the loading dose were not re-examined. Intraocular pressure was measured in patients diagnosed with glaucoma or suspected glaucoma. The Pro-Re-Nata (PRN) protocol was the primary treatment regimen from 2006 to 2019. In 2019, some patients were treated with a treat-and-extend (TE) regimen, while others with frequent relapses were treated with fixed-interval injections every two months during the COVID-19 pandemic period. Study cohort A total of 102 eyes of 82 patients were included in the study. The primary outcome measure was change in VA. Patients whose final VA increased from baseline by ≥2 lines or ≥10 letters were considered increasing, those who lost ≥2 lines or ≥10 letters were considered decreasing, and the remaining group was considered stable. In addition, the final BCVA level was classified and analyzed according to the Snellen chart as groups 1, 2, and 3 respectively: 20/200 and below, between 20/200 and 20/40, and 20/40 and above. Patients with an increase of ≥2 lines or ≥10 letters after three loading doses were classified as patients who benefited from the treatment. Other outcomes included the percentage of quiescent eyes, central atrophy or fibrosis area at the final visit, and ocular or systemic complications. Patient and Public Involvement This study did not include direct involvement of patients or the public in its design and implementation. Statistical analysis While evaluating the findings obtained in the study, NCSS (Number Cruncher Statistical System) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) program was used for statistical analysis. Shapiro Wilks test and Box Plot graphics were used to evaluate the suitability of the data for normal distribution. Student's t-test was used to evaluate normally distributed variables in two groups; for comparisons of three or more groups, one-way ANOVA was used, and Bonferroni test was used to determine the group causing the difference. Mann Whitney U test was used to evaluate variables that do not show normal distribution according to two groups; In comparisons of three groups or more, the Kruskal Wallis test was used, and the Dunn test was used to determine the group causing the difference. Chi-Square test, Fisher Exact test and Fisher's Freeman Halton test were used to compare qualitative data. The results were evaluated at a 95% confidence interval, and the significance level was set at p < 0.05. Result Our study included 102 eyes from 82 patients who received intravitreal anti-VEGF therapy for the treatment of nAMD. Demographic characteristics are presented in Table 1 . Table 1 Distribution of Demographic Characteristics n (%) Sex Female 58 (70,7) Male 24 (29,3) Age Mean ± SD (Min-Max) 69.2 ± 9.7 (49–89) Follow-up duration (month) Mean ± SD (Min-Max) 116.2 ± 24.9 (78–190) Eye OD 52 (51.0) OS 50 (49.0) Systemic Disease None 41 (50.0) DM 4 (4.8) HT 26 (31.7) Other 4 (4.8) DM & HT 7 (8.5) MNV type Type 1 Occult / PCV 94 (92.2) / 15 (14.7) Type 2 Classic 1 (0.98) Type 3 RAP 2 (1.96) Mixt 5 (4.90) SD: Standart Deviation Min: Minimum Max: Maximum DM: Diabetes Mellitus HT: Hypertension OD: Right Eye OS: Left Eye MNV: Macular Neovascularisation PCV: Polypoidal Choroidal Vasculopathy RAP: Retinal Angiomatous Proliferation A minimum follow-up period of 7 years was noted in 102 eyes, 8 years in 84 eyes, 9 years in 64 eyes, and 10 years and above in 54 eyes. During the first visit, fundus photographs were taken in 30 patients, FA was performed in 79 patients, and both FA and ICG were performed in 41 patients. At baseline, the mean BCVA was 59.0 ± 18.3 ETDRS letters. The mean BCVA after three loading doses was 69.80 ± 13.87 letters, and the 10th Year 60.44 ± 17.55 letters. The mean BCVA values, number of injections, and visits of the patients according to the year are shown in Table 2 . When patients were classified according to their initial VA, 17 eyes (17%) were 20/200 or below on the Snellen chart, 42 eyes (41%) were between 20/200 and 20/40, and 43 eyes (42%) were 20/40 or above. At the final visit, the group with 20/200 and below had increased to 24 eyes (24%), while there were 37 eyes (36%) between 20/200 and 20/40, and 41 eyes (40%) above 20/40. When looking at the change in final vision, 17 eyes (17%) lost ≥ 10 ETDRS letters, whereas 32 eyes (31%) gained ≥ 10 letters; the group in between was considered stable: eyes (52%). Table 2 Visual Acuity, Number of Exam and Injections according to Years VA (letters) Number of Exams Number of Injection Mean ± SD Median (Min-Max) Mean ± SD Median (Min-Max) Mean ± SD Median (Min-Max) 1.year 70.55 ± 12.72 75 (20–85) 6.13 ± 1.72 6 ( 3 – 12 ) 6.02 ± 1.70 6 ( 2 – 10 ) 2.year 70.20 ± 13.09 75 (20–85) 6.13 ± 1.65 6 ( 2 – 10 ) 4.52 ± 2.30 5 (0–11) 3.year 67.13 ± 16.57 73 (10–85) 6.26 ± 2.23 6 ( 2 – 17 ) 4.27 ± 2.27 4 (0–9) 4.year 65.62 ± 16.90 70 (10–85) 6.41 ± 2.28 6 ( 2 – 17 ) 4.33 ± 2.53 5 (0–12) 5.year 63.68 ± 18.17 65 (10–85) 6.24 ± 1.80 6 (0–10) 4.31 ± 2.46 5 (0–10) 6.year 61.67 ± 17.90 65 (20–85) 5.69 ± 2.15 6 (0–12) 3.76 ± 2.13 4 (0–8) 7.year 61.00 ± 18.00 65 (10–85) 5.62 ± 2.68 6 (0–13) 3.77 ± 2.40 4 (0–8) 8.year 61.65 ± 16.57 65 (20–85) 5.50 ± 2.31 6 (0–10) 3.71 ± 2.52 4 (0–10) 9.year 60.90 ± 16.54 65 (20–85) 5.17 ± 2.36 5 (0–10) 3.55 ± 2.31 3 (0–9) 10.year 60.44 ± 17.55 65 (20–85) 4.47 ± 2.21 5 (0–11) 3.18 ± 2.17 3 (0–8) 11.year 58.77 ± 18.09 65 (20–80) 4.61 ± 2.60 4 ( 1 – 12 ) 3.48 ± 2.78 4 (0–9) SD: Standart Deviation Min: Minimum Max: Maximum 27 (26%) patients did not require injection for 9 months; however, half of them (14%) started reinjection during the follow-up. The remaining 13 eyes (13%) whose anti-VEGF treatment was discontinued during their follow-up visits did not recur and, therefore, did not require further injections. When eyes with PCV and the rest of the eyes were compared, final vision, atrophy progression, submacular hemorrhage development, and vision loss did not show a statistically significant difference (p > 0.05). Patients were categorized and compared as follows: increasing for individuals exhibiting a gain of two lines or 10 letters, decreasing for a loss of two lines or 10 letters, and stable for the remaining cohort (Table 3 ). A statistically significant difference was found between the age, and development of submacular hemorrhage (p 60 letters at the initial examination was higher than that in the stable and increasing groups. The number of patients in the stable group receiving PDT along with anti-VEGF was higher than that in the decreasing group (p = 0.025). The follow-up period, number of injections and examinations, MNV type, those who benefited from three injections, atrophy progression, vision loss, and pandemic status did not show statistically significant differences (p > 0.05). Table 3 Outcomes for decreasing (loss of 10 or more letters), stable and increasing (gain of 10 or more letters) groups p value Loss of ≥10 letters (n = 17) Stable (n = 53) Gain of ≥10 letters (n = 32) Age(years) Mean ± SD 75.0 ± 7.0 67.0 ± 10.0 69.0 ± 9.0 c 0.018* Median (Min-Max) 73 (63–86) 67 (49–87) 68 (51–89) Follow-up time (months) Mean ± SD 112.0 ± 29.0 119.0 ± 26.0 114.0 ± 21.0 c 0.549 Median (Min-Max) 114 (72–170) 119(80–190) 116 (84–160) Number of injections Mean ± SD 37.0 ± 16.0 39.0 ± 18.0 36.0 ± 12.0 c 0.673 Median (Min-Max) 38 (14–66) 37 (13–92) 38 (13–62) Number of exams Mean ± SD 52.41 ± 13.11 55.15 ± 14.4 53 ± 11.87 c 0.671 Median (Min-Max) 50 (32–77) 53 (34–104) 53 (30–84) MNV Type, n (%) Type 1 occult/PCV 15 (88.2) 50 (94.3) 29 (90.6) a 0.546 Type 2 classic 0 (0.0) 0 (0.0) 1 (3.1) Type 3 rap 1 (5.9) 1 (1.9) 0 (0.0) Mixt 1 (5.9) 2 (3.8) 2 (6.3) Baseline BCVA, n (%) > 60 17 (100.0) 23 (43.4) 17 (53.1) a 0.001** ≤ 60 0 (0.0) 30 (56.6) 15 (46.9) Eyes benefited from 3 loading doses, n (%) No 10 (58.8) 19 (35.8) 10 (31.3) a 0.160 Yes 7 (41.2) 34 (64.2) 22 (68.8) Anti VEGF / PDT n (%) Anti VEGF 16 (94.1) 41 (77.4) 31 (96.9) a 0.025* PDT + Anti-VEGF 1 (5.9) 12 (22.6) 1 (3.1) Atrophy progression n (%) Present 12 (70.6) 36 (67.9) 22 (68.8) a 1.000 Absent 5 (29.4) 17 (32.1) 10 (31.3) Submacular hemorrhage, n (%) Present 11 (64.7) 48 (90.6) 27 (84.4) a 0.049* Absent 6 (35.3) 5 (9.4) 5 (15.6) Pandemic, n (%) Continuous exam 13 (76.5) 42 (79.2) 26 (81.3) a 0.946 SD: Standart Deviation Min: Minimum Max: Maximum MNV: Macular Neovascularisation PCV: Polypoidal Choroidal Vasculopathy RAP: Retinal Angiomatous Proliferation BCVA:Best Corrected Visual Acuity PDT: Photodynamic Therapy a Fisher Freeman Halton Test c One Way Anova Test & Dunn-Bonferroni Test d Kruskal Wallis Test& Dunn-Bonferroni Test *p < 0,05 **p < 0,01 The final BCVA status was classified and analyzed according to the Snellen chart as Groups 1, 2 and 3: 20/200 and below, between 20/200 and 20/40, and 20/40 and above. Statistically significant differences were found in age, follow-up time, number of injections and examinations, baseline BCVA, and the presence of submacular hemorrhage between the groups (p < 0.05). Age, number of injections and visits, and follow-up time were significantly higher in Group 2 than in Groups 1 and 3 (p < 0.05). The baseline BCVA in Group 1 was significantly lower than the baseline BCVA in the other groups (p = 0.001). The rate of development of submacular hemorrhage during the follow-up period was lower in group 3 than in the other groups (p = 0.039). No significant difference in final BCVA status was found among patients who had previously received photodynamic therapy (PDT) and who received only anti-VEGF therapy(p = 0.061). Age, number of injections, type of MNV, and BCVA at baseline did not differ significantly between the patients with and without progression of macular atrophy (p > 0.05). However, progression of atrophy was significantly more frequent in patients who received PDT in addition to anti-VEGF treatment (p = 0.004). RPE rupture developed in 4 eyes during the follow-up period. RPE rupture was present in one patient at the first admission; in one patient, it developed after the first three injections; in one patient, it developed in the 7th year of treatment; and in one patient, it developed at the last examination at the 11th year. The final vision was 45 letters (Snellen 20/125) for the first patient, 65 letters (Snellen 20/50) for the second, 75 letters (Snellen 20/30) for the third, and 80 letters (Snellen 20/25) for the last. No serious local or systemic complications such as endophthalmitis developed in any of our patients. Vitreous hemorrhage was observed in only one patient after intravitreal injection. However, the hemorrhage resolved spontaneously. Discussion Intravitreal anti-VEGF therapy is the primary treatment for wet AMD. Since their clinical introduction, various studies have examined the optimal treatment regimens and injection frequencies, often with strict exclusion criteria. Our study aimed to provide real-life data for nAMD patients treated and monitored for approximately 10 years. In our study, the average initial vision was 59.0 ± 18.3 letters, after 3 loading injections, there was an average gain of 10.8 letters, which was maintained for the first 2 years. There are many short-term randomized controlled studies in the literature which showed similar results ( 5 , 11 , 12 ). In the SEVEN-UP study, which is a continuation of the ANCHOR, MARINA, and HORIZON studies, when the final vision was evaluated after an average of 7.3 years, a loss of 8.6 letters compared to the beginning and a loss of 22 letters compared to the 2nd year of treatment was observed, and their number of injections per year was 1.6 for 4 to 7 years ( 13 ). Although intravitreal anti-VEGF treatment may not sustain first-year success, it preserves vision better than the natural progression of the disease ( 14 ). In our study, visual acuity decreased gradually over the following years. At the end of 10 years, the average BCVA was 60.4 ± 17.5, the initial vision level was preserved, and there was a gain of 1.4 letters, but the 11-letter gain after loading treatment, which was maintained for 2 years, was significantly lost. Spooner et al. in their LATAR study, showed a gain of 3 letters after 10 years of follow-up with the modified TE regimen, In the 'The Fight Retinal Blindness!' (FRB) project, there was a gain of three letters at the end of 10 years of follow-up with the modified TE regimen and a loss of 0.9 letters in both the PRN and TE groups. There was a loss of five letters in patients who were followed for 10 years with the PRN regimen in the study conducted by Brynskov et al., and the Moorsfields group reported that there was a loss of 2.1 letters in patients who were initially treated with the PRN regimen followed by TE( 8 , 15 – 17 ). These results are similar to those of our study and show that vision levels can be preserved after 10 years. In the study conducted by Peden et al., at the end of 7 years of follow-up, they achieved a gain of 12.1 letters with an average of 10.5 injections per year, while Adrean et al. reported a gain of 8.7 letters in patients followed for an average of 8 years who had 50 or more injections during their follow-up( 18 , 19 ). A common feature of these two studies was the high average number of injections per year. While Peden et al. had been following their patients on monthly fixed doses, Adrean et al. practice the treat-extend-stop (TES) protocol. These studies indicates that the treat-and-extend approach may yield improved visual acuity outcomes and enhanced disease management, involving more injections administered during fewer clinical visits. Nevertheless, the research conducted by Peden et al and Adrean et al reported mean baseline VA scores of 45.6 and 55.6 letters, respectively, which are 14 and 4 letters lower than our study's findings. As a result, their study participants might have had a greater opportunity for improvement. Many studies on treatment regimens have been published, with variable results. Pro-re-nata (PRN), a primary treatment regimen, has been effective for years. Essentially, it involves administering treatment during follow-up as needed after a 3-month loading dose. Regimens like treat-and-extend and treat-extend-stop are commonly used and yield results comparable to fixed monthly treatments ( 19 ). In our study, there was no significant difference in the number of injections between the increasing, decreasing, and stable groups (p = 0.673). The variables that were found to be significantly different were age (p = 0.018), baseline BCVA (p = 0.001), previous PDT treatment (p = 0.025), and detection of submacular hemorrhage(p = 0.049). The mean age of the patients in the stable group was significantly lower than those in the decreasing and increasing groups (p = 0.005). Brynskov et al., Spooner et al., and SEVEN-UP found that the mean age was significantly lower in patients with increasing vision. In contrast, the Moorfields group did not show a significant difference in age( 13 , 15 – 17 ). A statistically significant difference was found in the baseline BCVA values between the decreasing, stable, and increasing groups (p = 0.001). There were more patients in the decreasing group with > 60 letters at the initial examination than in the stable and increasing groups. Despite a more frequent decline in vision among patients with higher initial visual acuity, their final vision was superior (p < 0.001). This phenomenon, known as the ceiling effect, has been well-documented in the literature. Brynskov et al. and Westborg et al. reported that patients with low initial vision experienced greater gains, although the ceiling effect was less pronounced in the Danish group ( 17 , 20 ). Conversely, the Moorfields group found that patients with letter gains had better initial visual acuity. They noted that patients starting with 52 letters or fewer had limited improvement potential, likely because of the underlying irreversible retinal damage( 16 ). According to the groups, there was a statistically significant difference between receiving anti-VEGF treatment alone or in combination with PDT (p 0.05). The efficacy of PDT in treating MNV has been previously demonstrated; however, with the advent of anti-VEGF therapy, PDT has been superseded in AMD patients, although it retains importance in PCV treatment in conjunction with anti-VEGF therapy( 21 , 22 ). Nevertheless, selective occlusion of choroidal vessels by PDT may contribute to maintaining stable VA in AMD patients in our study. This study coincided with the COVID-19 pandemic, complicating hospital access for many patients, particularly those over 65 years of age. Despite various precautions in our clinic to minimize the impact, some treatments were interrupted. A total of 22 eyes experienced a treatment break of 1 to 1.5 years. Upon separate evaluation, no significant difference in final vision was found (p = 0.946). This may be attributed to fibrosis or atrophy that develops during the natural progression of the disease despite treatment. When the patients' vision levels at the last examination were examined, 24 eyes (24%) were below 20/200, 37 eyes (36%) were between 20/200 and 20/40, and 41 eyes (40%) were above 20/40 according to the Snellen chart. After an average of 10 years, 76% of our participants were self-sufficient, while 40% had sufficient vision to drive in many countries. In the Moorfields group, 67.1% of the patients were above 20/70, 33.5% had a final vision level above 20/40, and 14% were below 20/200. In the SEVEN-UP study, one-third of the patients were above 20/70, while a quarter were above 20/40( 13 , 16 ). Similar rates have been observed in studies categorized according to vision level; however, the disease remains active in many patients. In our study, after an average of 10 years, MNV had become inactive (fibrotic or atrophic scar) in only 13 eyes (13%), with no need for injections for at least 12 months. Although effective treatment can prevent blindness in wet AMD patients, the potential for recurrence necessitates continuous follow-up. Anti-VEGF therapy raises concerns regarding long-term ocular side effects, particularly macular atrophy (MA). In our study, infrared images obtained during OCT imaging were evaluated because of the lack of fundus autofluorescence and colored fundus photography in many cases. Comparing the first and last visit images, progression of macular atrophy was noted in 70 (69%) eyes over an average follow-up period of 10 years, which is consistent with the findings of other studies (Seven up 98%, Munk et al. 74%, Li et al. 53.6%, Tsilimbaris et al. 50.9%)( 13 , 23 – 25 ). MA development is characterized by risk factors including type 3 MNV, choroidal thinning, age, and posterior vitreous detachment ( 26 ). In our study, MA progression was observed more frequently in PDT patients, possibly attributed to additional choroidal thinning. Kawai et al. reported similar results with PDT in their study involving polypoidal choroidal vasculopathy patients ( 27 ). It remains uncertain whether MA development in patients with nAMD is due to disease progression or anti-VEGF treatment. Long-term studies are yet to establish a definitive link between MA and anti-VEGF injections. The strengths of our study include the substantial sample size (102 eyes) and the extended follow-up period (mean, 116 ± 25 months). Initial examinations included fundus photography for 30 of 82 patients, FA for 79 patients, and both FA and ICG for 41 patients. The study included all patients who received anti-VEGF treatment with follow-ups of at least seven years, irrespective of initial vision, thus avoiding selection bias and reflecting real-life data. A limitation of this study is its retrospective design, which is common in long-term studies. In conclusion, for patients with nAMD, visual acuity can be significantly preserved long-term with regular follow-up and consistent intravitreal anti-VEGF treatment. Declarations Disclosure: The authors have no financial or proprietary interests in any material described in this article. The authors are responsible for the content and writing of this manuscript. Author Contribution Medical Practices: FC, BI, ZC, NK; Concept: FC, BI, ZC, NK; Design: FC, ZC,BI, NK; Data Collection or Processing: FC, NK; Analysis or Interpretation: FC, BI, ZC, NK; Literature Search: FC, ZC, NK; Writing: FC, ZC, NK References Wong WL, Su X, Li X, Cheung CMG, Klein R, Cheng C-Y, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global Health. 2014;2(2):e106-e16. Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. The Lancet. 2018;392(10153):1147–59. Pugazhendhi A, Hubbell M, Jairam P, Ambati B. Neovascular Macular Degeneration: A Review of Etiology, Risk Factors, and Recent Advances in Research and Therapy. Int J Mol Sci. 2021;22(3). Amari B, Merle BMJ, Korobelnik JF, Delyfer MN, Boniol M, Dore JF, et al. Lifetime Ambient Ultraviolet Radiation Exposure and Incidence of Age-Related Macular Degeneration. Retina. 2024;44(1):28–36. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419–31. Owen CG, Jarrar Z, Wormald R, Cook DG, Fletcher AE, Rudnicka AR. The estimated prevalence and incidence of late stage age related macular degeneration in the UK. Br J Ophthalmol. 2012;96(5):752–6. Berg K, Roald AB, Navaratnam J, Bragadottir R. An 8-year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration. Acta Ophthalmol. 2017;95(8):796–802. Gillies M, Arnold J, Bhandari S, Essex RW, Young S, Squirrell D, et al. Ten-Year Treatment Outcomes of Neovascular Age-Related Macular Degeneration from Two Regions. Am J Ophthalmol. 2020;210:116–24. Wolff B, Macioce V, Vasseur V, Castelnovo L, Michel G, Nguyen V, et al. Ten-year outcomes of anti-vascular endothelial growth factor treatment for neovascular age-related macular disease: A single-centre French study. Clin Exp Ophthalmol. 2020;48(5):636–43. Spaide RF, Jaffe GJ, Sarraf D, Freund KB, Sadda SR, Staurenghi G, et al. Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data: Consensus on Neovascular Age-Related Macular Degeneration Nomenclature Study Group. Ophthalmology. 2020;127(5):616–36. Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432–44. Ho AC, Busbee BG, Regillo CD, Wieland MR, Van Everen SA, Li Z, et al. Twenty-four-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration. Ophthalmology. 2014;121(11):2181–92. Rofagha S, Bhisitkul RB, Boyer DS, Sadda SR, Zhang K, Group S-US. Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON: a multicenter cohort study (SEVEN-UP). Ophthalmology. 2013;120(11):2292–9. Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008;115(1):116–26. Spooner K, Fraser-Bell S, Hong T, Phan L, Wong JG, Chang A. Long-term Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: The LATAR Study: Report 1: Ten-Year, Real-World Outcomes. Ophthalmol Retina. 2021;5(6):511–8. Chandra S, Arpa C, Menon D, Khalid H, Hamilton R, Nicholson L, et al. Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration. Eye (Lond). 2020;34(10):1888–96. Brynskov T, Munch IC, Larsen TM, Erngaard L, Sorensen TL. Real-world 10-year experiences with intravitreal treatment with ranibizumab and aflibercept for neovascular age-related macular degeneration. Acta Ophthalmol. 2020;98(2):132–8. Peden MC, Suner IJ, Hammer ME, Grizzard WS. Long-term outcomes in eyes receiving fixed-interval dosing of anti-vascular endothelial growth factor agents for wet age-related macular degeneration. Ophthalmology. 2015;122(4):803–8. Adrean SD, Chaili S, Ramkumar H, Pirouz A, Grant S. Consistent Long-Term Therapy of Neovascular Age-Related Macular Degeneration Managed by 50 or More Anti-VEGF Injections Using a Treat-Extend-Stop Protocol. Ophthalmology. 2018;125(7):1047–53. Westborg I, Granstam E, Rosso A, Albrecht S, Karlsson N, Lovestam-Adrian M. Treatment for neovascular age-related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register. Acta Ophthalmol. 2017;95(8):787–95. Vadalà M, Castellucci M, Guarrasi G, Cillino G, Bonfiglio VME, Casuccio A, Cillino S. Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept. Int Ophthalmol. 2022;42(2):601–610. doi: 10.1007/s10792-021-02032-4 . Epub 2022 Jan 16. PMID: 35034223. Nomura Y, Aoki S, Kitamoto K, Ueda K, Azuma K, Inoue T, Obata R. Three-year outcome of photodynamic therapy combined with VEGF inhibitor for pachychoroid neovasculopathy. Graefes Arch Clin Exp Ophthalmol. 2024;262(10):3191–3200. doi: 10.1007/s00417-024-06499-6 . Epub 2024 May 9. PMID: 38722321. Munk MR, Ceklic L, Ebneter A, Huf W, Wolf S, Zinkernagel MS. Macular atrophy in patients with long-term anti-VEGF treatment for neovascular age-related macular degeneration. Acta Ophthalmol. 2016;94(8):e757-e64. Li A, Rieveschl NB, Conti FF, Silva FQ, Sears JE, Srivastava S, et al. Long-Term Assessment of Macular Atrophy in Patients with Age-Related Macular Degeneration Receiving Anti-Vascular Endothelial Growth Factor. Ophthalmol Retina. 2018;2(6):550–7. Blazaki S, Blavakis E, Smoustopoulos G, Bontzos G, Stavrakakis A, Chlouverakis G, et al. Progression of Macular Atrophy in Patients Receiving Long-Term Anti-VEGF Therapy for Age-Related Macular Degeneration: Real-Life Data. Ophthalmologica. 2022;245(2):152–60. Foss A, Rotsos T, Empeslidis T, Chong V. Development of Macular Atrophy in Patients with Wet Age-Related Macular Degeneration Receiving Anti-VEGF Treatment. Ophthalmologica. 2022;245(3):204–217. doi: 10.1159/000520171 . Epub 2021 Oct 25. PMID: 34695835. Kawai, K., et al., Macular atrophy at 5 years after photodynamic therapy for polypoidal choroidal vasculopathy. Eye (Lond), 2022. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in International Ophthalmology → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 15 May, 2025 Reviewers agreed at journal 14 May, 2025 Reviewers agreed at journal 12 Mar, 2025 Reviewers agreed at journal 08 Mar, 2025 Reviewers invited by journal 06 Mar, 2025 Editor assigned by journal 06 Mar, 2025 Submission checks completed at journal 06 Mar, 2025 First submitted to journal 06 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6169313","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":426022035,"identity":"545f7d4c-50c5-4a36-a495-7e59979176e2","order_by":0,"name":"Feyza Cukurova","email":"data:image/png;base64,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","orcid":"","institution":"Mardin Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Feyza","middleName":"","lastName":"Cukurova","suffix":""},{"id":426022036,"identity":"5ad2a4f9-b399-407c-a3a5-8bdab0b463b6","order_by":1,"name":"Belgin İzgi","email":"","orcid":"","institution":"Istanbul University Istanbul Medical Faculty","correspondingAuthor":false,"prefix":"","firstName":"Belgin","middleName":"","lastName":"İzgi","suffix":""},{"id":426022037,"identity":"635e0547-b46c-4ca1-9b3e-fc9f6998b668","order_by":2,"name":"Zafer Cebeci","email":"","orcid":"","institution":"Istanbul University Istanbul Medical Faculty","correspondingAuthor":false,"prefix":"","firstName":"Zafer","middleName":"","lastName":"Cebeci","suffix":""},{"id":426022038,"identity":"97a60e25-4010-4797-8719-fa19ed722208","order_by":3,"name":"Nur Kır","email":"","orcid":"","institution":"Istanbul University Istanbul Medical Faculty","correspondingAuthor":false,"prefix":"","firstName":"Nur","middleName":"","lastName":"Kır","suffix":""}],"badges":[],"createdAt":"2025-03-06 09:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6169313/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6169313/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10792-025-03644-w","type":"published","date":"2025-07-01T15:58:18+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86179160,"identity":"04e298a6-4fd3-4629-84a7-012b8e960d9e","added_by":"auto","created_at":"2025-07-07 16:16:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":931440,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6169313/v1/a8750484-b503-4d08-830c-d725342226dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Long-Term Observational Data on Neovascular Age-related Macular Degeneration: A 10-Year Follow-up Study","fulltext":[{"header":"Synopsis","content":"\u003cp\u003eIn this study, mean VA was maintained from baseline to 10 years. Age, baseline VA, prior PDT, retinal hemorrhage significantly influenced visual outcomes. Regular follow-up and consistent anti-VEGF treatment can preserve vision long-term in nAMD.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eAge-related macular degeneration (AMD) accounts for 8% of the causes of blindness worldwide and is the most common cause of blindness in individuals over 60 years of age, particularly in developed countries(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is expected that its prevalence will increase with an aging population. Clinically, AMD is classified as early (retinal pigment epithelial change and medium-sized drusen) to late stage (neovascular and atrophic)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although the dry type is more common, the wet type accounts for 90% of AMD-related blindness(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAMD is a multifactorial disease, and dysregulation of complement factors, lipid levels, and vascular, inflammatory, and extracellular matrix pathways contributes to its pathogenesis. More than 50 gene locations have been identified, with CFH and ARMS2 being the most important genes. Among non-genetic risk factors, the most important are smoking, ultraviolet radiation exposure, and a diet low in antioxidants(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe course of nAMD changed dramatically in 2006 when intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGF) was accepted as the first-line treatment. Within the first year of onset, the disease worsens and results in central vision loss, if left untreated. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Phase 3 and short- to medium-term observational studies have demonstrated the success of anti-VEGFs(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 8- to 10-year follow-up results for anti-VEGF agents have recently been published in several retrospective cohort studies. These studies have shown that visual acuity cannot be preserved over the long term. The underlying reasons for this have been reported to be macular atrophy or fibrosis, which vary in frequency according to studies(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The reasons for the progression of the underlying disease should be investigated to guide the treatment of patients with nAMD. Therefore, further long-term studies are required to confirm this finding.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to reveal real-life data of patients who received intravitreal anti-VEGF treatment for nAMD and were followed-up for an average of 10 years.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003e The research followed the tenets of the Declaration of Helsinki and the STROBE reporting guidelines. The requirement for informed consent was waived because of the retrospective nature of the study, and a waiver was granted by the Institutional Review Board of the Istanbul University(\u003cem\u003e04.01.2023\u0026ndash;1536721)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003ePatients who received intravitreal anti-VEGF treatment for nAMD diagnosis at a University Hospital between June 2006 and September 2022 and were followed up for at least seven years were included in the study, and their files were retrospectively assessed. The follow-up duration was calculated from the first injection to the final visit. Patients lost to follow-up were excluded from the study; all participants in our study cohort attended their scheduled examinations until the study's endpoint.\u003c/p\u003e \u003cp\u003eExclusion criteria for the study were previous anti-VEGF treatment, other ophthalmological pathologies (diabetic retinopathy, retinal vascular occlusions, inflammatory diseases, etc.), pathologies that may cause macular neovascularization (MNV), such as high myopia, angioid streaks, and previous intraocular surgery other than cataract surgery. Patients who underwent photodynamic therapy (PDT) in addition to anti-VEGF treatment were included in the study. When there was no anti-VEGF treatment in our country, some patients were treated with PDT and continued with anti-VEGF treatment. PDT was administered to patients with polypoidal choroidal vasculopathy (PCV), in addition to anti-VEGF injections when necessary.\u003c/p\u003e \u003cp\u003eData collected from the files included patient age, sex, systemic disease, number of injections and examinations, any complications, best-corrected visual acuity (Snellen VA converted to Early Treatment Diabetic Retinopathy Study (ETDRS) letters), anterior segment findings (such as cataract), intraocular pressure values, glaucoma presence, and fundus examination findings. Baseline fundus fluorescein angiography (FA), indocyanine green angiography (ICG) (if any), and OCT images were graded by two ophthalmologists (NK and FC) according to the Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data (CONAN)(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). PCV diagnosis was confirmed using ICG.\u003c/p\u003e \u003cp\u003eAtrophy progression was analyzed using the baseline and final red-free pictures of the eyes. This study adhered to the tenets of the Declaration of Helsinki and was approved by the Clinical Effectiveness Committee of the hospital.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTreatment protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eTreatment protocol\u003c/div\u003e \u003cp\u003eAll patients received three consecutive loading anti-VEGF injections and were referred for monthly check-up BCVA measurement and biomicroscopic and fundus examination, and OCT screening was performed at each visit. Patients with no complaints during the loading dose were not re-examined. Intraocular pressure was measured in patients diagnosed with glaucoma or suspected glaucoma. The Pro-Re-Nata (PRN) protocol was the primary treatment regimen from 2006 to 2019. In 2019, some patients were treated with a treat-and-extend (TE) regimen, while others with frequent relapses were treated with fixed-interval injections every two months during the COVID-19 pandemic period.\u003c/p\u003e\n\u003ch3\u003eStudy cohort\u003c/h3\u003e\n\u003cp\u003eA total of 102 eyes of 82 patients were included in the study. The primary outcome measure was change in VA. Patients whose final VA increased from baseline by \u0026ge;2 lines or \u0026ge;10 letters were considered increasing, those who lost \u0026ge;2 lines or \u0026ge;10 letters were considered decreasing, and the remaining group was considered stable. In addition, the final BCVA level was classified and analyzed according to the Snellen chart as groups 1, 2, and 3 respectively: 20/200 and below, between 20/200 and 20/40, and 20/40 and above. Patients with an increase of \u0026ge;2 lines or \u0026ge;10 letters after three loading doses were classified as patients who benefited from the treatment. Other outcomes included the percentage of quiescent eyes, central atrophy or fibrosis area at the final visit, and ocular or systemic complications.\u003c/p\u003e\n\u003ch3\u003ePatient and Public Involvement\u003c/h3\u003e\n\u003cp\u003eThis study did not include direct involvement of patients or the public in its design and implementation.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003e While evaluating the findings obtained in the study, NCSS (Number Cruncher Statistical System) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) program was used for statistical analysis. Shapiro Wilks test and Box Plot graphics were used to evaluate the suitability of the data for normal distribution.\u003c/p\u003e \u003cp\u003eStudent's t-test was used to evaluate normally distributed variables in two groups; for comparisons of three or more groups, one-way ANOVA was used, and Bonferroni test was used to determine the group causing the difference.\u003c/p\u003e \u003cp\u003eMann Whitney U test was used to evaluate variables that do not show normal distribution according to two groups; In comparisons of three groups or more, the Kruskal Wallis test was used, and the Dunn test was used to determine the group causing the difference.\u003c/p\u003e \u003cp\u003eChi-Square test, Fisher Exact test and Fisher's Freeman Halton test were used to compare qualitative data.\u003c/p\u003e \u003cp\u003eThe results were evaluated at a 95% confidence interval, and the significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eOur study included 102 eyes from 82 patients who received intravitreal anti-VEGF therapy for the treatment of nAMD. Demographic characteristics are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of Demographic Characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (70,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (29,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Min-Max)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 (49\u0026ndash;89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up duration\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u003cstrong\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (Min-Max)\u003c/strong\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116.2\u0026thinsp;\u0026plusmn;\u0026thinsp;24.9 (78\u0026ndash;190)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eEye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystemic Disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM \u0026amp; HT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eMNV type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 1 Occult / PCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94 (92.2) / 15 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 2 Classic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 3 RAP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixt\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (4.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eSD: Standart Deviation Min: Minimum Max: Maximum DM: Diabetes Mellitus HT: Hypertension OD: Right Eye OS: Left Eye MNV: Macular Neovascularisation PCV: Polypoidal Choroidal Vasculopathy RAP: Retinal Angiomatous Proliferation\u003c/p\u003e\n\u003cp\u003eA minimum follow-up period of 7 years was noted in 102 eyes, 8 years in 84 eyes, 9 years in 64 eyes, and 10 years and above in 54 eyes. During the first visit, fundus photographs were taken in 30 patients, FA was performed in 79 patients, and both FA and ICG were performed in 41 patients.\u003c/p\u003e\n\u003cp\u003eAt baseline, the mean BCVA was 59.0 \u0026plusmn; 18.3 ETDRS letters. The mean BCVA after three loading doses was 69.80 \u0026plusmn; 13.87 letters, and the 10th Year 60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;17.55 letters. The mean BCVA values, number of injections, and visits of the patients according to the year are shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eWhen patients were classified according to their initial VA, 17 eyes (17%) were 20/200 or below on the Snellen chart, 42 eyes (41%) were between 20/200 and 20/40, and 43 eyes (42%) were 20/40 or above. At the final visit, the group with 20/200 and below had increased to 24 eyes (24%), while there were 37 eyes (36%) between 20/200 and 20/40, and 41 eyes (40%) above 20/40. When looking at the change in final vision, 17 eyes (17%) lost\u0026thinsp;\u0026ge;\u0026thinsp;10 ETDRS letters, whereas 32 eyes (31%) gained\u0026thinsp;\u0026ge;\u0026thinsp;10 letters; the group in between was considered stable: eyes (52%).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eVisual Acuity, Number of Exam and Injections according to Years\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVA (letters)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNumber of Exams\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNumber of Injection\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(Min-Max)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(Min-Max)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003cp\u003e(Min-Max)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.55\u0026thinsp;\u0026plusmn;\u0026thinsp;12.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (20\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.20\u0026thinsp;\u0026plusmn;\u0026thinsp;13.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (20\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.52\u0026thinsp;\u0026plusmn;\u0026thinsp;2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0\u0026ndash;11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.13\u0026thinsp;\u0026plusmn;\u0026thinsp;16.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (10\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.62\u0026thinsp;\u0026plusmn;\u0026thinsp;16.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (10\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0\u0026ndash;12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.68\u0026thinsp;\u0026plusmn;\u0026thinsp;18.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (10\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.67\u0026thinsp;\u0026plusmn;\u0026thinsp;17.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (20\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (0\u0026ndash;12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0\u0026ndash;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.00\u0026thinsp;\u0026plusmn;\u0026thinsp;18.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (10\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (0\u0026ndash;13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0\u0026ndash;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.65\u0026thinsp;\u0026plusmn;\u0026thinsp;16.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (20\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.90\u0026thinsp;\u0026plusmn;\u0026thinsp;16.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (20\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0\u0026ndash;10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;17.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (20\u0026ndash;85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (0\u0026ndash;11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0\u0026ndash;8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58.77\u0026thinsp;\u0026plusmn;\u0026thinsp;18.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (20\u0026ndash;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0\u0026ndash;9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eSD: Standart Deviation Min: Minimum Max: Maximum\u003c/p\u003e\n\u003cp\u003e27 (26%) patients did not require injection for 9 months; however, half of them (14%) started reinjection during the follow-up. The remaining 13 eyes (13%) whose anti-VEGF treatment was discontinued during their follow-up visits did not recur and, therefore, did not require further injections.\u003c/p\u003e\n\u003cp\u003eWhen eyes with PCV and the rest of the eyes were compared, final vision, atrophy progression, submacular hemorrhage development, and vision loss did not show a statistically significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003ePatients were categorized and compared as follows: increasing for individuals exhibiting a gain of two lines or 10 letters, decreasing for a loss of two lines or 10 letters, and stable for the remaining cohort (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). A statistically significant difference was found between the age, and development of submacular hemorrhage (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, the baseline BCVA values were significantly different between groups (p\u0026thinsp;=\u0026thinsp;0.001). The rate of patients in the decreasing group with \u0026gt;\u0026thinsp;60 letters at the initial examination was higher than that in the stable and increasing groups. The number of patients in the stable group receiving PDT along with anti-VEGF was higher than that in the decreasing group (p\u0026thinsp;=\u0026thinsp;0.025).\u003c/p\u003e\n\u003cp\u003eThe follow-up period, number of injections and examinations, MNV type, those who benefited from three injections, atrophy progression, vision loss, and pandemic status did not show statistically significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eOutcomes for decreasing (loss of 10 or more letters), stable and increasing (gain of 10 or more letters) groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLoss of \u0026ge;10 letters\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;17)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStable\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;53)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGain of \u0026ge;10 letters\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.018*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (63\u0026ndash;86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67 (49\u0026ndash;87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (51\u0026ndash;89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up time (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112.0\u0026thinsp;\u0026plusmn;\u0026thinsp;29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119.0\u0026thinsp;\u0026plusmn;\u0026thinsp;26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114.0\u0026thinsp;\u0026plusmn;\u0026thinsp;21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.549\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114 (72\u0026ndash;170)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119(80\u0026ndash;190)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116 (84\u0026ndash;160)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of injections\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.673\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (14\u0026ndash;66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (13\u0026ndash;92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (13\u0026ndash;62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of exams\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.41\u0026thinsp;\u0026plusmn;\u0026thinsp;13.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.15\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u0026thinsp;\u0026plusmn;\u0026thinsp;11.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.671\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (32\u0026ndash;77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (34\u0026ndash;104)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (30\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eMNV Type, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 1 occult/PCV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (90.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.546\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 2 classic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eType 3 rap\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixt\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline BCVA, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le;\u0026thinsp;60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (56.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eEyes benefited from 3 loading doses, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.160\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti VEGF / PDT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti VEGF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (94.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (77.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.025*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePDT\u0026thinsp;+\u0026thinsp;Anti-VEGF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eAtrophy progression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e1.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubmacular hemorrhage, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (90.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (84.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.049*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbsent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePandemic, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eContinuous exam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (79.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e0.946\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eSD: Standart Deviation Min: Minimum Max: Maximum MNV: Macular Neovascularisation PCV: Polypoidal Choroidal Vasculopathy RAP: Retinal Angiomatous Proliferation BCVA:Best Corrected Visual Acuity PDT: Photodynamic Therapy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp;\u003cem\u003ea\u003c/em\u003e\u0026nbsp;\u003c/sup\u003e \u003cem\u003eFisher Freeman Halton Test\u003c/em\u003e \u003csup\u003e\u003cem\u003ec\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eOne Way Anova Test \u0026amp; Dunn-Bonferroni Test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp;\u003cem\u003ed\u003c/em\u003e\u0026nbsp;\u003c/sup\u003e \u003cem\u003eKruskal Wallis Test\u0026amp; Dunn-Bonferroni Test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0,05 **p\u0026thinsp;\u0026lt;\u0026thinsp;0,01\u003c/p\u003e\n\u003cp\u003eThe final BCVA status was classified and analyzed according to the Snellen chart as Groups 1, 2 and 3: 20/200 and below, between 20/200 and 20/40, and 20/40 and above. Statistically significant differences were found in age, follow-up time, number of injections and examinations, baseline BCVA, and the presence of submacular hemorrhage between the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Age, number of injections and visits, and follow-up time were significantly higher in Group 2 than in Groups 1 and 3 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The baseline BCVA in Group 1 was significantly lower than the baseline BCVA in the other groups (p\u0026thinsp;=\u0026thinsp;0.001). The rate of development of submacular hemorrhage during the follow-up period was lower in group 3 than in the other groups (p\u0026thinsp;=\u0026thinsp;0.039). No significant difference in final BCVA status was found among patients who had previously received photodynamic therapy (PDT) and who received only anti-VEGF therapy(p\u0026thinsp;=\u0026thinsp;0.061).\u003c/p\u003e\n\u003cp\u003eAge, number of injections, type of MNV, and BCVA at baseline did not differ significantly between the patients with and without progression of macular atrophy (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, progression of atrophy was significantly more frequent in patients who received PDT in addition to anti-VEGF treatment (p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\n\u003cp\u003eRPE rupture developed in 4 eyes during the follow-up period. RPE rupture was present in one patient at the first admission; in one patient, it developed after the first three injections; in one patient, it developed in the 7th year of treatment; and in one patient, it developed at the last examination at the 11th year. The final vision was 45 letters (Snellen 20/125) for the first patient, 65 letters (Snellen 20/50) for the second, 75 letters (Snellen 20/30) for the third, and 80 letters (Snellen 20/25) for the last.\u003c/p\u003e\n\u003cp\u003eNo serious local or systemic complications such as endophthalmitis developed in any of our patients. Vitreous hemorrhage was observed in only one patient after intravitreal injection. However, the hemorrhage resolved spontaneously.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIntravitreal anti-VEGF therapy is the primary treatment for wet AMD. Since their clinical introduction, various studies have examined the optimal treatment regimens and injection frequencies, often with strict exclusion criteria. Our study aimed to provide real-life data for nAMD patients treated and monitored for approximately 10 years.\u003c/p\u003e \u003cp\u003eIn our study, the average initial vision was 59.0 \u0026plusmn; 18.3 letters, after 3 loading injections, there was an average gain of 10.8 letters, which was maintained for the first 2 years. There are many short-term randomized controlled studies in the literature which showed similar results (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In the SEVEN-UP study, which is a continuation of the ANCHOR, MARINA, and HORIZON studies, when the final vision was evaluated after an average of 7.3 years, a loss of 8.6 letters compared to the beginning and a loss of 22 letters compared to the 2nd year of treatment was observed, and their number of injections per year was 1.6 for 4 to 7 years (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Although intravitreal anti-VEGF treatment may not sustain first-year success, it preserves vision better than the natural progression of the disease (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In our study, visual acuity decreased gradually over the following years. At the end of 10 years, the average BCVA was 60.4 \u0026plusmn; 17.5, the initial vision level was preserved, and there was a gain of 1.4 letters, but the 11-letter gain after loading treatment, which was maintained for 2 years, was significantly lost.\u003c/p\u003e \u003cp\u003eSpooner et al. in their LATAR study, showed a gain of 3 letters after 10 years of follow-up with the modified TE regimen, In the 'The Fight Retinal Blindness!' (FRB) project, there was a gain of three letters at the end of 10 years of follow-up with the modified TE regimen and a loss of 0.9 letters in both the PRN and TE groups. There was a loss of five letters in patients who were followed for 10 years with the PRN regimen in the study conducted by Brynskov et al., and the Moorsfields group reported that there was a loss of 2.1 letters in patients who were initially treated with the PRN regimen followed by TE(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These results are similar to those of our study and show that vision levels can be preserved after 10 years. In the study conducted by Peden et al., at the end of 7 years of follow-up, they achieved a gain of 12.1 letters with an average of 10.5 injections per year, while Adrean et al. reported a gain of 8.7 letters in patients followed for an average of 8 years who had 50 or more injections during their follow-up(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). A common feature of these two studies was the high average number of injections per year. While Peden et al. had been following their patients on monthly fixed doses, Adrean et al. practice the treat-extend-stop (TES) protocol. These studies indicates that the treat-and-extend approach may yield improved visual acuity outcomes and enhanced disease management, involving more injections administered during fewer clinical visits. Nevertheless, the research conducted by Peden et al and Adrean et al reported mean baseline VA scores of 45.6 and 55.6 letters, respectively, which are 14 and 4 letters lower than our study's findings. As a result, their study participants might have had a greater opportunity for improvement. Many studies on treatment regimens have been published, with variable results. Pro-re-nata (PRN), a primary treatment regimen, has been effective for years. Essentially, it involves administering treatment during follow-up as needed after a 3-month loading dose. Regimens like treat-and-extend and treat-extend-stop are commonly used and yield results comparable to fixed monthly treatments (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, there was no significant difference in the number of injections between the increasing, decreasing, and stable groups (p\u0026thinsp;=\u0026thinsp;0.673). The variables that were found to be significantly different were age (p\u0026thinsp;=\u0026thinsp;0.018), baseline BCVA (p\u0026thinsp;=\u0026thinsp;0.001), previous PDT treatment (p\u0026thinsp;=\u0026thinsp;0.025), and detection of submacular hemorrhage(p\u0026thinsp;=\u0026thinsp;0.049).\u003c/p\u003e \u003cp\u003eThe mean age of the patients in the stable group was significantly lower than those in the decreasing and increasing groups (p\u0026thinsp;=\u0026thinsp;0.005). Brynskov et al., Spooner et al., and SEVEN-UP found that the mean age was significantly lower in patients with increasing vision. In contrast, the Moorfields group did not show a significant difference in age(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA statistically significant difference was found in the baseline BCVA values between the decreasing, stable, and increasing groups (p\u0026thinsp;=\u0026thinsp;0.001). There were more patients in the decreasing group with \u0026gt;\u0026thinsp;60 letters at the initial examination than in the stable and increasing groups. Despite a more frequent decline in vision among patients with higher initial visual acuity, their final vision was superior (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This phenomenon, known as the ceiling effect, has been well-documented in the literature. Brynskov et al. and Westborg et al. reported that patients with low initial vision experienced greater gains, although the ceiling effect was less pronounced in the Danish group (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Conversely, the Moorfields group found that patients with letter gains had better initial visual acuity. They noted that patients starting with 52 letters or fewer had limited improvement potential, likely because of the underlying irreversible retinal damage(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the groups, there was a statistically significant difference between receiving anti-VEGF treatment alone or in combination with PDT (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The proportion of PDT patients in the stable group was higher than in the decreasing group. However, the final VA of PDT patients did not differ significantly from the other group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The efficacy of PDT in treating MNV has been previously demonstrated; however, with the advent of anti-VEGF therapy, PDT has been superseded in AMD patients, although it retains importance in PCV treatment in conjunction with anti-VEGF therapy(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Nevertheless, selective occlusion of choroidal vessels by PDT may contribute to maintaining stable VA in AMD patients in our study.\u003c/p\u003e \u003cp\u003eThis study coincided with the COVID-19 pandemic, complicating hospital access for many patients, particularly those over 65 years of age. Despite various precautions in our clinic to minimize the impact, some treatments were interrupted. A total of 22 eyes experienced a treatment break of 1 to 1.5 years. Upon separate evaluation, no significant difference in final vision was found (p\u0026thinsp;=\u0026thinsp;0.946). This may be attributed to fibrosis or atrophy that develops during the natural progression of the disease despite treatment.\u003c/p\u003e \u003cp\u003eWhen the patients' vision levels at the last examination were examined, 24 eyes (24%) were below 20/200, 37 eyes (36%) were between 20/200 and 20/40, and 41 eyes (40%) were above 20/40 according to the Snellen chart. After an average of 10 years, 76% of our participants were self-sufficient, while 40% had sufficient vision to drive in many countries. In the Moorfields group, 67.1% of the patients were above 20/70, 33.5% had a final vision level above 20/40, and 14% were below 20/200. In the SEVEN-UP study, one-third of the patients were above 20/70, while a quarter were above 20/40(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Similar rates have been observed in studies categorized according to vision level; however, the disease remains active in many patients. In our study, after an average of 10 years, MNV had become inactive (fibrotic or atrophic scar) in only 13 eyes (13%), with no need for injections for at least 12 months. Although effective treatment can prevent blindness in wet AMD patients, the potential for recurrence necessitates continuous follow-up.\u003c/p\u003e \u003cp\u003eAnti-VEGF therapy raises concerns regarding long-term ocular side effects, particularly macular atrophy (MA). In our study, infrared images obtained during OCT imaging were evaluated because of the lack of fundus autofluorescence and colored fundus photography in many cases. Comparing the first and last visit images, progression of macular atrophy was noted in 70 (69%) eyes over an average follow-up period of 10 years, which is consistent with the findings of other studies (Seven up 98%, Munk et al. 74%, Li et al. 53.6%, Tsilimbaris et al. 50.9%)(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). MA development is characterized by risk factors including type 3 MNV, choroidal thinning, age, and posterior vitreous detachment (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In our study, MA progression was observed more frequently in PDT patients, possibly attributed to additional choroidal thinning. Kawai et al. reported similar results with PDT in their study involving polypoidal choroidal vasculopathy patients (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). It remains uncertain whether MA development in patients with nAMD is due to disease progression or anti-VEGF treatment. Long-term studies are yet to establish a definitive link between MA and anti-VEGF injections.\u003c/p\u003e \u003cp\u003eThe strengths of our study include the substantial sample size (102 eyes) and the extended follow-up period (mean, 116\u0026thinsp;\u0026plusmn;\u0026thinsp;25 months). Initial examinations included fundus photography for 30 of 82 patients, FA for 79 patients, and both FA and ICG for 41 patients. The study included all patients who received anti-VEGF treatment with follow-ups of at least seven years, irrespective of initial vision, thus avoiding selection bias and reflecting real-life data. A limitation of this study is its retrospective design, which is common in long-term studies.\u003c/p\u003e \u003cp\u003eIn conclusion, for patients with nAMD, visual acuity can be significantly preserved long-term with regular follow-up and consistent intravitreal anti-VEGF treatment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDisclosure:\u003c/h2\u003e \u003cp\u003eThe authors have no financial or proprietary interests in any material described in this article. The authors are responsible for the content and writing of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMedical Practices: FC, BI, ZC, NK; Concept: FC, BI, ZC, NK; Design: FC, ZC,BI, NK; Data Collection or Processing: FC, NK; Analysis or Interpretation: FC, BI, ZC, NK; Literature Search: FC, ZC, NK; Writing: FC, ZC, NK\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWong WL, Su X, Li X, Cheung CMG, Klein R, Cheng C-Y, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global Health. 2014;2(2):e106-e16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. The Lancet. 2018;392(10153):1147\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePugazhendhi A, Hubbell M, Jairam P, Ambati B. Neovascular Macular Degeneration: A Review of Etiology, Risk Factors, and Recent Advances in Research and Therapy. Int J Mol Sci. 2021;22(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmari B, Merle BMJ, Korobelnik JF, Delyfer MN, Boniol M, Dore JF, et al. Lifetime Ambient Ultraviolet Radiation Exposure and Incidence of Age-Related Macular Degeneration. Retina. 2024;44(1):28\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwen CG, Jarrar Z, Wormald R, Cook DG, Fletcher AE, Rudnicka AR. The estimated prevalence and incidence of late stage age related macular degeneration in the UK. Br J Ophthalmol. 2012;96(5):752\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerg K, Roald AB, Navaratnam J, Bragadottir R. An 8-year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration. Acta Ophthalmol. 2017;95(8):796\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillies M, Arnold J, Bhandari S, Essex RW, Young S, Squirrell D, et al. Ten-Year Treatment Outcomes of Neovascular Age-Related Macular Degeneration from Two Regions. Am J Ophthalmol. 2020;210:116\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolff B, Macioce V, Vasseur V, Castelnovo L, Michel G, Nguyen V, et al. Ten-year outcomes of anti-vascular endothelial growth factor treatment for neovascular age-related macular disease: A single-centre French study. Clin Exp Ophthalmol. 2020;48(5):636\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpaide RF, Jaffe GJ, Sarraf D, Freund KB, Sadda SR, Staurenghi G, et al. Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data: Consensus on Neovascular Age-Related Macular Degeneration Nomenclature Study Group. Ophthalmology. 2020;127(5):616\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHo AC, Busbee BG, Regillo CD, Wieland MR, Van Everen SA, Li Z, et al. Twenty-four-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration. Ophthalmology. 2014;121(11):2181\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRofagha S, Bhisitkul RB, Boyer DS, Sadda SR, Zhang K, Group S-US. Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON: a multicenter cohort study (SEVEN-UP). Ophthalmology. 2013;120(11):2292\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008;115(1):116\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpooner K, Fraser-Bell S, Hong T, Phan L, Wong JG, Chang A. Long-term Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: The LATAR Study: Report 1: Ten-Year, Real-World Outcomes. Ophthalmol Retina. 2021;5(6):511\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandra S, Arpa C, Menon D, Khalid H, Hamilton R, Nicholson L, et al. Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration. Eye (Lond). 2020;34(10):1888\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrynskov T, Munch IC, Larsen TM, Erngaard L, Sorensen TL. Real-world 10-year experiences with intravitreal treatment with ranibizumab and aflibercept for neovascular age-related macular degeneration. Acta Ophthalmol. 2020;98(2):132\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeden MC, Suner IJ, Hammer ME, Grizzard WS. Long-term outcomes in eyes receiving fixed-interval dosing of anti-vascular endothelial growth factor agents for wet age-related macular degeneration. Ophthalmology. 2015;122(4):803\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdrean SD, Chaili S, Ramkumar H, Pirouz A, Grant S. Consistent Long-Term Therapy of Neovascular Age-Related Macular Degeneration Managed by 50 or More Anti-VEGF Injections Using a Treat-Extend-Stop Protocol. Ophthalmology. 2018;125(7):1047\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestborg I, Granstam E, Rosso A, Albrecht S, Karlsson N, Lovestam-Adrian M. Treatment for neovascular age-related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register. Acta Ophthalmol. 2017;95(8):787\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVadal\u0026agrave; M, Castellucci M, Guarrasi G, Cillino G, Bonfiglio VME, Casuccio A, Cillino S. Polypoidal choroidal vasculopathy in pachychoroid: combined treatment with photodynamic therapy and aflibercept. Int Ophthalmol. 2022;42(2):601\u0026ndash;610. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10792-021-02032-4\u003c/span\u003e\u003cspan address=\"10.1007/s10792-021-02032-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2022 Jan 16. PMID: 35034223.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNomura Y, Aoki S, Kitamoto K, Ueda K, Azuma K, Inoue T, Obata R. Three-year outcome of photodynamic therapy combined with VEGF inhibitor for pachychoroid neovasculopathy. Graefes Arch Clin Exp Ophthalmol. 2024;262(10):3191\u0026ndash;3200. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00417-024-06499-6\u003c/span\u003e\u003cspan address=\"10.1007/s00417-024-06499-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2024 May 9. PMID: 38722321.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunk MR, Ceklic L, Ebneter A, Huf W, Wolf S, Zinkernagel MS. Macular atrophy in patients with long-term anti-VEGF treatment for neovascular age-related macular degeneration. Acta Ophthalmol. 2016;94(8):e757-e64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi A, Rieveschl NB, Conti FF, Silva FQ, Sears JE, Srivastava S, et al. Long-Term Assessment of Macular Atrophy in Patients with Age-Related Macular Degeneration Receiving Anti-Vascular Endothelial Growth Factor. Ophthalmol Retina. 2018;2(6):550\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlazaki S, Blavakis E, Smoustopoulos G, Bontzos G, Stavrakakis A, Chlouverakis G, et al. Progression of Macular Atrophy in Patients Receiving Long-Term Anti-VEGF Therapy for Age-Related Macular Degeneration: Real-Life Data. Ophthalmologica. 2022;245(2):152\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoss A, Rotsos T, Empeslidis T, Chong V. Development of Macular Atrophy in Patients with Wet Age-Related Macular Degeneration Receiving Anti-VEGF Treatment. Ophthalmologica. 2022;245(3):204\u0026ndash;217. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000520171\u003c/span\u003e\u003cspan address=\"10.1159/000520171\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2021 Oct 25. PMID: 34695835.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawai, K., et al., Macular atrophy at 5 years after photodynamic therapy for polypoidal choroidal vasculopathy. Eye (Lond), 2022.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"age related macular degeneration, intravitreal anti-VEGF, long term","lastPublishedDoi":"10.21203/rs.3.rs-6169313/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6169313/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAIM: \u003c/strong\u003eTo report real-life data of eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors for an average of 10 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS: \u003c/strong\u003eAnti-VEGF naïve eyes with nAMD and had at least 7-year follow-up at a tertiary center were evaluated. The primary outcome was a change in best-corrected visual acuity (BCVA) at 10 years; secondary outcomes included anatomical outcomes, number of injections, and examinations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS: \u003c/strong\u003eThe study included 102 eyes of 82 patients, with a mean initial age of 69.2 ± 9.7 years. The average follow-up duration was 116.19 ± 24.98 months, and the mean number of injections was 37.42 ± 15.81. Initial mean BCVA was 59.0 ± 18.3 letters, increasing to 70.55 ± 12.72 in the first year, then gradually declining to 60.44 ± 17.55 by the tenth year. Patients had an average of 6.13 ± 1.72 exams in the first year and 4.61 ± 2.60 in the last year, with 6.02 ± 1.70 injections in the first year and 3.18 ± 2.17 in the tenth year. Patients were classified as increasing, decreasing, or stable based on changes in VA by 2 lines or 10 letters. Significant variables among the groups included age (p=0.018), baseline BCVA (p=0.001), prior photodynamic therapy (PDT) (p=0.025), and retinal hemorrhage due to macular neovascularization (MNV) (p=0.049).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSION: \u003c/strong\u003eEyes with nAMD maintained their initial BCVA after treatment with VEGF inhibitors for 10 years. With regular and prompt treatment, functional vision can be achieved over a long period of time in nAMD.\u003c/p\u003e","manuscriptTitle":"Long-Term Observational Data on Neovascular Age-related Macular Degeneration: A 10-Year Follow-up Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-10 09:12:59","doi":"10.21203/rs.3.rs-6169313/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T19:19:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T20:25:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178724024606837241644281902104956761007","date":"2025-05-14T10:56:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253557574745791704675813635224157127952","date":"2025-03-12T06:15:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60586612363516080670066495803661150264","date":"2025-03-08T16:31:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-06T11:06:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-06T09:47:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-06T09:46:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Ophthalmology","date":"2025-03-06T09:38:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inte","sideBox":"Learn more about [International Ophthalmology](https://www.springer.com/journal/10792)","snPcode":"10792","submissionUrl":"https://submission.nature.com/new-submission/10792/3","title":"International Ophthalmology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9e00dc18-50cb-4e4a-8ab4-20362def7596","owner":[],"postedDate":"March 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:06:24+00:00","versionOfRecord":{"articleIdentity":"rs-6169313","link":"https://doi.org/10.1007/s10792-025-03644-w","journal":{"identity":"international-ophthalmology","isVorOnly":false,"title":"International Ophthalmology"},"publishedOn":"2025-07-01 15:58:18","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-03-10 09:12:59","video":"","vorDoi":"10.1007/s10792-025-03644-w","vorDoiUrl":"https://doi.org/10.1007/s10792-025-03644-w","workflowStages":[]},"version":"v1","identity":"rs-6169313","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6169313","identity":"rs-6169313","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}