Outcomes of Intravitreal Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration in Kazakhstan

Abstract

Background: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss among older adults. Although randomised controlled trials have demonstrated the robust efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, real-world outcomes often differ markedly from trial findings. This study aimed to evaluate the anatomical and functional outcomes of anti-VEGF therapy in a clinical cohort of nAMD patients, including a subgroup that received adjunctive rescue photodynamic therapy (PDT) with verteporfin. Methods: This single-centre, retrospective observational cohort study included 568 patients (634 eyes) with nAMD treated with intravitreal anti-VEGF injections. Bevacizumab was used in 49% of eyes, ranibizumab in 44%, and aflibercept in 7%. Best recorded visual acuity (BRVA) and central retinal thickness (CRT) measured by optical coherence tomography (OCT) were recorded at baseline and at the final documented follow-up. Eyes with eccentric fixation were excluded from BRVA analysis but were retained for CRT analysis. Results: Mean patient age was 71.7 ± 8.8 years, and 67.6% of eyes were from female patients. The mean number of anti-VEGF injections was 5 ± 5.3 per eye; the mean follow-up duration was 11.5 months. Mean CRT decreased significantly from 347.3 ± 27.5 μm at baseline to 324.9 ± 28.8 μm at final follow-up (p < 0.001). Mean BRVA (logMAR) improved modestly from 0.98 ± 0.55 (Snellen ~20/190; ~35 ETDRS letters) to 0.93 ± 0.56 (Snellen ~20/175; ~37.5 ETDRS letters) (p < 0.001), with 67.9% of eyes demonstrating BRVA stability (change < 0.1 logMAR). Rescue PDT was administered in 10.3% of eyes. Conclusions: In this real-world cohort, anti-VEGF therapy was associated with significant anatomical improvement, as measured by CRT reduction, while functional outcomes were characterised by visual stabilisation rather than substantial gains.