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

Noyabr, 2025-Yil 104 EVALUATION OF ANTI-VEGF THERAPY IN AGE-RELATED MACULAR DEGENERATION Jalalova Dilfuza Zuhridinovna Scientific supervisor. Department of Ophthalmology, Samarkand State Medical University Kasimov Turdali Samarkand State Medical University, Department of Ophthalmology, 2st year clinical ordinator. https://doi.org/10.5281/zenodo.17584019 Annotation. Age-related macular degeneration (AMD) is a leading cause of irreversible central vision loss among the elderly, profoundly impacting quality of life and independence. The advent of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy revolutionized the management of neovascular (wet) AMD, shifting treatment goals from mere stabilization of vision to meaningful visual improvement. This study evaluates the long-term clinical efficacy, safety, and outcomes of anti-VEGF therapy in patients with various stages of neovascular AMD. Data from 230 patients treated over a 24-month period were analyzed, focusing on bestcorrected visual acuity (BCVA), central retinal thickness (CRT), and frequency of injections. Results revealed significant improvement in BCVA and reduction in CRT within the first year, followed by a plateau phase with maintenance dosing. Anti-VEGF agents, including ranibizumab, aflibercept, and bevacizumab, demonstrated comparable safety profiles with minimal adverse effects. The findings emphasize the necessity of individualized treatment regimens, adherence to follow-up schedules, and early intervention to maximize therapeutic outcomes. Keywords: Age-related macular degeneration, anti-VEGF, ranibizumab, aflibercept, bevacizumab, intravitreal injection, visual acuity, retinal thickness, neovascular AMD, ophthalmology. Introduction Age-related macular degeneration is a chronic, progressive retinal disorder primarily affecting the macula, the central region responsible for sharp, detailed vision. It is a multifactorial disease associated with aging, oxidative stress, genetic predisposition, and environmental influences such as smoking and poor nutrition. The disease manifests in two main forms: the dry (atrophic) type, characterized by drusen deposits and retinal pigment epithelium (RPE) atrophy, and the wet (neovascular) type, which involves abnormal choroidal neovascularization leading to fluid leakage, hemorrhage, and rapid central vision loss. Before the introduction of anti-VEGF therapy, treatment options were limited to photodynamic therapy and laser photocoagulation, both of which offered limited efficacy and risked collateral retinal damage. VEGF, a key mediator of angiogenesis, plays a central role in the pathogenesis of neovascular AMD. Inhibition of VEGF signaling has proven effective in reducing vascular permeability and neovascular growth, thereby preserving retinal integrity. Anti-VEGF agents, such as ranibizumab, aflibercept, and off-label bevacizumab, are now the standard of care, offering significant improvements in visual outcomes and quality of life. Noyabr, 2025-Yil 105 This study aims to evaluate the efficacy and safety of these agents through longitudinal assessment of anatomical and functional parameters, emphasizing evidence-based optimization of dosing strategies and individualized patient management. Materials and Methods The study included 230 patients (124 females, 106 males) aged 55–87 years with clinically and angiographically confirmed neovascular AMD. Inclusion criteria were treatment-naïve patients with active choroidal neovascularization and baseline BCVA ranging between 20/40 and 20/400. Exclusion criteria included other retinal vascular disorders, diabetic macular edema, uveitis, and history of intraocular surgery within six months. Patients were divided into three groups based on the anti-VEGF agent used: Group A received ranibizumab (0.5 mg/0.05 ml), Group B received aflibercept (2.0 mg/0.05 ml), and Group C received bevacizumab (1.25 mg/0.05 ml). All injections were administered intravitreally under sterile conditions following a treat-and-extend protocol after an initial loading phase of three monthly injections. Comprehensive ophthalmologic evaluation, including BCVA using ETDRS charts, spectral-domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FFA), and intraocular pressure measurement, was performed at baseline and every three months thereafter. The primary outcome measures were change in BCVA and CRT over 24 months. Safety assessments included intraocular inflammation, endophthalmitis, retinal detachment, and systemic vascular events. Statistical analyses were conducted using paired t-tests and ANOVA, with p-values <0.05 considered significant. Results Significant improvement in BCVA was observed in all treatment groups at three months, with mean gain of +8.9 letters in Group A (ranibizumab), +9.3 in Group B (aflibercept), and +8.4 in Group C (bevacizumab). Mean CRT reduction after the first three injections was 134 μm, 145 μm, and 128 μm, respectively. At 12 months, 78% of patients maintained or improved vision, and 42% gained ≥15 ETDRS letters. Visual and anatomical improvements were sustained through 24 months with a mean injection frequency of 7.5 per year. No significant differences in visual outcomes were detected between treatment groups (p>0.05). Adverse events were rare, with mild subconjunctival hemorrhage (12%), transient intraocular pressure rise (5%), and isolated cases of mild anterior uveitis (2%). No instances of endophthalmitis or retinal detachment occurred. Patients receiving consistent follow-up demonstrated better visual preservation compared to those with irregular attendance (p<0.01). Long-term OCT monitoring revealed stabilization of retinal structure, resolution of intraretinal and subretinal fluid, and restoration of foveal contour in responsive cases. Discussion The study confirms that anti-VEGF therapy remains the gold standard for managing neovascular AMD, offering sustained visual and anatomical benefits with acceptable safety. Ranibizumab, aflibercept, and bevacizumab demonstrate equivalent efficacy when administered under structured regimens. The observed early improvement in BCVA and CRT reduction underscores the significance of early diagnosis and prompt treatment initiation. Individual response variability suggests that tailored dosing strategies, such as treat-and-extend and PRN protocols, optimize therapeutic efficacy while minimizing patient burden and healthcare costs. Aflibercept’s longer binding affinity to VEGF may allow for extended dosing intervals, enhancing patient adherence. Regular OCT monitoring is essential for guiding retreatment decisions and detecting subclinical recurrence. Noyabr, 2025-Yil 106 Although anti-VEGF therapy primarily targets vascular proliferation, future directions include combination therapy with anti-inflammatory or neuroprotective agents to address the multifactorial nature of AMD. Long-term management requires a holistic approach, including nutritional support, smoking cessation, and genetic counseling. The minimal adverse event rate observed supports the long-term safety of intravitreal anti-VEGF injections when performed under aseptic conditions. Conclusion Anti-VEGF therapy significantly improves and stabilizes vision in patients with neovascular AMD, reducing retinal thickness and preventing further visual deterioration. The study demonstrates comparable efficacy and safety among ranibizumab, aflibercept, and bevacizumab, highlighting the value of individualized treatment regimens and regular monitoring. 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