PURPOSE To investigate the incidence, characteristics, and baseline predictors of poor visual outcomes in eyes with neovascular age-related macular degeneration (nAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in daily clinical practice. DESIGN Observational study. PARTICIPANTS Treatment-naive eyes starting anti-VEGF therapy for nAMD between 2007 and 2012 tracked in the Fight Retinal Blindness! registry. Eyes had sustained ≥15 letters of loss from baseline without recovery of visual acuity (VA) at final end point. A subgroup analysis included eyes that sustained ≥30 letters of loss. Controls had not sustained ≥15 letters of loss. METHODS Kaplan-Meier curves estimated time to first development of loss of ≥15 letters. Cox proportional hazards models evaluated predictors of loss of ≥15 letters. MAIN OUTCOME MEASURES The proportion of eyes with sustained VA loss within 5 years, the time to development of sustained VA loss, and baseline predictors of sustained VA loss. RESULTS There were 1760 eyes in total and 856 eyes that completed 5 years follow-up. The proportion of eyes with sustained VA loss of ≥15 letters at 5 years was 22.9% (95% confidence interval [CI], 20.7%-25.1%) and VA loss of ≥30 letters was 10.8% (95% CI, 9.1%-12.5%). Factors independently associated with higher incidence of sustained ≥15-letter loss included age >80 years (odds ratio [OR], 1.33 for patients >80 years vs. ≤80 years; 95% CI, 1.05-1.69; P = 0.02), fewer injections (OR, 0.97 per injection; 95% CI, 0.96-0.98; P = 0.0005), and more visits at which the choroidal neovascularization was graded as active (OR, 1.97 for eyes in upper quartile of active visits vs. eyes in lowest quartile of active visits; 95% CI, 1.39-2.79; P = 0.0001). Baseline VA ≥70 letters was associated with reduced risk of sustained ≥30-letter loss (OR, 0.61; 95% CI, 0.38-0.98; P = 0.04). Baseline angiographic lesion criteria were not significantly associated with sustained VA loss. CONCLUSIONS Twenty-three percent of eyes with nAMD developed sustained VA loss of ≥15 letters over 5 years of anti-VEGF therapy. Baseline predictors of poor outcomes provide more accurate assessment of the potential benefit from anti-VEGF therapy.

中文翻译：

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抗血管内皮生长因子药物治疗的新血管性年龄相关性黄斑变性的视觉效果较差。

目的探讨在日常临床实践中，接受玻璃体内抗血管内皮生长因子（anti-VEGF）治疗的新生血管性年龄相关性黄斑变性（nAMD）患者眼睛视力不佳的发生率，特征和基线预测指标。设计观察性研究。参与者在2007年至2012年之间，针对天真无邪的眼睛开始针对nAMD进行抗VEGF治疗的现象可追溯到“对抗视网膜盲症”中！注册表。眼睛从基线持续失去≥15个字母，而在最终终点没有恢复视力（VA）。亚组分析包括持续≥30个丢失字母的眼睛。对照没有丢失≥15个丢失字母。方法Kaplan-Meier曲线估计首次出现丢失≥15个字母的时间。考克斯比例风险模型评估了≥15个字母的损失的预测因子。主要观察指标5年内持续性VA丧失的眼睛比例，持续性VA丧失发展的时间以及持续性VA丧失的基线预测指标。结果总共进行了5年的随访，共1760眼，856眼。5年内持续VA丢失≥15个字母的眼睛比例为22.9％（95％置信区间[CI]，20.7％-25.1％），并且VA≥30个字母丢失的比例为10.8％（95％CI，9.1％） -12.5％）。与持续≥15个字母的丢失发生率较高相关的独立因素包括年龄> 80岁（赔率[OR]，> 80岁vs.≤80岁的患者为1.33； 95％CI，1.05-1.69； P = 0.02），注射次数较少（OR，每次注射0.97； 95％CI，0.96-0.98； P = 0.0005），并且脉络膜新生血管分级为活跃的就诊次数较多（OR，1。主动造访的上四分之一的眼睛与主动造访的下四分之一的眼睛97 95％CI，1.39-2.79；P = 0.0001）。基线VA≥70个字母与持续≥30个字母丢失的风险降低相关（OR，0.61; 95％CI，0.38-0.98; P = 0.04）。基线血管造影病变标准与持续性VA丢失没有显着相关。结论nAMD的23％的眼睛在抗VEGF治疗的5年中持续出现VA丧失≥15个字母。不良预后的基线预测因子可更准确地评估抗VEGF治疗的潜在益处。基线血管造影病变标准与持续性VA丢失没有显着相关。结论nAMD的23％的眼睛在抗VEGF治疗的5年中持续出现VA丧失≥15个字母。不良预后的基线预测因子可更准确地评估抗VEGF治疗的潜在益处。基线血管造影病变标准与持续性VA丢失没有显着相关。结论nAMD的23％的眼睛在抗VEGF治疗的5年中持续出现VA丧失≥15个字母。不良预后的基线预测因子可更准确地评估抗VEGF治疗的潜在益处。