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    long-Term Real-World outcomes of Anti-VEGF Treatment in Early Good Responders with Neovascular Age-Related Macular Degeneration
    (Gazi Eye Foundation, 2025) Bektas, Caglar; Ozdemir, Huseyin Baran; Kepez Yildiz, Burçin; Gürelık, İhsan Gökhan; O¨zdek, Šengül C.
    Objective: To evaluate long-term visual and anatomical outcomes in eyes with neovascular age-related macular degeneration (nAMD) that responded favorably to initial anti-VEGF loading therapy. Materials and Methods: This retrospective study included 55 eyes of 55 patients with at least 12 months of follow-up. Early good responders (EGR) were defined as those who showed ?5 letter gain in BCVA, complete resolution of intraretinal/subretinal fluid, reduction in lesion size, and disappearance of subretinal hemorrhage after three loading injections. Retreatments were guided by visual decline, fluid on OCT, or persistent/new hemorrhage. Results: The mean baseline BCVA improved from 51.1 ± 22.6 letters to 63.9 ± 21.5 after loading and was 58.5 ± 23.1 at the end of year-5 (p<0.001 and p=0.003 vs. baseline). Although BCVA decreased between month 3 and year 1 (p=0.009), it remained stable thereafter. Central foveal thickness decreased significantly from 327.9 ± 166.9 µm to 195.3 ± 97.1 µm post-loading and to 175.7 ± 59.6 µm at final visit (p<0.001). The mean annual number of injections declined from 5.1 in year 1 to 2.4 in year 5. Visual decline after loading was seen in 51% of eyes, mostly due to lesion activity (57%) or atrophy (43%). Notably, 27.2% of eyes required no further injections after the loading phase during the first year. No cases of tachyphylaxis or treatment switch were observed. Conclusions: EGR patients with nAMD can sustain functional and anatomical improvements over 5 years with significantly fewer injections. A substantial subset may require minimal or no additional treatment following initial therapy. © © 2025 The author(s). This is an open-access article under the terms of the Creative Commons Attribution License (CC BY).