Repeated anti-VEGF injections do not cause vascular issue in patients with AMD

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Investigators from the Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, led by Ying Zhu, MD, PhD, who studied the ocular effects of repeated intravitreal anti-vascular endothelial growth factor (VEGF) injections, found no changes in the vascular metrics over time in patients with age-related macular degeneration (AMD).

Zhu reported the group’s findings at the Association for Research in Vision and Ophthalmology 2025 annual meeting in Salt Lake City.

Anti-VEGF injections are the first-line treatment for exudative AMD; however, it is unknown if suppressing VEGF with repeated injections over the long term has any effect on the normal retinal vasculature, and long-term repetitive anti-VEGF injections are required to stabilize the disease.

The investigators conducted this retrospective longitudinal study to determine if swept-source optical coherence tomography angiography identified any changes in the vascular metrics in patients with AMD.

The study was conducted over a 6-year period and included patients with AMD who had been followed for a minimum of 18 months. The eyes were divided into two groups based on whether or not the had received anti-VEGF injections.

All patients underwent imaging. The following parameters were studied: vessel density and vessel skeleton density in the superficial, deep, and retinal slab; the size of the foveal avascular zone, circularity, and perimetry of the retina slab were calculated, Zhu described.

Study findings

The authors reported that 107 patients (164 eyes) were included in the study; 57 eyes comprised the injection group (mean number of injections, 12.56) and 107 eyes the non-injection group. The average patient follow-up time was 34 months.

No significant differences were seen in the baseline or the follow-up vascular metrics between the injection and non-injection groups.

In addition, no significant changes were seen between the changes in the vascular metrics and the changes in the visual acuity.

The investigators concluded that in their retrospective longitudinal study of 164 eyes, the repeated intravitreal anti-VEGF injections were not associated with any relevant significant change in the vascular metrics studied on optical coherence tomography angiography over time.