MACULAR DEGENERATION: PERIODIC INTRAVITREAL INJECTION OF VEGF INHIBITORS

Abstract

INTRODUCTION: Age-related macular degeneration (AMD), particularly its neovascular form, is characterized by the formation of abnormal blood vessels in the macular region—a process directly linked to the activity of vascular endothelial growth factor (VEGF). Neovascularization promotes fluid leakage, hemorrhages, retinal thickening, and structural changes that can culminate in permanent central vision loss. In this context, intravitreal injections of VEGF inhibitors have become a primary therapeutic strategy, as they reduce neovascular activity and vascular permeability, thereby contributing to the preservation or recovery of visual acuity. OBJECTIVE: This systematic literature review aimed to analyze scientific evidence regarding the efficacy, safety, dosing intervals, and functional impact of intravitreal anti-VEGF injections for treating neovascular AMD, considering various treatment regimens and their effects on visual acuity and macular anatomy. METHODOLOGY: The review was structured according to the PRISMA checklist, utilizing scientific articles published within the last 10 years and consulting the PubMed, SciELO, and Web of Science databases. The following descriptors were used: Age-related macular degeneration; Anti-VEGF; Intravitreal injection; Neovascularization; Visual acuity. Included studies were those published in scientific journals, research involving patients with neovascular AMD, and works evaluating intravitreal anti-VEGF treatment. Studies published outside the established timeframe, works unrelated to the intervention in question, and publications lacking relevant clinical data were excluded. RESULTS: Studies demonstrated that ranibizumab, aflibercept, bevacizumab, and other anti-VEGF agents reduced neovascular activity and promoted the maintenance or improvement of visual acuity. The "treat-and-extend" regimen yielded favorable visual outcomes, allowing for greater individualization of treatment intervals and a reduction in the therapeutic burden. Long-acting agents had also demonstrated the potential to extend treatment intervals without significantly compromising anatomical and functional outcomes. Conclusion: It was concluded that periodic intravitreal injections of VEGF inhibitors represented a fundamental approach to managing neovascular AMD, reducing the progression of neovascularization, fluid accumulation, and the risk of vision loss. Tailoring treatment intervals allowed for a better balance between efficacy, safety, vision preservation, and the reduction of the burden associated with frequent injections.