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Bulgarian Review of Ophthalmology

Complications After Anti-VEGF Therapy in Patients with Wet Form of AMD

D. Antonova, H. Vidinova, L. Voynov


Anti-VEGF therapy is the main treatment in patients with the wet form of AMD. Although successful in most cases, prolonged use of intravitreal therapy can lead to serious complications. The aim of this study is to present the possible longterm complications of anti-VEGF therapy in patients with the wet form of AMD, as well as the ways to prevent them. Methods: In our study, we included 32 patients with a wet form of AMD. They were all examined ophthalmologically in detail for VA, fundus color photography, OCT (Revue, Optovue) and OCT-A (Angiophlex, Zeiss). All patients were treated with aflibercept (Eylea) - according to the Treat and Extend scheme for a period of 2 years. They were followed for complications for a period of 2 years. Results: In the long run we observed the following complications expressed in %: tachyphylaxis to the drug substance – 20%; tears of RPE-10%; fibrosis and scarring - 45%; retinal atrophy 25%. In 20% of the observed patients we found tachyphylaxis after the first year, which led to a decrease in the effectiveness of treatment. In 10% of cases we observed rupture of RPE. This occurred mainly in patients with previous detachment of RPE with a large area and height. Retinal fibrosis developed in patients with macular hemorrhage, low VA, refractory retinal cysts, or cases of RAP. Retinal fibrosis usually appeared after 10 injections. These are patients with low initial visual acuity, thin choroid especially subfoveolar and usually occurred after a small number of intravitreal injections. Conclusion: Complications after anti-VEGF therapy are relatively rare, but always associated with very serious visual impairment. The stronger the effect of the anti-VEGF drug, the more common the complications, especially retinal fibrosis. Early detection of risk factors such as low initial vision, refractory retinal cysts, macular hemorrhage, large neovascular membrane, are a prerequisite for successful prevention and treatment of these complications.


AMD, fibrosis, rupture of RPE

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About The Authors

D. Antonova
Military Medical Academy – Sofia

Clinic of Eye Diseases

H. Vidinova
Military Medical Academy – Sofia

Clinic of Eye Diseases

L. Voynov
Military Medical Academy – Sofia

Clinic of Eye Diseases