SHORT-TERM CORNEAL ENDOTHELIAL SAFETY OF ANTI-VEGF TREATMENT REGIMENS IN AGE-RELATED MACULAR DEGENERATION

To compare corneal endothelial safety between continuous bevacizumab versus sequential bevacizumab-aflibercept therapy in neovascular age-related macular degeneration patients.

This prospective, randomized study included one eye from 70 treatment-naïve nAMD patients between December 2024 and May 2025. Exclusion criteria comprised surgical or laser interventions during follow-up, contact lens use, cataract surgery within the preceding 6 months, corneal dystrophy, or conditions potentially causing endothelial damage. 

Group 1 (n=35) received monthly bevacizumab for 6 months, while Group 2 (n=35) received bevacizumab for the first 3 months followed by aflibercept for the subsequent 3 months. Specular microscopy was employed to assess endothelial cell density (ECD), hexagonality (HEX%), coefficient of variation (CV), and central corneal thickness (CCT) at baseline, 3 months, and 6 months.

Mean age was 74.2±6.8 years; 42(60%) phakic, 28(40%) pseudophakic eyes. No significant changes occurred in any parameter during 6-month follow-up. Group 1 ECD: 2564±128 to 2549±131 cells/mm²; Group 2: 2559±125 to 2552±129 cells/mm² (p=0.42). HEX% (p=0.68), CV (p=0.73), and CCT (p=0.71) showed no between-group differences. Subgroup analyses by lens status revealed no significant changes (p>0.05).

Continuous bevacizumab and sequential bevacizumab-aflibercept demonstrate equivalent corneal endothelial safety profiles in nAMD patients over six months.