Long-Term Visual and Structural Outcomes of Photodynamic Therapy Combined with Anti-VEGF for Neovascular Age-Related Macular Degeneration at Nigerian Tertiary Hospitals

Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible central visual loss in older adults. While anti-VEGF monotherapy is the global standard of care, combination photodynamic therapy (PDT) with anti-VEGF has been explored as a treatment-reducing strategy for selected patients. Long-term outcomes of this combination approach have not been studied in Nigeria, where anti-VEGF injection frequency has major cost and compliance implications. This study evaluates the long-term visual and structural outcomes of combination PDT and anti-VEGF therapy for nAMD at Lagos University Teaching Hospital and UCH Ibadan over a five-year period. A prospective cohort study will enrol 60 eyes with subfoveal nAMD confirmed on OCT and fluorescein angiography, treated with a same-day combination of PDT and intravitreal ranibizumab or bevacizumab. Primary outcomes at 12, 24, and 60 months will include best-corrected visual acuity change, central retinal thickness on OCT, number of re-treatment injections, and lesion size on fluorescein angiography. Secondary outcomes include treatment-related adverse events and patient quality-adjusted life years assessed using the EQ-5D instrument. Combination PDT and anti-VEGF has demonstrated superior durability of response in some international trials, potentially reducing injection burden, which is a critical advantage in resource-constrained settings where injection frequency drives cost and adherence challenges. This study generates Nigerian-specific long-term evidence supporting or refuting this combination strategy. Recommendations will address nAMD treatment protocols, access to photodynamic therapy equipment, and reimbursement frameworks. Keywords: neovascular AMD, photodynamic therapy, anti-VEGF, long-term outcomes, Nigerian ophthalmology