Recurrence of neovascular age-related macular degeneration after discontinuation of modified treat and extend treatment

Abstract

We evaluated the incidence and risk factors for recurrence in patients with neovascular age-related macular degeneration (nAMD) who discontinued anti-vascular endothelial growth factor (VEGF) therapy under a modified treat-and-extend (TAE) protocol. A retrospective analysis of 68 patients was conducted. Therapy was discontinued after extending the treatment interval to ≥ 5 months and maintaining disease stability for 6 months. The modified TAE protocol included three phases: loading, observation, and TAE, with initial treatment intervals determined by the first recurrence interval. Recurrence rates were 22.2%, 42.2%, and 54.4% at 1-, 2-, and 3-year follow-ups, respectively. The median time to recurrence was 16 months, with patients receiving an average of 7.7 injections before discontinuation. Intraretinal cysts were significantly more prevalent in patients with recurrence. Rapid early response to treatment was associated with a lower risk of exudative recurrence. Vision loss of two or more lines occurred in five patients despite treatment resumption; all exhibited subretinal hemorrhages on baseline imaging. The modified TAE protocol allows for successful therapy discontinuation with fewer injections and reduced recurrence rates. Patients with a favorable early response to anti-VEGF therapy had a lower risk of recurrence.