Outcome of 5-year treatment of neovascular age-related macular degeneration with intravitreal anti-VEGF using "Treat and Extend" regimen

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Abstract

Objective The aim of this study is twofold. First, to evaluate the long-term outcome of anti-vascular endothelial growth factor (anti-VEGF) treatment in a clinical setting using the "treat-and-extend regimen" (TER) in patients with neovascular age-related macular degeneration (nAMD). Second, to determine the proportion of patients treated with anti-VEGF with good visual acuity (VA), i.e., vision sufficient to maintain a high level of independence. Design We conducted a single center retrospective review of patients with treatment-naive nAMD who were treated with anti-VEGF. Patients were treated with anti-VEGF intravitreal injections according to the TER. Patients started treatment with monthly injections of either bevacizumab (1.25 mg/0.05 mL) or ranibizumab (0.5 mg/0.05 mL) until there were no signs present of choroidal neovascularization (CNV) activity. CNV activity was determined from fundus examination and SD-OCT imaging. Follow-up administration of intravitreal injections was extended by 2-week intervals, up to a total of 14 weeks, provided no signs of CNV activity were detected. In some patients, the first treatment was replaced with aflibercept (2 mg/0.05 mL). Participants On the basis of the inclusion criterion for the study, that patients had to be treated for 5 years, a total of 101 patients were included in the study. In all patients, one eye was treated for a 5-year period, and thus we studied 101 eyes. Measurements Best corrected VA was analyzed at baseline and each year during the 5-year follow-up. Results VA improved initially after year 1 of the treatment. VA decreased in the subsequent 4 years of treatment, but remained significantly higher from year 1 to year 3 of the treatment compared to baseline values. Patients with good VA followed a similar trend: the proportion increased in the first year, and thereafter gradually decreased during the course of the 5-year follow up. At year 5, the number of patients with good VA decreased to baseline values. Conclusion TER with anti-VEGF for nAMD treatment prevents long-term severe visual loss in real-world setting and maintains patients' VA at levels sufficient to ensure independence.

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Mekjavic, P. J., & Benda, P. Z. (2018). Outcome of 5-year treatment of neovascular age-related macular degeneration with intravitreal anti-VEGF using “Treat and Extend” regimen. Frontiers in Medicine, 5(MAY). https://doi.org/10.3389/fmed.2018.00125

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