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Corinne Gonzalez; Treatment of Neovascular AMD by Aflibercept ( Eylea) with Proreactive protocol. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4600.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the functional, anatomical, vascular flow, effects of intravitreal Aflibercept injections (IVT) for subretinal neovascularization complicating AMD, done with Proreactive protocol, and the recurrences frequency at 1 year follow-up.
54 eyes of 42 patients, 15 men, 27 women, with subretinal neovascularization complicating AMD. 48 eyes were switch cases, 6 naïve cases. Patients received intravitreous Aflibercept (Eylea) with Proreactive protocol: such as, firstly an inductive treatment ( 3 monthly IVT ), then series of 3 IVT (IVT done every 6 weeks ), every time that active neovascularization is present. The score of all follow-up exams assessment determine neovascular activity and so if neovascularization is active or no. First exam, 2 months, and then 3 months’ interval follow-up exam included ETDRS visual acuity (VA), complete ophthalmic examination with ocular fundus, optical coherence tomography (spectral domain OCT), fluorescein (FA) and infracyanine (ICG) angiography (SLO Spectralis HRA-OCT).VA and OCT were done before each IVT. We want to evaluate the incidence of this protocol on the functional results and frequency of recurrences so on the number of IVT needed.
VA improved in 44% cases, more than 10 letters in 22% cases. Diffuse edema was 30% reduced in 88% , pigment epithelial detachment was flattened and less dense in all cases, by OCT. Angiographic leakage reduced about 70% in 65% cases, 30% in 96% cases. At ICG, vascular flow, vessel’s diameter were 2/3 time less in 68% cases, 1/3 in 97% cases. Most of patients had good functional, anatomical, vascular flow, results, with less IVT needed, with follow-up reliable and less frequent. Inductive treatment was sufficient in 49% cases, needed added series of IVT in 51% cases. Neovascular activity criteria and definition of active neovascularization are main points for follow-up and treatment indications. This protocol was compared, discussed.
The results, with generally improved visual function, reduction of exudation on OCT, lack of fluorescein leakage, low neovascularisation’s flow in ICG, less recurrences, suggest Proreactive Eylea protocol seems effective, less restrictive, lastly cheaper. This protocol appears attractive, its indication must be optimized.
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