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Irmela Mantel, Parmis Parvin, Christina Gianniou, Aude Ambresin, Ali Dirani; Managing the Clinical Burden of Anti-VEGF Treatment for Neovascular Age-Related Macular Degeneration: The Observe and Plan Regimen using Intravitreal Aflibercept Injections.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4621.
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The purpose of this study was to evaluate an individually planned treatment regimen for neovascular age-related macular degeneration (nAMD), termed “Observe and Plan”, using intravitreal aflibercept. This regimen was based on the predictability of an individual's need for retreatment. It aimed to reduce the clinical burden by employing individually fixed injection intervals with reduced number of evaluation visits. This report summarizes the one year results.
This was a prospective case series that included 104 patients (114 eyes) with treatment-naive nAMD. Following three loading doses of aflibercept, monthly observation visits allowed the disease recurrence interval to be determined. This individually measured recurrence interval was reduced by 2 weeks to give the retreatment interval for the next three injections, with an interval range allowed from one to three months. Periodical control visits (at least every 6 months) allowed the effectiveness of the treatment to be assessed and individual intervals to be adjusted (by 2 weeks) for the next following treatment plan. Shortening of lenghthening of the interval was performed according to the presence or absence of exudative signs on spectral domain optical coherence tomography.
The mean patient age was 80.8 years (SD 24.3), with 71.2% females. Mean visual acuity was 62.3 letters ETDRS at baseline and improved significantly by 8.2 and 8.5 letters by Month 3 and 12, respectively (p=0.001 and p=0.002, respectively). This result was achieved with a mean of 3.8 ophthalmic visits after baseline (SD 0.9). The mean number of injections was 8.7 (SD 3.0).
The observe-and-plan regimen, using intravitreal aflibercept for nAMD significantly improved VA over the first 12 months of the study. This was obtained with fewer clinic visits and a similar number of injections, compared with other regimens. Thus, the observe-and-plan regimen has the potential to dramatically reduce the clinical burden of the anti-VEGF treatment in nAMD, with maintained functional benefit.
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