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Heinrich Gerding; 7-YEARS RESULTS OF PRN ANTI-VEGF TREATMENT IN AGE-REALATED MACULAR DEGENERATION. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5380.
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To analyze the long-term outcome of anti-VEGF treatment in patients with wet AMD.
A retrospective analysis of an institutional case series (104 patients, 104 eyes, mean age +/- SD: 77.6 +/- 7.3 years), treated according to a prospective protocol, was performed. All patients were examined monthly during year 1 and further on according to an individualized PRN regimen. Re-treatment was allowed for any signs of disease activity. In all cases basic treatment consisted of ranibizumab, starting with a loading of 3 injections. In 17 eyes treatment was switched to aflibercept in year 6 or 7.
59 of 104 patients (57 %) continued treatment or observation until year 7 and 43 (41 %) finished the 84 months visit. LogMAR-Visual acuity improved by +1.4 +/- 0.3 (mean +/- SE) lines during the loading phase and was +1.0 +/- 0.3 lines at month 12, +0.1 +/- 0.4 lines at month 48, and -1.1 +/- 0.6 at month 84. Over all 1787 intravitreal injections (17.2/recruited patient) were applied. The number of intravitreal injections in those patients completing the final yearly examinations was 5.8 (6) +/- 2.3 (mean (median) +/- 1 standard deviation) in year 1, 16.6 (13.5) +/- 8.4 until month 48, and 22.5 (23) +/- 16.5 injections until month 84. 29 of 59 patients (49 %) with ongoing observation in year 7 presented disease activity and needed further intravitreal anti-VEGF injections.
The results of this case series demonstrate that flexible intravitreal anti-VEGF injections can result in a long-term stabilization of visual function well above the level of the natural course of the disease. The relatively stable long-term visual acuity results can be achieved with a low mean frequency of less than 3-4 injections/year after month 12. In year 7 approximately every second eye under observation presented ongoing disease activity.
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