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Dimple Modi, Benjamin J. Ernst, Eylem Y. Pnarc, Clayton G. Scanlon, Levent Akduman; Outcomes After "Completing" Treatment With Anti-VEGF Agents For AMD. Invest. Ophthalmol. Vis. Sci. 2011;52(14):104.
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To determine the effect of deferring injections of anti-VEGF agents for an extended period in neovascular age-related macular degeneration (nAMD) with an as-needed dosing regimen.
Medical records of consecutive patients with nAMD treated with an as-needed regimen of intravitreal bevacizumab or ranibizumab injections at a single clinical practice were reviewed. Injections were given based on visual acuity (VA) and optical coherence tomography (OCT) criteria. After initial treatment, eyes observed for at least 6 months continuously without an injection were included. VA was measured using Snellen charts at 20 feet by over-refraction at each visit. OCT was performed at each visit. Anti-VEGF injections were given monthly until foveal thickness on OCT and VA failed to improve (decrease) compared with the prior month. At this point, injections were stopped and patients were evaluated monthly. Any recurrence of fluid on OCT, such as retinal cysts or subretinal fluid, resulted in resuming monthly injections until macular fluid resolved or no further VA or OCT improvement was seen. Outcomes assessed included change in VA, duration of observation, and number of reinjections given.
Of 153 patients treated for nAMD, 26 eyes of 23 patients (14 females), mean age 78 years, were observed for at least 6 months after initial anti-VEGF treatment and included. Median initial VA was 20/200 and improved to 20/40 after a mean of 29 months of follow-up. Fourteen eyes received ranibizumab, six received bevacizumab, and six received both. Twelve eyes were not retreated during the study period. Of these, 7 were not retreated due to macular scarring. Five eyes were successfully treated and observed for a mean of 17 months without an injection. All 12 eyes had stable visual acuity (≤2 line change) during the observation period. Fourteen eyes were retreated based on OCT changes, of which 7 also had VA changes. Retreatment occurred at a mean of 15 months after the last injection. These eyes required a mean of 2.3 reinjections. VA was stable in 12 eyes, increased 3 lines in 1 eye, and decreased 3 lines in 1 eye.
Halting anti-VEGF treatment for an extended period of time if OCT and VA are stable was generally safe. Close, regular follow-up is essential.
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