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M. Falcão, A. Carneiro, E. Brandão, F. Falcão-Reis; Restults of Intravitreal Bevacizumab in Exudative AMD in a 1+PRN Regime With More Than One Year of Follow-Up. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1878.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the visual acuity results of patients with neovascular AMD treated with PRN bevacizumab over a time period greater than one year in a clinical setting.
93 eyes of 90 patients (mean age 76,6) with wet AMD were treated with bevacizumab on a one plus PRN modality for a period greater than one year. Baseline visits included ETDRS visual acuity, OCT and fluorescein angiography. Treated patients were scheduled for medical re-evaluation 30±7 days after the injection with ETDRS visual acuity, OCT and, whenever deemed necessary, fluorescein angiography. When indicated re-injection was performed 3 to 7 days after the follow-up visit in operating room settings. In cases where visual loss occurred, combination therapy with either verteporfin or intra-vitreal steroids was used. When ranibizumab became available in our department, patients with poor response to bevacizumab were switched to ranibizumab. Patients without re-treatment criteria were re-observed monthly for evidence of disease activity. The mean follow-up was 570.7 days (370-881). All lesion types were treated.
Mean initial visual acuity was 41.8 ETDRS letters (20/160). After the first injection mean improvement was +3.2 letters (p=0.021) and increased to +4.4 letters at visit 3 (p=0.003). However at the end of the follow up period, the visual improvement dropped to +2.6 letter (p=0.228). Mean time period between intra-vitreal treatments was 68.2 days (5,4 injections/year). Many patients missed follow-up visits and/or treatments for various reasons including decreased mobility and other systemic diseases that are frequent in this age group.
One plus PRN dosing of anti-VEGF for neovascular AMD prevents vision loss, increases the injection-free period of patients and reduces the number of injections each patient receives yearly. However, this regime may compromise the visual gains obtained with the first injections. The elderly population has difficulties in complying with tight visiting schedules thus resulting in non-medically decided suspensions of treatments. This may result in worst visual benefits when comparing these results to clinical trials with monthly ranibizumab.
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