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G. Shienbaum, O. P. Gupta, A. Patel, C. Fecarotta, R. S. Kaiser, C. D. Regillo; Ranibizumab for Neovascular Age-Related Macular Degeneration using a Treat and Extend Regimen. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2373.
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To evaluate the "treat and extend" approach in managing neovascular age-related macular degeneration (nAMD) using intravitreal ranibizumab.
Retrospective, consecutive case series from a single clinical practice. All patients with new-onset nAMD were treated monthly with intravitreal ranibizumab until no intraretinal or subretinal fluid was observed on optical coherence tomography (OCT). The treatment intervals were then extended continuously by 2 weeks unless signs of exudation recurred. The interval was individualized for each patient in an attempt to maintain an exudation-free macula. Eyes with any prior treatment for nAMD were excluded. Main outcomes measures included mean change in visual acuity, percentage of eyes losing or gaining 3 or more lines, and mean number of injections over 1 year.
82 eyes of 82 patients met the entry criteria. The mean follow-up was 1.3 years. Mean Snellen visual acuity improved from 20/138 at baseline to 20/70 at final follow-up (p<0.05). The proportion of eyes losing less than 3 or more lines of visual acuity was 96.8% and the proportion that gained 3 or more lines was 27%. The mean number of patient visits and injections over the first year was 7.7. The mean OCT central retinal thickness decreased from 303 microns at baseline to 212 microns at final follow-up (p<0.05).
Eyes with nAMD experienced significant visual improvement when managed with intravitreal ranibizumab using the treat and extend approach. The visual outcomes are similar to the ranibizumab pivotal trials, but with significantly less patient visits and injections over 1 year of follow-up.
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