September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Anti-VEGF-treatment for wet-AMD According to a Treat-and-Extend Protocol at a Swedish County Hospital: clinical outcomes at 12 Months.
Author Affiliations & Notes
  • Elisabet Granstam
    Center for Clinical Research, Uppsala University/County Council of Västmanland, Vasteras, Sweden
    Ophthalmology, Västmanland County Hospital, Västerås, Sweden
  • Kersti Sjövall
    Ophthalmology, Västmanland County Hospital, Västerås, Sweden
  • Anna Paul
    Ophthalmology, Västmanland County Hospital, Västerås, Sweden
  • Åsa Morén
    Ophthalmology, Västmanland County Hospital, Västerås, Sweden
  • Footnotes
    Commercial Relationships   Elisabet Granstam, Allergan (R), Bayer (C), Novartis (R); Kersti Sjövall, Novartis (R); Anna Paul, None; Åsa Morén, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 2668. doi:
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      Elisabet Granstam, Kersti Sjövall, Anna Paul, Åsa Morén; Anti-VEGF-treatment for wet-AMD According to a Treat-and-Extend Protocol at a Swedish County Hospital: clinical outcomes at 12 Months.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2668.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : To evaluate the clinical outcome in terms of visual acuity, OCT-findings, frequency of intravitreal anti-VEGF-injections and treatment interval of a treat-and-extend protocol for wet AMD at a Swedish county hospital

Methods : Data from the national Swedish Macular Registry was used to monitor visual acuity (ETDRS) and number of intravitreal injections given to patients treated for wet-AMD in routine clinical care at Swedish county hospital. Additionally, assessment of signs of disease acitivity on optical coherence tomography (OCT) as well as planned treatment intervals were documented separately.

Results : Anti-VEGF-treatment with ranibizumab was initiated in 82 previously treatment-naive eyes of 75 patients aged 79 (SD 7) years old during 1 May until 31 Oct, 2014. In 21 eyes (25%), treatment was discontinued within 12 months, mainly due to low visual acuity (11/21) or wish of patient (4/21). In two patients, treatment was switched to PDT. Out of the remaining eyes, 12-months follow-up data with ETDRS and OCT were obtained in 44 eyes. Visual acuity increased from a mean of ETDRS 59 (SD 16) to 67 (SD 13; P=.001 paired t-test). At the start of treatment, OCT-findings included intraretinal edema (IRE) in 66% of eyes, subretinal fluid (SRF) in 79% of eyes and pigment epithelial detachment (PED) in 59% of eyes. At 12 months, IRE was found in 9% of eyes, SRF in 27% and PED in 39% of eyes. During the first treatment-year, patients received on average 10.0 (SD 1.9) intravitreal anti-VEGF-injections. At 12 months, the distribution of treatment intervals was: 4 weeks 28%, 6 weeks 30%, 8 weeks 10%, 10 weeks 13 % and 12 weeks treatment interval 16%. One case of endophthalmitis occurred

Conclusions : Anti-VEGF-treatment with ranibizumab for wet-AMD according to a treat-and-extend-protocol for 12 months induced a significant increase in visual acuity. At 12 months, very few eyes had intraretinal edema whereas persistent subretinal fluid and PED were more frequent. Treatment interval extension to 10 weeks or more was obtained in 28% of eyes in this clinical setting, which is less than has been observed in other studies (Berg et al Ophthalmology 2015;122:146; Wykoff et al Ophthalmology 2015; e-pub). Continued follow-up is needed to evalute long-term effect on visual acuity, OCT-findings and treatment interval.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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