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Christopher Brady, Rayan Alshareef, Andre Witkin, Carl Regillo; A Treat and Extend Regimen Using Anti-VEGF Therapies for Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4659.
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© ARVO (1962-2015); The Authors (2016-present)
With the FDA approval of ranibizumab and aflibercept for macular edema due to central retinal vein occlusion (CRVO), a new standard of care has been adopted for this condition. The initial clinical trials were designed using a monthly treatment approach followed by as-needed injections. A treat and extend (T&E) approach has been described in the treatment of neovascular age-related macular degeneration (ARMD), and is being increasingly adopted. Such an approach has the potential to reduce the burden of treatment on patients and physicians while maintaining effectiveness in the treatment of CRVO.
Nine physicians who routinely adopt a T&E extend approach were identified. A retrospective analysis of their patients with CRVO treated with either bevacizumab or ranibizumab for at least six months was undertaken. Change in Snellen visual acuity and central macular thickness (CMT) were analyzed. Adherence to a T&E protocol was also analyzed.
Sixty-six patients were identified, 25 of whom were treatment-naïve, and thus included in the analysis. The mean age was 73.6 years, and 63% were female. Sixty-seven percent reported hypertension and 14.8% reported diabetes mellitus. Mean duration of symptoms prior to therapy was 131 days. After 6 months follow-up, mean visual acuity improved to 20/80 from 20/200+1. Mean CMT improved 229.4 microns (from 652 to 422 microns).
There are several theoretical advantages to a T&E regimen for CRVO compared with monthly and as needed strategies including fewer office visits and fewer injections, and therefore lower risk of side effects including endophthalmitis. Compared with ARMD, T&E for CRVO appears to be less successful. This may be due to differences in pathophysiology, or perhaps demographics that hinder adherence to a strict treatment protocol. Given the logistical benefits and reduced risk profile, an initial attempt at T&E with a low threshold to maintain therapy at fixed interval is reasonable.
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