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Fabian Lehmann, Horst Helbig, Maria Andreea Gamulescu; Is there an individual re-injection frequency in patients treated with intravitreal anti-VEGF for AMD?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2849.
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In intravitreal anti-VEGF-therapy for age-related macular degeneration (AMD) different treatment strategies address the wish for maximum visual acuity gain combined with minimum number of control visits. However, there is little knowledge about time-point of recurrences after initial upload-therapy in these patients. We investigated if individual differences in re-injection frequencies could be detected in our out-patient population and if these could be correlated to the AMD-subtype (occult or classic choroidal neovascularization (CNV) or retinal angiomatous proliferation (RAP)).
65 eyes of 60 patients (mean age 79.7 ± 7.9 years; 36 female, 24 male) with exudative AMD who received at least 20 injections (27.9 ± 6.1 injections) of Ranibizumab were included into our retrospective study. All patients received an initial upload-therapy of three consecutive monthly intravitreal injections. Re-injection intervals (weeks) after this upload period were calculated to analyze the individual re-injection frequency. Patients with an abnormal long interval (> 1 year) between two injections were excluded from the analysis. AMD sub-types were classified by fundus photography (FP), fluorescein angiography (FA) and optical coherence tomography (OCT) at the baseline visit.
AMD-subtyping resulted in 6 eyes with classic CNV, 47 eyes with occult CNV and 12 eyes with RAP. Mean follow-up time was 4.7 ± 1.6 years. Average visual acuity was 0.43 ± 0.24 log MAR at baseline and 0.55 ± 0.33 log MAR at the end of follow-up. Mean number of re-injections was 24.8 ± 7.2 in the classic CNV group and 25.0 ± 6.3 and 25.0 ± 5.3 in the occult CNV and RAP group, respectively. Mean interval between re-injections was 13.0 ± 1.8 weeks in the classic CNV group, 11.3 ± 2.8 weeks in the occult CNV group and 11.7 ± 1.3 in the RAP group.
In this retrospective study, no statistical significant difference concerning the mean re-injection interval in weeks between each AMD-subtype group could be shown. A trend towards a longer interval in patients with classic CNV might be biased by the small patient number in this group. However, this study underlines the need for continuous and potential life-long follow-up with intervals not exceeding 3 months.
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