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M. Engelbert, S. A. Zweifel, K. B. Freund; "Treat and Extend" Dosing of Intravitreal Anti Vascular Endothelial Growth Factor (anti-VEGF) Agents for Retinal Angiomatous Proliferation (RAP/Type 3 Neovascularization). Invest. Ophthalmol. Vis. Sci. 2009;50(13):1888.
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To analyze long-term functional and anatomic outcomes for the treatment of RAP using a "Treat and Extend" regimen with the anti-VEGF drugs bevacizumab and/or ranibizumab.
We performed a retrospective analysis of twelve consecutive patients with newly diagnosed RAP/type 3 neovascularization treated with intravitreal bevacizumab and/or ranibizumab having at least twelve months of follow-up. Patients all received three monthly injections followed by continued treatment at intervals increasing by two weeks per visit. The treatment interval was extended to a maximum of ten weeks maintenance unless clinical examination or optical coherence tomography (OCT) detected new hemorrhage or persistent/recurrent exudation. In these cases, the interval was shortened by two weeks and maintained at that duration. Visual acuity (VA) and center-point OCT thickness data were collected at presentation and one, three, twelve and 24 months following the initiation of treatment. The total number of injections at 12 and 24 months were analyzed.
Median Snellen VA at presentation was 20/60 at baseline, improved to 20/40 at one month, and was maintained throughout the 24 month study period (n=12 at 12 months, and n=10 at 24 months). At 12 months, 7 of 12 (58%) patients improved by one or more lines, 4 (33%) remained stable and 1 (8%) worsened. At 24 months, 8 of 10 (80%) improved and 2 (20%) remained stable. The improvement in LogMAR converted VA at 12 and 24 months was statistically significant (paired t-test, p<0.02). There were statistically significant decreases in median OCT thickness from 309 µm to 170 µm at 12 and 24 months (p<0.007). The mean number of injections was 7 over the first 12 months and 13 over 24 months.
"Treat and Extend" dosing of intravitreal anti-VEGF therapy appears capable of promising visual and anatomic outcomes in RAP/type 3 neovascularization, a condition traditionally associated with poor long-term outcomes despite single or multi-modality treatment.
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