Purchase this article with an account.
D. S. Dyer, M. P. Ellis, L. D. Dyer; Long-Term Outcome of Common AMD Treatment Protocols. Invest. Ophthalmol. Vis. Sci. 2010;51(13):512.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To assess the recurrence rate of choroidal neovascularization in AMD patients treated for 24 months of continued anti-VEGF therapy.
A retrospective review was conducted of the charts of all patients treated in a retinal referral practice with intravitreal injections of anti-VEGF agents for neovascular AMD. All patients treated for > 24 months were included. Treatment regimen, visual acuity at each visit, total number of injections and duration of therapy were recorded for each patient. Following cessation of treatment patients were examined at a minimum of three month intervals to monitor for the development of recurrent choroidal neovascularization following cessation of anti-VEGF therapy.
314 patients with NV-AMD treated with intravitreal injections from 7/14/04 to 7/24/09 were eligible for inclusion in the review. All patients received an initial period of "induction" with monthly injections of either bevacizumab or ranibizumab. Once the neovascular complex was felt to be regressed, an extended regimen with an anti-VEGF antagonist was initiated. Two treatment patterns were identified that received extended anti-VEGF therapy, Induction/Maintenance (n=171) and Treat and Extend (n=143). 46.3% of patients developed recurrent CNV within two years after treatment stopped. 63.1% of the recurrences occurred within the first year after the cessation of treatment.
Patients treated with intravitreal injections of an anti-VEGF antagonist at consistent interval for an extended time period retained visual gains achieved by the induction therapy. PRN therapy produced a steady decline in vision throughout the extended phase of treatment/follow-up. Induction therapy followed by maintenance injections of pegaptanib produced the largest visual gains during the extended period. Those receiving the T&E regimen showed a trend toward better visual results with more frequent injections. Longer treatment intervals with T&E (> 8 weeks) placed patients at risk for greater visual loss. Patients treated at 6 week intervals with either pegaptanib or ranibizumab during the extended phase of treatment had the best visual gains at the end of 24 months of treatment.
This PDF is available to Subscribers Only