Abstract
Purpose: :
In current clinical practice there are several retreatment regimen paradigms in use for age-related subretinal neovascularisation (SRNVM). Detailed prospective trials (CATT, IVAN) are currently underway to answer questions about which regimen is most suitable. The optimal retreatment regime for age-related SRNVM is currently a matter for debate.Experience of the anti-VEGF regime used at Hillingdon Hospital, London, is detailed. After diangnosis and an initial 3 loading anti-VEGF injections, any reaccumulation of intraretinal fluid received 3 intravitreal anti-VEGF injections spaced one month apart. This regimen is compared with other retreatment approaches (e.g. monthly treatment, treat & extend).
Methods: :
403 patients who received intravitreal Lucentis (n=261) or Avastin (n=142) and completed 3 year followup at Hillingdon Hospital for age-related SRNVM from introduction of anti-VEGF treatment were included in this review. Visual outcomes using Logmar Visual acuity were measured and outcomes charted. Local and systemic adverse events were monitored.
Results: :
Baseline characteristics for patients receiving Lucentis & Avastin were not significantly different. A policy of three retreatment injections produced visual improvement gains comparable to the ANCHOR & MARINA trials in the first year of treatment, with both Lucentis (+13 letters) and Avastin (+11 letters). These gains were maintained over a three year follow-up period, with a mean number of injections of 6 in the first year (5.8/y Lucentis, 5.7/y Avastin), 6/y in the second year, and 5/y in year 3 of treatment. There were no local injection-related ocular complications in either group.
Conclusions: :
A policy of three retreatment injections is a cost-effective and practical method of improving and maintaining central visual acuity in age-related SRNVM. This retreatment regimen produces equivalent efficacy in comparison to the trial gold standard of monthly injections, with fewer injections than in a monthly, or treat and extend, regimens. Efficacy was shown for both Lucentis and Avastin over the 3 year period under review. This regimen is recommended to maximise therapeutic impact of anti-VEGF therapy in age-related SRNVM, given the large numbers of patients presenting who need this sight-saving treatment.
Keywords: age-related macular degeneration • vascular endothelial growth factor