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Mio Hosokawa, Yuki Morizane, Shuhei Kimura, Mika Hosogi, Shinichiro Doi, Fumio Shiraga; Two year results of intravitreal aflibercept injections for neovascular age-related macular degeneration using a treat and extend regimen. Invest. Ophthalmol. Vis. Sci. 2016;57(12):529.
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© ARVO (1962-2015); The Authors (2016-present)
The treatment of neovascular age-related macular degeneration (nAMD) has been revolutionized by anti-vascular endothelial growth factor (VEGF) medications. However, there is no consensus on a particular standard regimen for anti-VEGF medications in nAMD. In this retorospective consecutive case series, We have evaluated 2 year outcomes for intravitreal aflibercept injections using a treat and extend regimen for these patients .
Eighteen eyes of 18 patients diagnosed with treatment-naive nAMD were treated monthly with 2 mg aflibercept injections, for at least 3 months. Monthly injections continued until no retinal exudative changes (i.e. new subretinal hemorrhage or subretinal and/or intraretinal fluid) were observed by optical coherence tomography. If no retinal exudative changes were seen, the interval between injections was extended by 2 weeks, up to a maximum of 12 weeks during the first year or 16 weeks during the second year. If signs of exudation recurred, this interval was shortened by 2 weeks. The main outcome measures were changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), and retinal exudation, the mean number of injections, and the interval between injections at 2 years.
The mean BCVA (logarithm of the minimal angle of resolution, log MAR) improved significantly from 0.42 ± 0.31 at baseline to 0.21 ± 0.31 at 2 years (p = 0.005, paired t-test). The BCVA improved by more than 0.3 logMAR units in 8 eyes (44.4%), was unchanged in 9 eyes (50%) and worsened by more than 0.3 logMAR units in 1 eye (5.6%). The mean CRT decreased significantly from 360.4 ± 123.2 μm at baseline to 210.6 ± 67.1 μm at 2 years, (p < 0.0001, paired t - test). After 2 years, 66.7% patients (12 eyes) had no retinal exudation. The mean number of injections was 7.8 ± 1.5 in year 1 and 5.9 ± 2.6 in year 2. The mean interval between injections at 2 years was 11.2 ± 4.9 weeks.
The use of a treat and extend regimen for intravitreal aflibercept injections in nAMD was effective in improving BCVA, CRT, and retinal exudates for up to 2 years. The mean number of injections and mean interval between them was very variable between cases.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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