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Claudio Azzolini, Alfredo Pece, Simone Donati; Italian multicenter real-life experience in anti VEGF treatments for maculopathies: what is the best clinical pathway?. Invest. Ophthalmol. Vis. Sci. 2017;58(8):427.
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To evaluate the best clinical approach on real-life for the treatment with antiVEGF in different maculopathies.
Eighty-five ophthalmologists coming from thirty-five Retina Centers around Italy were involved in this project. Twelve county meetings were organized to collect and discuss experiences and methodologies on antiVEGF treatments. Meeting leaders presented the following topics: 1-Induction phase: application and modalities, 2- Individualized therapy during follow up. Literature data were presented for each topic before discussion. A questionnaire was completed to investigate main technical and practical issues in patients management. All data coming from discussion and questionnaires were collected and analyzed.
The following statements were shared: (topic 1) the time of diagnosis and therapy are the keys; the “loading phase” modality has to be changed into “treatment until stabilization” modality; the treatment interval must not be more than one month. (topic 2): aim of the follow up is to maintain the results of induction phase, treatment could be applied according to Pro Re Nata or Treat and Extend regimen; the participants agreed to apply different clinical approaches and systemic monitoring according to the pathology.The questionnaire underlined the real life aspects of the management: mean time between diagnosis and treatment less than 10 days in 40% centers; about 53% of involved clinician perform induction phase of three injection for AMD and DME; the personalized PRN is applied by 52% ophthalmologists in AMD and by 62% in DME, a monthly control and PRN by 38% and 27% respectively.The questionnaire underlined the difficulties on economical and administrative aspects for drugs management and lack of medical staff. A final document was prepared to ameliorate clinical approach, follow up and management of patients.
The project and the consensus coming from the meeting discussion underlined the new phase of antiVEGF treatment procedure: the induction and follow up phases of the treatment must be tailored on patients responsivity. A key moment is the beginning of the therapy but its continuation its crucial in all the considered pathologies. The creation of Maculopathies Centers could be a new dimension, to control cost and to ameliorate significantly the management of these pathologies.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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