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Mio Hosokawa, Yuki Morizane, Shuhei Kimura, Yusuke Shiode, Masayuki Hirano, Shinichiro Doi, Shinji Toshima, Kosuke Takahashi, Atsushi Fujiwara, Yuki Kanzaki, Mika Hosogi, Fumio Shiraga; Three-year outcomes of a treat and extend regimen of aflibercept for neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2018;59(9):807.
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The treatment of neovascular age-related macular degeneration (AMD) has been revolutionized by anti-vascular endothelial growth factor (VEGF) medications. However, there is no consensus on a standard regimen of anti-VEGF medications for AMD. Recently, a treat and extend regimen (TER) has been widely used for AMD, but there has been no report of a TER for over 3 years using aflibercept. In this retrospective consecutive case series, we evaluated 3 year outcomes of intravitreal aflibercept injections using a TER for patients with AMD.
Forty-one eyes with treatment-naive AMD treated with aflibercept using a TER for 3 years were retrospectively reviewed. After three monthly loading injections, if no retinal exudative changes were seen, the interval between injections was extended by 2 weeks, up to a maximum of 16 weeks. If signs of exudation recurred, the interval was shortened by 2 weeks. The interval was shortened in increments of 4–6 weeks if the exudation recurred when the interval between injections was ≥14 weeks. The main outcome measures were changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), the mean number of injections, and the interval between injections.
The mean BCVA (logarithm of the minimal angle of resolution, log MAR) improved significantly from 0.36±0.31 at baseline to 0.20±0.30, 0.20±0.27, and 0.19±0.27 at year 1, 2 and 3, respectively (p<0.001 for all). At the final visit of year 3, BCVA had improved by more than 0.3 logMAR units in 15 eyes (36.6%) and was unchanged in 26 eyes (63.4%). No eyes were observed to have worsened BCVA values. Mean CRT decreased significantly from 347.8±133.4 μm at baseline to 202.8±53.6 μm, 220.0±102.7 μm, and 219.3±73.5 μm at year 1, 2 and 3, respectively (p<0.001 for all). The mean number of injections was 8.3±1.6, 6.0±2.4, and 5.8±2.5 in year 1, 2 and 3, respectively. At the final visit in year 3, the mean interval between injections was 10.5±4.0 weeks, and 34.2% of eyes were being treated at an interval of 13 weeks or more.
A TER of aflibercept was effective in achieving and maintaining visual and anatomic improvements in patients with AMD for up to 3 years of treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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