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Rehab Ismail, Deepali Varma; Treatment of neovascular Age related macular degeneration (AMD) using a Modified ‘Treat and Extend regimen’. Invest. Ophthalmol. Vis. Sci. 2018;59(9):801.
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Ideal treatment regimen is still being debated for neovascular age-related macular degeneration (nAMD) due to lack of real world data achieving clinical outcomes comparable to benchmark clinical trials. We conducted a prospective audit on clinical outcomes of anti-VEGF for nAMD using a modified Treat & Extend (T&E) regimen.
Electronic data was prospectively collected for 81 consecutive nAMD cases who were either commenced on /or switched to a modified T&E regimen and had a follow up for at least 24 months. Switched patients (n=8) were either those on monthly anti VEGF or had insufficient response to first line anti-VEGF (i.e. suboptimal responders) prior to switching to a modified T&E regimen. Primary clinical outcomes measured included visual, anatomical and injection data. Patients with non AMD CNV were excluded.Modified T& E regimen involved patients receiving a loading phase for 3-months, followed by fixed dosing for next 3 injections at 2 month intervals until month 11 and T&E in year 2. The injection intervals were extended by 2 weeks for next 2 batches of injections if no CNV activity or shortened to the ‘last interval’ before extension on any sign of recurrence..
Total 75 nAMD cases were included for analysis. Mean Baseline visual acuity (VA)= 59.7 ETDRS letters. Mean Baseline central retinal thickness (CRT) = 321 Um. Mean improvement in VA year 1 =6.3 ETDRS letters and 5.3 ETDRS letters in year 2. Mean change in CRT at year 1= -46.2 um and -75 um in year 2. Mean injection n=9 (year 1) & n=5 (year 2) for Lucentis, and n= 8 (year 1) & n=4 (year 2) for Eylea.
In light of the current treatment burden of nAMD with regular anti-VEGF injections, frequent monitoring and long-term therapy, a proactive modified T&E approach that can ease the capacity challenge while maintaining good visual outcomes is desirable. Maximum extension period with our regimen was 20 weeks with Eylea and 16 weeks with Lucentis. While this regimen reduces the number of monitoring visits the number of injections may be higher during the year 1 and 2.
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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