Cargando…

Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen

OBJECTIVE: The aim of this study is twofold. First, to evaluate the long-term outcome of anti-vascular endothelial growth factor (anti-VEGF) treatment in a clinical setting using the “treat-and-extend regimen” (TER) in patients with neovascular age-related macular degeneration (nAMD). Second, to det...

Descripción completa

Detalles Bibliográficos
Autores principales: Jaki Mekjavic, Polona, Zaletel Benda, Polona
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938349/
https://www.ncbi.nlm.nih.gov/pubmed/29765959
http://dx.doi.org/10.3389/fmed.2018.00125
_version_ 1783320762843660288
author Jaki Mekjavic, Polona
Zaletel Benda, Polona
author_facet Jaki Mekjavic, Polona
Zaletel Benda, Polona
author_sort Jaki Mekjavic, Polona
collection PubMed
description OBJECTIVE: The aim of this study is twofold. First, to evaluate the long-term outcome of anti-vascular endothelial growth factor (anti-VEGF) treatment in a clinical setting using the “treat-and-extend regimen” (TER) in patients with neovascular age-related macular degeneration (nAMD). Second, to determine the proportion of patients treated with anti-VEGF with good visual acuity (VA), i.e., vision sufficient to maintain a high level of independence. DESIGN: We conducted a single center retrospective review of patients with treatment-naive nAMD who were treated with anti-VEGF. Patients were treated with anti-VEGF intravitreal injections according to the TER. Patients started treatment with monthly injections of either bevacizumab (1.25 mg/0.05 mL) or ranibizumab (0.5 mg/0.05 mL) until there were no signs present of choroidal neovascularization (CNV) activity. CNV activity was determined from fundus examination and SD-OCT imaging. Follow-up administration of intravitreal injections was extended by 2-week intervals, up to a total of 14 weeks, provided no signs of CNV activity were detected. In some patients, the first treatment was replaced with aflibercept (2 mg/0.05 mL). PARTICIPANTS: On the basis of the inclusion criterion for the study, that patients had to be treated for 5 years, a total of 101 patients were included in the study. In all patients, one eye was treated for a 5-year period, and thus we studied 101 eyes. MEASUREMENTS: Best corrected VA was analyzed at baseline and each year during the 5-year follow-up. RESULTS: VA improved initially after year 1 of the treatment. VA decreased in the subsequent 4 years of treatment, but remained significantly higher from year 1 to year 3 of the treatment compared to baseline values. Patients with good VA followed a similar trend: the proportion increased in the first year, and thereafter gradually decreased during the course of the 5-year follow up. At year 5, the number of patients with good VA decreased to baseline values. CONCLUSION: TER with anti-VEGF for nAMD treatment prevents long-term severe visual loss in real-world setting and maintains patients’ VA at levels sufficient to ensure independence.
format Online
Article
Text
id pubmed-5938349
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-59383492018-05-14 Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen Jaki Mekjavic, Polona Zaletel Benda, Polona Front Med (Lausanne) Medicine OBJECTIVE: The aim of this study is twofold. First, to evaluate the long-term outcome of anti-vascular endothelial growth factor (anti-VEGF) treatment in a clinical setting using the “treat-and-extend regimen” (TER) in patients with neovascular age-related macular degeneration (nAMD). Second, to determine the proportion of patients treated with anti-VEGF with good visual acuity (VA), i.e., vision sufficient to maintain a high level of independence. DESIGN: We conducted a single center retrospective review of patients with treatment-naive nAMD who were treated with anti-VEGF. Patients were treated with anti-VEGF intravitreal injections according to the TER. Patients started treatment with monthly injections of either bevacizumab (1.25 mg/0.05 mL) or ranibizumab (0.5 mg/0.05 mL) until there were no signs present of choroidal neovascularization (CNV) activity. CNV activity was determined from fundus examination and SD-OCT imaging. Follow-up administration of intravitreal injections was extended by 2-week intervals, up to a total of 14 weeks, provided no signs of CNV activity were detected. In some patients, the first treatment was replaced with aflibercept (2 mg/0.05 mL). PARTICIPANTS: On the basis of the inclusion criterion for the study, that patients had to be treated for 5 years, a total of 101 patients were included in the study. In all patients, one eye was treated for a 5-year period, and thus we studied 101 eyes. MEASUREMENTS: Best corrected VA was analyzed at baseline and each year during the 5-year follow-up. RESULTS: VA improved initially after year 1 of the treatment. VA decreased in the subsequent 4 years of treatment, but remained significantly higher from year 1 to year 3 of the treatment compared to baseline values. Patients with good VA followed a similar trend: the proportion increased in the first year, and thereafter gradually decreased during the course of the 5-year follow up. At year 5, the number of patients with good VA decreased to baseline values. CONCLUSION: TER with anti-VEGF for nAMD treatment prevents long-term severe visual loss in real-world setting and maintains patients’ VA at levels sufficient to ensure independence. Frontiers Media S.A. 2018-05-01 /pmc/articles/PMC5938349/ /pubmed/29765959 http://dx.doi.org/10.3389/fmed.2018.00125 Text en Copyright © 2018 Jaki Mekjavic and Zaletel Benda. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Jaki Mekjavic, Polona
Zaletel Benda, Polona
Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen
title Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen
title_full Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen
title_fullStr Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen
title_full_unstemmed Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen
title_short Outcome of 5-Year Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Using “Treat and Extend” Regimen
title_sort outcome of 5-year treatment of neovascular age-related macular degeneration with intravitreal anti-vegf using “treat and extend” regimen
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938349/
https://www.ncbi.nlm.nih.gov/pubmed/29765959
http://dx.doi.org/10.3389/fmed.2018.00125
work_keys_str_mv AT jakimekjavicpolona outcomeof5yeartreatmentofneovascularagerelatedmaculardegenerationwithintravitrealantivegfusingtreatandextendregimen
AT zaletelbendapolona outcomeof5yeartreatmentofneovascularagerelatedmaculardegenerationwithintravitrealantivegfusingtreatandextendregimen