Arshad M Khanani,1 Greggory M Gahn,2 Micaela M Koci,2 Jonathan M Dang,2 Sandra M Brown,3 Lauren F Hill4
1Sierra Eye Associates, Reno, NV, USA; 2School of Medicine, University of Nevada, Reno, NV, USA; 3Cabarrus Eye Center, Concord, NC, USA; 4Hill Statistical Consulting, Morrison, CO, USA
Objective: To assess outcomes in treatment-naive eyes with neovascular age-related macular degeneration (nAMD) and good baseline visual acuity (VA) treated using a treat-and-extend (T&E) regimen with intravitreal aflibercept, ranibizumab, or bevacizumab.
Design: Single center, retrospective, observational case series.
Participants: Ninety-one patients (93 eyes) with nAMD and baseline VA ≥20/60 followed for ≥1 year after the first intravitreal injection. Minimum of 6 (first year) and 3 (subsequent years) and maximum of 12 injections per 12 calendar months.
Intervention: Intravitreal aflibercept 2.0 mg, ranibizumab 0.5 mg, or bevacizumab 1.25 mg. Three monthly injections. Treatment interval extended in 2-week increments after resolution of macular edema and reduced in 2-week increments if edema recurred; maximum interval of 12 weeks. Medication changed if edema recurred during and persisted after three monthly injections of original agent.
Main outcome measures: VA maintenance over time. Total number of injections received by year of treatment.
Results: Ninety-three eyes were analyzed. Pretreatment VA was 20/20–20/25 (N=16), 20/30–20/40 (N=47), and 20/50–20/60 (N=30). Mean follow-up was 3.2 years. Follow-up by year was 93, 73, 65, 44, and 26 eyes for years 1–5, respectively. Mean number of injections during years 1–5 was 7.9, 5.9, 5.6, 5.9, and 6.0, respectively; mode number of injections was 7, 5, 3, 6, and 4, respectively. For years 1–5, percent of all eyes at or above baseline was 70%, 66%, 65%, 59%, and 58%, respectively; percent ≥20/60 was 86%, 88%, 86%, 84%, and 77% for years 1–5. For eyes with baseline VA ≥20/40, percent of eyes at or above baseline was 83%, 82%, 81%, 68% and 76% for years 1–5, respectively.
Conclusion: Using a T&E intravitreal injection protocol, more than 75% of treatment-naive eyes with nAMD and baseline VA ≥20/60 can maintain VA ≥20/60 over 5 years.
Keywords: neovascular age-related macular degeneration, ranibizumab, aflibercept, bevacizumab, treat and extend protocol, visual acuity
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License.
By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.