The authors report on 24-month outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy using a ‘treat and extend’ regime for treatment-naïve neovascular age-related macular degeneration (nAMD). Data for this study was collected from the Fight Retinal Blindness observational registry based in Australia and New Zealand. The treat and extend protocol involved initial treatment once every four weeks until the nAMD was no longer active. This was followed by extension of treatment interval by one to two weeks, provided the visual acuity was stable and there were no clinical or OCT signs of activity. Should there be recurrence of nAMD activity, the treatment interval was shortened again. In total, 1198 eyes of 1011 patients were included in the study. Ranibizumab monotherapy was received by 588 eyes (49%) while bevacizumab monotherapy was received by 25 eyes (2%). Five hundred and eighty-five eyes (49%) received a combination of bevaczumab, ranibizumab and aflibercept. Over the two year study period, the mean number of injections was 13 per eye (7.5 in the first year, and 5.5 in the second year). The mean number of visits was 14.8 (7.9 in the first year, and 6.7 in the second year). The endophthalmitis rate was 0.013% (one per 7272 injections). Visual acuity improved by a mean of 5.3 letters (from 56.5 at baseline to 61.8 at 24 months). The proportion of eyes achieving a vision of 6/12 increased from 27% at baseline to 45% at 24 months, while those with vision worse than 6/60 remained unchanged (13% at baseline; 11% at 24 months). Although there were quite a number of eyes that were lost to follow-up, this shows that ‘treat and extend’ for nAMD can achieve good visual outcomes in routine clinical practice and at the same time reduce the need for monthly clinic visits and injections. 

Two-year outcomes of “treat and extend” intravitreal therapy for neovascular age-related macular degeneration.
Arnold JJ, Campain A, Barthelmes D, et al.
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Brian Ang

Royal Victorian Eye and Ear Hospital, Melbourne, Australia

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