Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration.
- Essex RW Academic Unit of Ophthalmology, Australian National University, Acton, Australia. Electronic address: rohan.essex@act.gov.au.
- Nguyen V The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.
- Walton R The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.
- Arnold JJ Marsden Eye Specialists, Parramatta, Australia.
- McAllister IL Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Australia.
- Guymer RH Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Australia.
- Morlet N Department of Population Health, University of Western Australia, Perth, Australia.
- Young S Gladesville Eye Specialists, Gladesville, Australia.
- Barthelmes D The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Gillies MC The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia.
- 2016-08-25
Published in:
- Ophthalmology. - 2016
Aged
Angiogenesis Inhibitors
Bevacizumab
Female
Follow-Up Studies
Humans
Intravitreal Injections
Male
Prospective Studies
Ranibizumab
Registries
Time Factors
Treatment Outcome
Vascular Endothelial Growth Factor A
Visual Acuity
Wet Macular Degeneration
English
PURPOSE
To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections).
DESIGN
Database observational study.
PARTICIPANTS
Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase.
METHODS
Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity.
MAIN OUTCOME MEASURES
For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters).
RESULTS
The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months -0.6 letters at 24 months and -1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently.
CONCLUSIONS
The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.
To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections).
DESIGN
Database observational study.
PARTICIPANTS
Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase.
METHODS
Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity.
MAIN OUTCOME MEASURES
For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters).
RESULTS
The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months -0.6 letters at 24 months and -1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently.
CONCLUSIONS
The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.ophtha.2016.07.012
- PMID 27554034
- Persistent URL
- https://sonar.ch/global/documents/142033
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