LONG-TERM FOLLOW-UP FOR TYPE 1 (SUBRETINAL PIGMENT EPITHELIUM) NEOVASCULARIZATION USING A MODIFIED “TREAT AND EXTEND” DOSING REGIMEN OF INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY

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Abstract
Purpose: The purpose of the study was to analyze long-term outcomes for the treatment of type 1 (subretinal pigment epithelium) neovascularization using a modified “treat and extend” antivascular endothelial growth factor dosing regimen. Methods: We performed a retrospective, noncomparative analysis of visual acuity, funduscopic, and optical coherence tomography data for 18 eyes of 16 consecutive patients with newly diagnosed type 1 neovascularization treated with intravitreal bevaci-zumab and/or ranibizumab with at least 24-month follow-up. Three monthly injections were followed by continued treatment at intervals increasing by 2 weeks per visit to a maximum of 10 weeks. The interval was shortened if clinical or optical coherence tomography evidence of recurrent fluid at the foveola or increased extrafoveolar fluid was detected. Results: Median baseline logarithm of the minimum angle of resolution visual acuity was 0.53 (20/69 Snellen equivalent) and remained stable at 24 months (logarithm of the minimum angle of resolution 0.52, P = 0.84) after an average of 12 injections (range, 8-19 injections) and at 36 months (logarithm of the minimum angle of resolution 0.52, P = 0.68) after an average of 20 injections (range, 18-25 injections). Although most eyes (15 of 18 [83%]) continued to manifest extrafoveolar subretinal fluid throughout the course of treatment, only 1 eye developed geographic atrophy overlying the areas of choroidal neovascularization. During a cumulative observation period of 540 months, no eyes developed a sight-threatening submacular hemorrhage. Conclusion: A modified “treat and extend” dosing regimen of intravitreal antivascular endothelial growth factor therapy reduces the need for monthly visits and imaging and allows for stable long-term visual acuity in eyes with type 1 neovascularization.

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