First Author: L.Onyeocha UK
Co Author(s): A. Al Mousawi V. Kit H. Soomro M. Karampelas S. Mall
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The emerging Treat and Extend (T&E) regimen moves from reactive to proactive intravitreal anti-vascular endothelial growth factor management in neovascular Age-Related Macular Degeneration (nAMD), resulting in better visual outcomes. Oubraham (2011) demonstrated better visual outcomes, reporting a 10.8 Early Treatment Diabetic Retinopathy Study (ETDRS) letter-gain with ranibizumab and a statistically significant difference in Best Corrected Visual Acuity (BCVA) and Central Retinal Thickness (CRT) between T&E and the pro re nata regimen. This study evaluates local data in a District General Hospital setting to compare real world effectiveness of an Aflibercept T&E regimen in nAMD against published data.
Department of Ophthalmology at a District General Hospital in London, UK.
Retrospective case note review of Aflibercept T&E patients comparing BCVA in ETDRS letters and CRT using optical coherence tomography at baseline, at the end of Year One (12 months) and Year Two (24 months) of treatment. Patients who completed Year Two Aflibercept for nAMD using a T&E approach were included in this study, which included treatment-naïve patients and those previously treated with ranibizumab or Aflibercept with a pro re nata approach.
32 eyes of 27 patients completed the Aflibercept T&E regime. 21 patients were female and 8 were male, with a mean age of 84. 27 eyes were treatment-naïve, 4 had previously been treated with ranibizumab and 1 eye previously treated with Aflibercept on a PRN regime. The mean change in CRT was an improvement of 137.22µm. Patients received 7 injections in Year One, as per license, and an average of 4.5 injections in Year Two. 12.5% gained ≥15 letters and 75% maintained stable vision. Of the 15 eyes that gained vision, there was a mean BCVA improvement of 10.87 letters. Mean BCVA at baseline was 25.00±15.05. At the end of Year One, following 12 months of treatment, mean BCVA improved to 27.38±13.42 and at the end of Year Two (24 months) mean BCVA remained stable at 25.00±14.82.
The majority of patients on the T&E regime had stable or improved vision at the end of Year Two. Improvements in anatomical outcomes were comparable to published data. T&E is an effective approach to nAMD management at a District General Hospital with real world impact stabilising vision. This approach benefits patients and aids clinical planning.