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.
OBJECTIVE
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.


CONCLUSIONS
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.
Engelbert
Michael
M
Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Zweifel
Sandrine A
SA
Freund
K Bailey
KB
D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D000069579:Ranibizumab; D015861:Retinal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D019233:Retreatment; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab