title: [Treatment of age-related macular degeneration: Expert opinion and therapeutic algorithm].
abstract: Intravitreal injections (IVT) of aflibercept are indicated in France for the treatment of neovascular age-related macular degeneration (AMD). An induction phase consisting of 3 monthly IVTs followed by follow-up visits and IVTs every other month during the first year is recommended. However, it may be necessary to adjust this schedule for some patients who might benefit from a more tailored approach, namely a follow-up visit immediately after the induction phase. The goal was to develop a treatment algorithm that would reflect current clinical experience and the opinions of experts on neovascular AMD.
  
  
  METHODS
  A group of retinologists took positions on therapeutic questions regarding management of AMD using a nominal group technique (NGT). The results were combined to create a treatment algorithm.
  
  
  RESULTS
  Seventy-nine percent of experts considered that the approved schedule was efficacious when fluid was completely resorbed after the induction phase. Ninety-four percent of experts recommended, after a successful induction phase, a monthly follow-up visit for 3 to 6 months in order to determine the rhythm of recurrence for each patient. Ninety-six percent of experts recommended that persistent fluid after the induction phase, even if visual acuity is improved satisfactorily, should be a criterion for systematic retreatment.
  
  
  CONCLUSIONS
  The proposed algorithm (expert opinion) after the first year of use of aflibercept in France captures the complexity of the clinical cases that exist in daily practice and the necessity for regular follow-ups.
authors: CHU de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon I, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France. Electronic address: kodjikian.laurent@wanadoo.fr.
authors: L
authors: L
authors: Kodjikian
authors: Centre ophtalmologique rétine Gallien-Bordeaux, 68, rue du Palais-Gallien, 33000 Bordeaux, France.
authors: E
authors: E
authors: Fourmaux
authors: Centre ophtalmologique de l'Odéon, 113, boulevard Saint-Germain, 75006 Paris, France.
authors: F
authors: F
authors: Coscas
authors: Centre ophtalmologie de La Louvière, 69, rue de la Louvière, 59042 Lille, France.
authors: S
authors: S
authors: Dumas
authors: Centre ophtalmologique de l'Odéon, 113, boulevard Saint-Germain, 75006 Paris, France.
authors: C
authors: C
authors: Français
authors: Centre Monticelli Paradis, 433, rue Paradis, 13008 Marseille, France.
authors: C
authors: C
authors: Morel
authors: Centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors: H
authors: H
authors: Oubraham
authors: Centre ophtalmologique transparence, 30, boulevard Heurteloup, 37000 Tours, France.
authors: S
authors: S
authors: Razavi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000188:drug therapy; D019468:Disease Management; D004334:Drug Administration Schedule; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000628:therapy; D060046:Maintenance Chemotherapy; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012074:Remission Induction; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Aflibercept; Algorithm; Algorithme; Avis d’experts; Contrôle; Dégénérescence maculaire néovasculaire liée à l’âge; Expert opinion; Follow-up; Neovascular age-related macular degeneration; Traitement; Treatment