title: TREAT-AND-EXTEND REGIMEN WITH AFLIBERCEPT FOR RETINAL ANGIOMATOUS PROLIFERATION.
abstract: OBJECTIVE
  To evaluate the effects of aflibercept therapy using a treat-and-extend regimen on treatment-naïve retinal angiomatous proliferation (RAP) and development of retinal pigment epithelium (RPE) atrophy.
  
  
  METHODS
  We retrospectively studied 17 treated eyes with RAP and 13 untreated fellow eyes. We assessed best-corrected visual acuity (BCVA) in logarithm of the minimal angle of resolution (logMAR) units and recorded the total number of injections for 12 months. Central macular thickness (CMT) and central choroidal thickness (CCT) were assessed by optical coherence tomography (OCT), and RPE atrophy extent in the macular area was assessed by fundus autofluorescence.
  
  
  RESULTS
  Average BCVA in eyes with RAP was 0.57 logMAR units (Snellen 20/74 or approximately 56.5 ETDRS letters) before treatment and significantly improved to 0.38 (Snellen 20/48 or approximately 66 ETDRS letters, P < 0.01) after 3 months and 0.32 (Snellen 20/42 or approximately 69 ETDRS letters, P < 0.01) after 12 months. Average CMT was 340 μm before treatment and significantly reduced to 133 μm (P < 0.001) after 3 months and 130 μm (P < 0.001) after 12 months. Average CCT was 147 μm before treatment, 123 μm (P < 0.01) after 3 months, and 131 μm (P < 0.01) after 12 months. Average total number of injections was 7.2. Average area of RPE atrophy enlarged by 1.00 mm in treated eyes compared with 0.34 mm in fellow eyes (P < 0.01). The enlarged area of RPE atrophy was inversely correlated with central choroidal thickness after 12 months (rs = -0.49, P < 0.01) and positively correlated with the number of injections (rs = 0.58, P < 0.01).
  
  
  CONCLUSIONS
  Treat-and-extend intravitreal therapy with aflibercept may be effective for improvement and stabilization of visual acuity and exudative change in eyes with RAP. However, choroidal thinning during the treatment regimen may accelerate enlargement of RPE atrophy.
authors.affiliation: Department of Ophthalmology, School of Medicine, Gunma University, Maebashi, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Taku
authors.initials: T
authors.lastname: Sato
authors.forename: Masahiro
authors.initials: M
authors.lastname: Morimoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Mukai
authors.forename: Maki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Hiroe
authors.forename: Kensuke
authors.initials: K
authors.lastname: Ehara
authors.forename: Mayuko
authors.initials: M
authors.lastname: Takayama
authors.forename: Kensuke
authors.initials: K
authors.lastname: Mimura
authors.forename: Shoji
authors.initials: S
authors.lastname: Kishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000798:Angiomatosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012163:Retinal Detachment / Q000188:drug therapy; D015861:Retinal Neovascularization / Q000188:drug therapy* / Q000473:pathology; D055213:Retinal Pigment Epithelium / Q000473:pathology; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000473:pathology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor