Abstract
Intravitreal injections of antivascular endothelial growth factors have been considered a milestone in the treatment of neovascular age-related macular degeneration (nAMD). However, the increasing incidence of AMD and the burden of visits and injections overcharge both the patient and the healthcare systems. Real-world solutions depend on treatment protocols aimed at optimizing the number of clinical visits while guaranteeing good functional outcomes. We performed a retrospective analysis of 72 eyes from 63 naïve patients diagnosed with nAMD that underwent a fixed intravitreal protocol consisting of bimonthly injections after a three-month loading dose, with either Aflibercept or Ranibizumab (no predefined criteria for treatment selection). Best corrected visual acuity (BCVA) and optical coherence tomography were analyzed at baseline and during follow-up clinical visits (months 3, 6, 12, and 18). From the included participants, 42 followed a fixed regimen with Aflibercept and 30 with Ranibizumab. At the 12-month visit, there was not a statistically significant difference in the mean change of BCVA between the two groups (p=0.121); however, the mean difference in the central retinal thickness was significantly superior in the Aflibercept group (-142.2 versus -51.5, p=0.011). The described fixed regimen seems to be efficient in the treatment of nAMD in a clinical practice setting.
Highlights
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the elderly in developed countries, with an estimated prevalence in the Portuguese population of 12,48% and 1,16% for the early and late forms, respectively [1, 2].Neovascular AMD, an advanced stage of the disease, is characterized by the growth and leakage of new blood vessels arising from the choroid, with vascular endothelial growth factor (VEGF) playing a key role in macular scarring and, loss of central vision
We present a single-center retrospective analysis of the realworld treatment of neovascular age-related macular degeneration (nAMD) with a fixed regimen of intravitreal injections of either Aflibercept or Ranibizumab
Our results revealed equivalent mean changes in Best corrected visual acuity (BCVA) at 12 months in both groups, despite a not statistically significant difference favoring the Aflibercept group
Summary
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in the elderly in developed countries, with an estimated prevalence in the Portuguese population of 12,48% and 1,16% for the early and late forms, respectively [1, 2].Neovascular AMD (nAMD), an advanced stage of the disease, is characterized by the growth and leakage of new blood vessels arising from the choroid, with vascular endothelial growth factor (VEGF) playing a key role in macular scarring and, loss of central vision. In the PRONTO study [8] and in the phase 3 clinical trial HARBOR [9], patients treated in a pro re nata (PRN, as needed) regimen based on optical coherence tomography (OCT) and VA criteria achieved comparable VA gains at month 24, as the fixed monthly Ranibizumab arm of the studies, with fewer number of injections. Another regimen that proved safe and effective is the treat-and-extend (T&E) regimen [10,11,12].
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