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Results of patients with neovascular age-related macular degeneration managed by a treat-extend-stop protocol without recurrence

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To assess vision, injection quantity, initial lesion size, and final anatomic status in patients with nAMD completing the treat-extend-stop (TES) protocol.

Methods

Patients with nAMD received ≥ 3 monthly anti-VEGF injections followed by 1–2 week injection interval extensions, with intra/subretinal fluid resolution on SD-OCT, to 12 weeks. With quiescent disease, and 2 quarterly injections, patients were monitored alone beginning at 4 weeks extending by 1–2 week intervals until quarterly monitoring.

Results

Eighty-eight of 143 eyes with nAMD completed the TES protocol without disease recurrence. Sixteen (18.2%) developed sub-foveal geographic atrophy (GA), 25 (28.4%) developed fibrovascular scarring (FV) and 47 (53.4%) developed regressed choroidal neovascularization (rCNV) with 16.9 ± 13.3 average injections between the 3 groups which was not statistically significant. Average treatment time was 30.3 ± 26.1 months and subsequent follow-up was 23.2 ± 19.8 months. Average lesion size for FV was 18.77 ± 10.8mm2 vs. GA at 12.00 ± 9.99mm2 vs. regressed CNV at 7.12 ± 6.5mm2 (p < 0.05). Pre, post, and final vision for GA was 39.6 letters (20/160) vs. 32.7 letters (20/200 + 2, p = 0.4725) vs. 25.0 letters (20/320, p = 0.0865); FV was 22.4 letters (20/400 + 2) vs. 11.6 letters (20/640, p = 0.0351) vs. 11.0 letters (20/640 + 1, p = 0.0226), and rCNV was 56.4 letters (20/80 + 1) vs. 69.5 letters (20/40, p < 0.001) vs. 67.3 letters (20/40–2, p = 0.0016). In the rCNV group, 17/46 eyes gained ≥ 3 lines and 30/46 eyes achieved ≥ 20/40 vision. Non-central GA expanded 0.226 ± 0.126 mm vs. 0.225 ± 0.098 mm during and after treatment completion over 24 months (p = 0.99).

Conclusions

Central GA or FV portends worse visual outcomes vs. rCNV after cessation of therapy. Anti-VEGF therapy may not affect the rate of GA expansion. Final anatomic character and location are key determinants of final vision.

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Data availability

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Authors and Affiliations

  1. Retina Consultants of Orange County, 301 W. Bastanchury Ave #285, Fullerton, CA, 92835, USA

    Sean D. Adrean, Siyang Chaili, Ash Pirouz & Scott Grant

  2. Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, 37212, USA

    Siyang Chaili

Authors
  1. Sean D. Adrean
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  2. Siyang Chaili
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  3. Ash Pirouz
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  4. Scott Grant
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Corresponding author

Correspondence to Sean D. Adrean.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (IRB# 2017–0023-RCOC, IRB Co, Buena Park, CA, USA) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Not needed as patient identifying information was removed and results were aggregated for reporting.

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Not applicable.

Competing interests

Dr. Adrean reports grants from Genentech, grants from Ohr, grants from Regeneron, grants from SciFluor, grants from Ophthotech, grants from Allergan, outside the submitted work. Dr. Chaili has no conflicts to report. Dr. Pirouz reports grants from Regeneron, grants from Ophthotech, grants from Allergan, outside the submitted work. Dr. Grant reports grants from Genentech, grants from Ohr, grants from Regeneron, grants from SciFluor, grants from Ophthotech, grants from Allergan, outside the submitted work.

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Adrean, S.D., Chaili, S., Pirouz, A. et al. Results of patients with neovascular age-related macular degeneration managed by a treat-extend-stop protocol without recurrence. Graefes Arch Clin Exp Ophthalmol 259, 3665–3673 (2021). https://doi.org/10.1007/s00417-021-05283-0

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  • DOI: https://doi.org/10.1007/s00417-021-05283-0

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