. 2019; 49(5): 258-269 | |||
Risk-Based Algorithm-Guided Treatment Protocol in the Management of Neovascular Age-Related Macular DegenerationMurat Karacorlu, Mumin Hocaoglu, Serra Arf, M. Giray Ersoz, Isıl Sayman MuslubasIstanbul Retina Institute, Istanbul, TurkeyObjectives: To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration. Materials and Methods: Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The ‘’short-term monthly injections’’ protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the ‘’short-term treat-and-extend (TREX)’’ protocol. The ‘’extended TREX’’ protocol was for patients with high-risk lesions and low fellow-eye visual acuity. Results: The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean number of 3.4±1.6 anti-VEGF injections per year. Conclusion: The risk-based algorithm-guided treatment protocol was able to achieve visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye. Keywords: Anti-vascular endothelial growth factor, individualized medicine, neovascular age-related macular degeneration, treat and extend dosingNeovasküler Tip Yaşa Bağlı Makula Dejenerasyonu Tedavisinde Risk Odaklı Tedavi ProtokolüMurat Karacorlu, Mumin Hocaoglu, Serra Arf, M. Giray Ersoz, Isıl Sayman Muslubasİstanbul Retina Enstitüsü, İstanbul, TürkiyeAmaç: Neovasküler tip yaşa bağlı makula dejenerasyonu tedavisinde uygulanan risk odaklı tedavi protokolün etkinliğinin değerlendirilmesi. Murat Karacorlu, Mumin Hocaoglu, Serra Arf, M. Giray Ersoz, Isıl Sayman Muslubas. Risk-Based Algorithm-Guided Treatment Protocol in the Management of Neovascular Age-Related Macular Degeneration. . 2019; 49(5): 258-269 Corresponding Author: Murat Karacorlu, Türkiye |
|