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Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society

Chaikitmongkol V 1 , Sagong M 2 , Lai TYY 3 , Tan GSW 4 , Ngah NF 5 , Ohji M 6 Show all authors , Mitchell P 7 , Yang CH 8 , Ruamviboonsuk P 9 , Wong I 10 , Sakamoto T 11 , Rajendran A 12 , Chen Y 13 , Lam DSC 14 , Lai CC 15 , Wong TY 4 , Cheung CMG 4 , Chang A 16 , Koh A 17

Affiliations 

  • 1 Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 2 Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
  • 3 Hong Kong Eye Hospital, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong
  • 4 Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
  • 5 Ministry of Health, Hospital Shah Alam, Selangor, Malaysia
  • 6 Department of Ophthalmology, Shiga University of Medical Science, Otsu, Shiga, Japan
  • 7 University of Sydney (Westmead Institute for Medical Research), Sydney, NSW, Australia
  • 8 Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
  • 9 Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
  • 10 Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
  • 11 Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
  • 12 Retina-Vitreous Service, Aravind Eye Care System, Chennai, India
  • 13 Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China
  • 14 C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China; C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
  • 15 Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
  • 16 Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSW, Australia
  • 17 Eye & Retina Surgeons, Camden Medical Centre, Singapore
Asia Pac J Ophthalmol (Phila), 2021 Nov 24;10(6):507-518.
PMID: 34839342 DOI: 10.1097/APO.0000000000000445

Abstract

PURPOSE: Review and provide consensus recommendations on use of treat-and-extend (T&E) regimens for neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) management with relevance for clinicians in the Asia-Pacific region.

METHODS: A systematic search of MEDLINE, EMBASE, and Cochrane databases, and abstract databases of the Asia-Pacific Vitreo-retina Society, European Society of Retina Specialists, American Academy of Ophthalmology, and Controversies in Ophthalmology: Asia-Australia congresses, was conducted to assess evidence for T&E regimens in nAMD. Only studies with ≥100 study eyes were included. An expert panel reviewed the results and key factors potentially influencing the use of T&E regimens in nAMD and PCV, and subsequently formed consensus recommendations for their application in the Asia-Pacific region.

RESULTS: Twenty-seven studies were included. Studies demonstrated that T&E regimens with aflibercept, ranibizumab, or bevacizumab in nAMD, and with aflibercept in PCV, were efficacious and safe. The recommendation for T&E is, after ≥3 consecutive monthly loading doses, treatment intervals can be extended by 2 to 4 weeks up to 12 to 16 weeks. When disease activity recurs, the recommendation is to reinject and shorten intervals by 2 to 4 weeks until fluid resolution, after which treatment intervals can again be extended. Intraretinal fluid should be treated until resolved; however, persistent minimal subretinal fluid after consecutive treatments may be tolerated with treatment intervals maintained or extended if the clinical condition is stable.

CONCLUSIONS: T&E regimens are efficacious and safe for nAMD and PCV, can reduce the number of visits, and minimize the overall burden for clinicians and patients.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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