Long Intervals between Intravitreal Injections Using a Treat-and-Extend Protocol in a Real-Life Context in AMD: The LIRE Study

Abstract

Introduction: To assess the outcome of long Treat-and-Extend (TE) anti-VEGF intravitreal injection (IVI) intervals (≥every 12 weeks [Q12W]) in neovascular age-related macular degeneration (nAMD). The aims of this retrospective study were to determine the proportion of nAMD eyes treated ≥Q12W, to analyze their longitudinal, functional and anatomical outcomes, and to compare functional and anatomical outcomes between eyes that rapidly versus slowly reached a Q12W regimen, and between eyes directly treated with versus initiating lately the TE regimen. Methods: All patients receiving IVIs for nAMD were screened. The longitudinal, functional and anatomical characteristics of Q12W-treated eyes were reported at different timepoints. Results: Ninety-one eyes were included (38% of our total nAMD cohort). The mean TE regimen time to reach a Q12W interval was 20.1 +/- 16.2 months. During this time, a mean number of 12.1 +/- 9.3 IVIs were needed. The mean BCVA was 68 letters at the time of diagnosis and was maintained (p >0.05). Eyes that rapidly reached a Q12W interval had a shorter follow-up before TE regimen initiation (p=0.04) and received fewer IVIs (p=0.02) than eyes that slowly reached a Q12W interval. Eyes directly treated with the TE regimen reached a Q12W interval more rapidly than eyes with late TE initiation. The neovascularization subtype was not a predictor of outcome in TE-treated eyes. Conclusion: ≥Q12W eyes represent an important part of the nAMD population in our real-life study. No baseline anatomical characteristics was associated with the outcome under a TE regimen, although early TE regimen initiation allowed extending more rapidly the IVI interval.

Association of Genetic Risk for Age-Related Macular Degeneration with Morphological Features of the Retinal Microvascular Network

“…The presence of these conditions can lead to the stimulation of new blood vessel growth in the retina or choroid as a response to reduced oxygen supply to the affected area [18]. Neovascular age-related macular degeneration (nvAMD) is a condition that requires frequent and long-term intravitreal injections to preserve vision with a significant treatment burden to maintain sight [19][20][21].…”

“…Modifiable risk factors include smoking, increased BMI, alcohol intake, and dietary habits [4]. Anti-VEGF therapies have emerged and are widely used, such as ranibizumab (Lucentis ® , Novartis, Basel, Switzerland), aflibercept (Eylea ® , Bayer, Berlin, Germany), brolucizumab (Beovu ® , Novartis, Basel, Switzerland), faricimab (Vabysmo ® , Roche, Basel, Switzerland), and the off-label use of bevacizumab (Avastin ® , Roche, Basel, Switzerland) [21,22].…”