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목적 : To validate a modified observe-and-plan regimen for neovascular age-related macular degeneration (AMD), aimed to reduce the clinical burden, while obtaining good functional results within the bounds of Korean Public Medical Insurance System.
방법 : Fourty-eight eyes (48 patients) with treatment naïve neovascular AMD who applied modified observe and plan regimen using aflibercept from December 2015 to December 2016 were retrospectively reviewed. After initial 3 loading injections, all patients were monitored monthly until signs of exudative activity appeared. For the patients with early recurrence (within 12 weeks), treatment-and-extend (TAE) regimen was chosen, and for the patients with late recurrence (over 12 weeks), pro re nata (PRN) regimen was selected. All patients were observed for at least 1 year.
결과 : No significant differences were observed in mean change of visual acuity (VA) and central macular thickness (CMT) between early and late recurrence groups during 12 months. The early recurrence group had improved or maintained VA in all eyes using TAE regimen and the late recurrence group had it in 92.8% using PRN regimen. The early recurrence group treated with TAE regimen had 6.4 injections with mean treatment interval of 11.2±3.3 weeks while the late recurrence group treated with PRN regimen had 3.7 injections over 12 months.
결론 : We adopted a modified protocol selecting the treatment regimens according to recurrence interval after initial loading injections. Even for the patients with early recurrence during the observation phase, the TAE regimen allowed for good functional outcomes with fewer injections compared with bimonthly-after 3 dosing regimen in the VIEW study. This regimen might be an ideal individualized protocol for neovascular AMD with diversity in Korea.
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