Purpose: To investigate outcomes in patients with neovascular age-related macular degeneration (AMD) switched from a pro re nata regimen (PRN) to a treat and extend regimen (TER) under aflibercept. Procedure: Thirty-two patients were observed over 2 years: the first year on PRN and the second year on TER. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated. Intra- and subretinal fluid as well as the number of visits and injections were assessed. Results: Both regimens resulted in a stable BCVA. Patients in TER had a significant decrease of CRT after 1 year compared to 1 year of treatment on PRN (p < 0.0001). TER resulted in significantly less visits; however, significantly more injections were observed over the course of 1 year compared to PRN (10.25 vs. 7.5, p < 0.0001 and 5.97 vs. 7.5, p = 0.0002, respectively). Conclusion: A switch from PRN to TER in patients treated with aflibercept for AMD appears to be safe.

1.
Stewart MW: Individualized treatment of neovascular age-related macular degeneration: what are patients gaining? Or losing? J Clin Med 2015;4:1079-1101.
2.
Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, Reeves BC; IVAN study investigators: Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet 2013;382:1258-1267.
3.
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group; Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL 3rd: Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012;119:1388-1398.
4.
Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, Davis JL, Flynn HW Jr, Esquiabro M: A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 2009;148:43-58.e1.
5.
Spaide R: Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol 2007;143:679-680.
6.
Spaide RF: The as-needed treatment strategy for choroidal neovascularization: a feedback-based treatment system. Am J Ophthalmol 2009;148:1-3.
7.
Berg K, Pedersen TR, Sandvik L, Bragadottir R: Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology 2015;122:146-152.
8.
Rahimy E, Rayess N, Ho AC, Regillo CD: Treatment outcomes for neovascular age-related macular degeneration patients with initial vision better than 20/40 using a treat-and-extend regimen. Retina 2016;36:875-880.
9.
Prünte C, Hatz K: Switch over from PRN to treat and extend in exudative AMD: 1-year results from a clinical series. Macula Society 37th Annual Meeting 2014, Key Largo Florida, February 20, 2014.
10.
Calvo P, Wang Y, Ferreras A, Lam W-C, Devenyi R, Brent MH: Treat and extend versus treat and observe regimens in wet age-related macular degeneration patients treated with ranibizumab: 3-year surveillance period. J Clin Exp Ophthalmol 2014;5:324.
11.
Fung AT, Kumar N, Vance SK, Slakter JS, Klancnik JM, Spaide RS, Freund KB: Pilot study to evaluate the role of high-dose ranibizumab 2.0 mg in the management of neovascular age-related macular degeneration in patients with persistent/recurrent macular fluid <30 days following treatment with intravitreal anti-vegf therapy (the last study). Eye 2012;26:1181-1187.
12.
Oubraham H, Cohen SY, Samimi S, Marotte D, Bouzaher I, Bonicel P, Fajnkuchen F, Tadayoni R: Inject and extend dosing versus dosing as needed: a comparative retrospective study of ranibizumab in exudative age-related macular degeneration. Retina 2011;31:26-30.
13.
Abedi F, Wickremasinghe S, Islam AF, Inglis KM, Guymer RH: Anti-VEGF treatment in neovascular age-related macular degeneration: a treat-and-extend protocol over 2 years. Retina 2014;34:1531-1538.
14.
Engelbert M, Zweifel SA, Freund KB: “Treat and extend” dosing of intravitreal antivascular endothelial growth factor therapy for type 3 neovascularization/retinal angiomatous proliferation. Retina 2009;29:1424-1431.
15.
Toalster N, Russell M, Ng P: A 12-month prospective trial of inject and extend regimen for ranibizumab treatment of age-related macular degeneration. Retina 2013;33:1351-1358.
16.
Wykoff CC, Croft DE, Brown DM, Wang R, Payne JF, Clark L, Abdelfattah NS, Sadda SR; TREX-AMD Study Group: Prospective trial of treat-and-extend versus monthly dosing for neovascular age-related macular degeneration: TREX-AMD 1-year results. Ophthalmology 2015;122:2514-2522.
17.
Freund KB, Korobelnik JF, Devenyi R, Framme C, Galic J, Herbert E, Hoerauf H, Lanzetta P, Michels S, Mitchell P, Mones J, Regillo C, Tadayoni R, Talks J, Wolf S: Treat-and-extend regimens with anti-VEGF agents in retinal diseases: a literature review and consensus recommendations. Retina 2015;35:1489-1506.
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