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Arendt, Petra, MD; Yu, Siqing, MD; Munk, Marion R., MD, PhD; Ebneter, Andreas, MD, PhD; Wolf, Sebastian, MD, PhD; Zinkernagel, Martin S., MD, PhD

doi: 10.1097/IAE.0000000000001923
Original Study: PDF Only

Purpose: To evaluate the outcome of an exit strategy in a treat-and-extend regimen for neovascular age-related macular degeneration.

Methods: Five hundred and ninety-eight eyes of 488 patients with neovascular age-related macular degeneration receiving intravitreal anti–vascular endothelial growth factor injections according to a treat-and-extend regimen were included in this retrospective study. A treat-and-extend regimen with either interval extension by 2 weeks or shortening by 1 week was used. “Exit criteria” were defined as 3 consecutive injections 16 weeks apart with stable findings after which the patient was exited from treatment and followed up at 3 to 4 monthly intervals without therapy. Best-corrected visual acuity, central retinal thickness at treatment initiation and termination, incidence of recurrence after treatment termination, presence of characteristics in the optical coherence tomography, duration of therapy, number and intervals of injections were analyzed.

Results: Seventeen percent of all included eyes met the exit criteria. The mean number of anti–vascular endothelial growth factor injections was 23.7 ± 14.7 with a mean treatment duration of 4.5 ± 2.5 years. Twelve percent reached exit with the minimal number of injections. Thirteen percent had recurrent disease after a mean of 37 ± 16 weeks. In the subgroup with recurrent disease, rate of pigment epithelial detachment at treatment termination was significantly higher than without recurrence (77% vs. 30%, P = 0.0018) with a significant higher proportion of serous pigment epithelial detachment (31% vs. 7%, P = 0.0247).

Conclusion: The high percentage of patients meeting the exit criteria and the relatively low incidence of recurrences underline the usefulness of a predefined exit strategy. However, in a subgroup of patients, continuation of therapy may be advisable.

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The analysis of an exit strategy in a treat-and-extend regimen for neovascular age-related macular degeneration revealed a high percentage of patients who met exit criteria and a relatively low incidence of recurrences.

Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland.

Reprint requests: Martin S. Zinkernagel, MD, PhD, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; e-mail:

M.R. Munk received lecturer fees from Novartis (Novartis AG) and travel support from Bayer (Bayer AG) and is a consultant for Allergan and Lumithera. A. Ebneter received lecturer fees and travel support from Bayer AG, grant and educational support from Novartis, and is a consultant for Allergan. S. Wolf is a consultant for Bayer and Novartis, and M.S. Zinkernagel is a consultant for Novartis and Bayer AG and stockholder of Novartis AG. The remaining authors have no financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.