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Turk J Ophthalmol. 2019 Oct 24;49(5):258-269. doi: 10.4274/tjo.galenos.2019.26235.

Risk-based Algorithm-guided Treatment Protocol for the Management of Neovascular Age-related Macular Degeneration

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İstanbul Retina Institute, İstanbul, Turkey



To assess outcomes of a risk-based algorithm-guided treatment protocol for neovascular age-related macular degeneration.

Materials and Methods:

Two hundred and ten eyes of 184 patients managed with anti-vascular endothelial growth factor (anti-VEGF) agents according to a protocol consisting of one of three initial regimens depending on risk with at least 2 years of follow-up were retrospectively evaluated. The “short-term monthly injections” protocol was used for low-risk patients with low-risk lesions and good fellow-eye vision. Patients with low-risk lesions but without good fellow-eye vision, or those with good fellow-eye vision and high-risk lesions were managed according to the “short-term treat-and-extend (TREX)” protocol. The “extended TREX” protocol was for patients with high-risk lesions and low fellow-eye visual acuity.


The initial treatment plan consisted of short-term monthly injections in 62 eyes (30%), the short-term TREX regimen in 120 eyes (57%), and the extended TREX regimen in 28 eyes (13%). Overall, 63% of cases met the criteria for cessation of treatment. Approximately 58% of these cases had recurrence, at a mean of 13 months. The mean change in VA from baseline was +9.0 letters at 12 months and +8.0 letters at 24 months. VA improved during a mean follow-up of 46.8±22 months, with a mean of 3.4±1.6 anti-VEGF injections per year.


The risk-based algorithm-guided treatment protocol yielded visual outcomes similar to those of the common alternative treatment and monitoring regimens, with a dramatically reduced number of injections, as required by the individual lesion and vision in the fellow eye.


Anti-vascular endothelial growth factor; individualized medicine; neovascular age-related macular degeneration; treat and extend dosing

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