250
OCT and Reviews: “Treat & Extend”
In patients with wet AMD treated with antiangiogenic
drugs, the frequency of the injection was not the only
parameter assessed. The high number of regular exami-
nations also is a substantial burden for patients, families,
and the health system. Several studies (PIER, EXCITE)
proposed revisions to the fixed protocols after 1 month,
but the results were worse than those obtained with
monthly revisions, with both fixed reinjection proto-
cols and those based on OCT.
6,57
Therefore, it is neces-
sary to establish specific criteria to control AMD and
allow more time between retreatments without losing
the treatment effectiveness. Once again, OCT had a
fundamental role in this approach. In this sense, Spaide
proposed a revision scheme called Treat and Extend;
after three monthly loading injections, patient were
reevaluated in 6 weeks, at which time the physicians
determine whether there are signs of activity by fun-
duscopy and edema or intraretinal or subretinal fluid
by OCT (Figure 20).
58
The results depend not only on treatment but also
the frequency of subsequent examinations by the
protocol presented in this proposal, which takes
a leading role in OCT. The use of this treatment
regimen is being evaluated in a study conducted at
Wills Eye Institute, Philadelphia, Pennsylvania. The
preliminary results are promising, with a lower fre-
quency of examinations, i.e., an average of 7.4 injec-
tions annually and similar VA outcomes to those
obtained in the PRONTO study in a greater number
of patients (n=92).
59
Prognostic Factors in OCT
Several OCT parameters are associated with decreased
VA and different responses to other antiangiogenic
treatments regarding VA, central thickness find-
ings, and prognosis after treatment. Singh and col-
leagues retrospectively analyzed a group of patients
with wet AMD treated with bevacizumab (Avastin,
Genentech, south San Francisco, CA) and concluded
that in addition to VA pretreatment the total retinal
thickness measured by OCT affected the final VA and
the total decrease in the post-treatment retinal thick-
ness, which was lower in patients who had received
Figure 20.
Treatment schedule and revisions of Treat & Extend.
