Abstract

SA.16.11

Up-loading phase completed, what to do now?
Efficent controls during the maintenance phase in AMD-patients receiving anti-VEGF therapy

Carsten H. Meyer
Universitäts-Augenklinik Bonn

Our decision pathways are strongly affected in the maintenance phase by the results of the phase II/III studies of Ranibizumab. AMD patient with a fresh CNV receive initially 3 consecutive intravitreal injections every 4 weeks (up-loading phase). Afterwards follows the maintenance phase, in which renewed injections should take place with renewed decreased visual acuity (VA), a disease progression or an increase of the central retina thickness (CRT). The results of the MARINA, ANCHOR and EXCITE study showed that monthly injections in the maintenance phase lead to the best functional results. On the other side taught us the PIER and EXCITE study the consequences of an too generous extension of the observation interval is after the up-loading phase. With quarterly observations increases the CRT constantly and a consecutive decrease of the final VA becomes apparent over 12 months. The PrONOTO, SUSTAIN and EXCITE study demonstrated repetitively, that beside VA also different anatomical parameters such as the CRT on OCT are important retreatment criteria, in order to maintain the initially gained VA. Both at the initial examination as well as during all follow-up visits need a set of stringent data, which support the decision for or against further injections.  A structured documentation belongs to the essential conditions for an efficient patient support in the maintenance phase. The new „electronic Bonn record form“ summarizes all important key findings including VA, FA and OCT of the maintenance phase clearly a computer screen.  A direct link of the electronic Bonn record form to the HRA-Spectralis-OCT offers an immediate analysis of all digitally stored FA-fundus and OCT-pictures.  The digitally stored data can be evaluated statistically, sent to colleagues and make the examiner independent of conventional patient charts.
In order to grant the success of modern anti-VEGF-therapy, a systematic monitoring with clear and transparent documentation is necessary in monthly intervals. A close co-operation with patients, local physicians and hospitals with modern electronic communication is essential for an efficient one time treatment of AMD-patients with anti-VEGF therapy.

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