随着抗VEGF药物的出现,新生血管性年龄相关性黄斑变性(nAMD)的治疗迈出了一大步。治疗和扩展(T&E)方法是一种精细化的管理策略,根据个体患者的病程和治疗结果进行调整。为在资源有限的医疗保健系统中实施抗VEGFT&E方案提供指导,举行了一个咨询委员会,讨论并达成专家共识,根据当地和国际准则,目前的证据,以及当地经验和报销政策。在专家看来,nAMD的治疗应旨在最大限度地提高和维持视力获益,同时最大限度地减少治疗负担.根据目前的证据,可以通过每月3次连续注射开始治疗.在初始阶段之后,对于合格的患者,治疗间隔可每次延长2或4周(即无BCVA丢失≥5个ETDRS字母和视网膜干燥),和16周的最大间隔是允许的。对于符合缩短标准的患者(即任何增加的液体,BCVA损失≥5个ETDRS字母,或存在新的黄斑出血或新的新生血管形成),治疗间隔应每次减少2或4周,以4周的最小间隔。对于那些已经接受间隔16周的2-3次连续注射并且存在稳定疾病的人,可以考虑停用抗VEGF。对于这些人来说,建议定期监测(例如3-4个月),并在出现疾病复发迹象时恢复每月注射.
The management of neovascular age-related macular degeneration (nAMD) has taken a major stride forward with the advent of anti-VEGF agents. The treat-and-extend (T&E) approach is a refined management strategy, tailoring to the individual patient\'s disease course and treatment outcome. To provide guidance to implementing anti-VEGF T&E regimens for nAMD in resource-limited health care systems, an advisory board was held to discuss and generate expert
consensus, based on local and international
guidelines, current evidence, as well as local experience and reimbursement policies. In the experts\' opinion, treatment of nAMD should aim to maximize and maintain visual acuity benefits while minimizing treatment burden. Based on current evidence, treatment could be initiated with 3 consecutive monthly injections. After the initial period, treatment interval may be extended by 2 or 4 weeks each time for the qualified patients (i.e. no BCVA loss ≥5 ETDRS letters and dry retina), and a maximum interval of 16 weeks is permitted. For patients meeting the shortening criteria (i.e. any increased fluid with BCVA loss ≥5 ETDRS letters, or presence of new macular hemorrhage or new neovascularization), the treatment interval should be reduced by 2 or 4 weeks each time, with a minimal interval of 4 weeks. Discontinuation of anti-VEGF may be considered for those who have received 2-3 consecutive injections spaced 16 weeks apart and present with stable disease. For these individuals, regular monitoring (e.g. 3-4 months) is recommended and monthly injections should be reinstated upon signs of disease recurrence.