**9. Conclusion**

**Trial No. of patients Injection protocol Drug, dosage, control Results**

mg-Sham

Ranibizumab; 0.3/0.5 mg-sham

Ranibizumab; 0.3/0.5 mg-Sham + PDT every 3 months if needed

PDT every 3 months

Ranibizumab; 0.3/0.5 mg-sham

Ranibizumab; 0.3/0.5 mg

Aflibercept; 0.05/0.15/0.5/1.0/2.0/4 .0 mg

Aflibercept (VTE);0.5/2.0 mg-Ranibizumab;0.5 mg 31%–37% stable vision, 4%–6%gained "/>3 lines (12 months)

95% stable vision, 26%– 34% gained"/>3 lines (12 months)

96%Stable vision,35%– 40% gained"/>3lines (12 months)

90% stable vision

Mean loss of vision 2–5 letters, 3% gained "/>3 lines, 7%– 14% lost "/>3 lines (12 months)

83%–90% stable vision, 12%–13% gained "/ >3lines (12 months)

(24 months)

Mean BCVA increased steadily from baseline to month 3 to reach +5.8 letters, decreased slightly from month 3 to 6, and remained stable from month 6 to 12, reaching +3.6 at month 12

95% stable vision, 50% of 2.0/4.0 mg group gained "/>3 lines (3 months)

All VTE groups were noninferior to ranibizumab.

Ranibizumab; 0.5 mg 43% gained "/>3 lines

VISION <sup>1186</sup> IVT every 6 weeks Pegaptanib; 0.3/1.0/3.0

184 Age-Related Macular Degeneration - Etiology, Diagnosis and Management - A Glance at the Future

FOCUS <sup>162</sup> IVT monthly+PDT Ranibizumab; 0.5 mg-

HORIZON 853 IVT monthly Ranibizumab; 0.5 mg

IVT monthly x 3, retreatment every 3 months

IVT monthly x 3, retreatment as needed (9.9 injections over 24 months)

IVT monthly x 3, re treatment as needed (5.3 injections for "naïve" patients over 12 months)

VTE 0.5 mg monthly (0.5q4wk), VTE 2 mg monthly (2q4wk),VTE 2 mg every two months (2q8wk), or ranibizumab 0.5mg monthly (Rq4wk)

MARINA 716 IVT monthly

ANCHOR 423 IVT monthly

PIER 183

PRONTO 37

SUSTAIN 513

VIEW1 VIEW2

CLEAR-IT 51 IVT single

1217 1240

**Table 1.** Summary of main clinical trials on anti VEGF treatment for AMD

Over the past decade, the treatment of nvAMD improved dramatically with the discovery of anti-VEGF agents that have enabled patients not only to stabilize the vision but to improve and regain vision in this potentially blinding disease.

With the goal of maximizing VA and minimizing the frequency of intravitreal injections and associated risks of treatment, evidence-based management of wet AMD has evolved into in‐ dividualized anti-VEGF therapy with frequent follow up and retreatment. As a safer and more cost-effective alternative to the traditional monthly treatments used in the ANCHOR and MARINA trials, two individualized anti-VEGF treatment regimens have been descri‐ bed, but neither has been proven superior to date: as-needed (or "PRN") therapy and the treat-and-extend strategy. Despite a paucity of evidence comparing the as-needed versus the treat-and extend treatment regimens, a possibility exists that the treat and extend regimen will prove to be the most efficacious, cost-saving, and preferred protocol. The current evi‐ dence based treatment strategy for the management of wet AMD supports the use of either bevacizumab or ranibizumab either monthly or with a more individualized treatmentstrat‐ egy with close followup. As second generation anti-VEGF agents become available and the stress on our healthcaresystems intensifies, increasingly efficacious and costconscioustreat‐ ment strategies will be essential.
