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Î The major anti-VEGF trials have used either a fixed continuous
treatment regimen (approximately every 4–8 weeks) or an individualized
discontinuous treatment regimen (PRN). (I++, G, D)
Î Caution should be used when dosing PRN bevacizumab, as it may be
slightly less effective than other monthly anti-VEGF regimens. (I++, M, D)
Î A continuous, variable dosing regimen that attempts to individualize
therapy, commonly referred to as "treat and extend," is frequently
used in clinical practice as an alternative to either fixed continuous
treatment or PRN dosing. (III, In, D)
Î The risks, benefits, complications, and alternatives of the treatment
should be discussed with the patient and informed consent obtained.
(III, G, S)
Î Verteporfin is contraindicated in patients with porphyria or a known
allergy or sensitivity to the drug. (III, G, S)
Î Careful consideration should be given to patients with liver
dysfunction and to patients who are pregnant, breast-feeding, or of
pediatric age. (III, G, S)
Î Introduction or enlargement of a pre-existing scotoma, with or
without visual acuity loss, is not a complication of thermal laser
photocoagulation; rather, it is an anticipated side effect of the
treatment. Similarly, recurrence or persistence of CNV, or the
development of new CNV and further visual deterioration after
adequate thermal laser surgery, is usually a result of the disease
process and is not a complication. These realities must be emphasized
to the patient and family before treatment. (III, G, S)
Î Because of the potential adverse effects, such as increased rate of
genitourinary conditions that may require hospitalizations, the high
doses of antioxidant vitamins and minerals recommended by the
original AREDS and AREDS2 should be reviewed by the patient's
primary care physician. (III, G, S)
