Kodjikian L, Fourmaux E, Coscas F, Dumas S, Français C, Morel C, Oubraham H, Razavi S
CHU de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon I, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France.
Centre ophtalmologique rétine Gallien-Bordeaux, 68, rue du Palais-Gallien, 33000 Bordeaux, France.
J Fr Ophtalmol. 2015 Sep;38(7):639-45. doi: 10.1016/j.jfo.2015.06.001. Epub 2015 Aug 24.
Intravitreal injections (IVT) of aflibercept are indicated in France for the treatment of neovascular age-related macular degeneration (AMD). An induction phase consisting of 3 monthly IVTs followed by follow-up visits and IVTs every other month during the first year is recommended. However, it may be necessary to adjust this schedule for some patients who might benefit from a more tailored approach, namely a follow-up visit immediately after the induction phase. The goal was to develop a treatment algorithm that would reflect current clinical experience and the opinions of experts on neovascular AMD.
A group of retinologists took positions on therapeutic questions regarding management of AMD using a nominal group technique (NGT). The results were combined to create a treatment algorithm.
Seventy-nine percent of experts considered that the approved schedule was efficacious when fluid was completely resorbed after the induction phase. Ninety-four percent of experts recommended, after a successful induction phase, a monthly follow-up visit for 3 to 6 months in order to determine the rhythm of recurrence for each patient. Ninety-six percent of experts recommended that persistent fluid after the induction phase, even if visual acuity is improved satisfactorily, should be a criterion for systematic retreatment.
The proposed algorithm (expert opinion) after the first year of use of aflibercept in France captures the complexity of the clinical cases that exist in daily practice and the necessity for regular follow-ups.
在法国，玻璃体内注射阿柏西普被用于治疗新生血管性年龄相关性黄斑变性（AMD）。建议采用诱导期，即每月进行3次玻璃体内注射，随后进行随访，并在第一年每隔一个月进行一次玻璃体内注射。然而，对于一些可能从更个性化方法中受益的患者，可能需要调整该方案，即在诱导期后立即进行随访。目标是制定一种治疗算法，以反映当前的临床经验以及专家对新生血管性AMD的意见。
一组视网膜专家采用名义群体技术（NGT）对AMD治疗相关的问题表明立场。将结果汇总以创建一种治疗算法。
79%的专家认为，当诱导期后积液完全吸收时，批准的方案是有效的。94%的专家建议，在成功的诱导期后，进行3至6个月的每月随访，以确定每位患者的复发节奏。96%的专家建议，即使视力得到令人满意的改善，诱导期后仍存在的积液应作为系统性再次治疗的标准。
在法国使用阿柏西普的第一年之后提出的算法（专家意见）体现了日常实践中临床病例的复杂性以及定期随访的必要性。
