Freund and colleagues conducted a literature review and consensus recommendations on treat-and-extend regimens with anti-VEGF agents in retinal diseases [Freund KB, et al. Retina. 2015;35(8):1489-1506]. Although they found there were too few published studies using the treat-and-extend approach in eyes with RVO-related macular edema to make specific recommendations, they felt from clinical experience that their proposed algorithm was applicable.
The panel recommended that monthly treatment should be maintained until maximum response was observed as defined by complete resolution of subretinal and intraretinal fluid or no further decrease in subretinal or intraretinal fluid for at least two consecutive visits in the absence of new retinal hemorrhage.
Thereafter, the treat-and-extend approach could be initiated and continued as long as the edema was resolved–or at least stable–and there was no new hemorrhage. The panel recommended increasing the treatment intervals by two-week increments with a maximum extension to 12 weeks. Decisions on adjusting the treatment interval in the event of disease reactivation with deterioration depend on the severity of the relapse.