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Kelly M Bui, Martin Krupa, Muneeswar G Nittala, Srinivas R Sadda; Comparison of Treat-and-Extend versus As Needed Treatment Protocols for the Management of Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3968.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the visual acuity outcomes of two different treatment protocols, treat-and-extend (TNE) versus as needed (PRN) in the treatment of neovascular age-related macular degeneration.
We performed a restropective analysis of randomly selected patients evaluated by two clinicians at a university-based retina clinic from September 2007 to August 2013. Patients were included if they were treated solely either by TNE or PRN (no load) regimens. Evidence of fluid on spectral domain optical coherence tomography (SDOCT) was used as the primary guide to dictate re-treatment interval for TNE or the need for treatment with PRN. Data analysis was performed using SPSS; Mann-Whitney-U and Wilcoxon rank sum tests were performed. Snellen visual acuity was converted to logMar.
Seven patients were identified in the TNE and 10 in the PRN group. Patients were treated with one of three anti-VEGF agents, bevacizumab ranibizumab, or aflibercept. Patients in the PRN group were followed every 4 weeks for evaluation, and intravitreal injection was performed on an as needed basis. There was no statistically significant difference between the two groups on initial visual acuity (logMar 0.59 TNE, logMar 0.64 PRN, p=0.46). Visual acuity outcomes were similar between the two treatment groups at 6 and 12 months follow up (logMar 0.40 TNE, logMar 0.35 PRN, p=0.81; logMar 0.36 TNE, 0.41 PRN, p=0.84). Overall, there was a gain in vision of -0.19 logMar in TNE group compare to -0.28 logMar in PRN group at 6 months and -0.24 logMar in TNE group compare to -0.22 logMar in PRN group at 12 months. On average, both groups received the same number of intraocular injections, approximately 7 of a possible 13 injections at 12 months follow up.
Visual acuity outcome did not differ between the two treatment paradigms. In both groups, there was a statistically significant gain in vision at both 6 and 12 months follow up.
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