Abstract
Purpose :
Compare treat and extend protocol (TAE) versus Pro re nata (PRN) treatment regimen in diabetic macular edema.
Methods :
This retrospective study was conducted between 2018-19. Fourty four eyes of 26 patients in TAE group and 66 eyes of 48 patient in PRN group met the inclusion criteria and had follow-up for 1 year. Patients were initially treated with 3 consecutive monthly anti-VEGF injections (loading phase). After loading phase, in PRN group anti-VEGF injection performed as needed and in TAE group the baseline treatment interval was selected to be 4 weeks. If the central macular thickness (CMT) was ≥ 300 µm on examination treatment was extended additionally for 2 weeks. If there is any sign of recurrence at visit, the interval between injections is reduced by 2 weeks until disease stability is reached before trying to extend again. Best-corrected visual acuity (BCVA) and central macular thickness (CRT) at baseline and after 1 year of treatment intervals and number of injections were analyzed.
Results :
The BCVA was improved significantly from 0.43±0.24 logMAR before treatment to 0.20±0.19 logMAR in TAE group. (paired t test: p < 0.0001) and in the PRN group BCVA was improved significantly from 0,77±0,48 logMAR to 0,53±0.43 logMAR (paired t test: p < 0.0001) The difference between the two groups was not statistically (p>0.05)The mean CRT decreasedsignificantly from 447±82 μm at baseline to 277±98 μm (P<0.001) in TAE group and decreased from 425,30±117 μm at baseline to 270,22±34 μm (P<0.001) in PRN group. The mean number of anti-VEGF injections was 6.3±1.7 in TAE group and 4,47 ± 1,67 in PRN group. The mean maximum interval between injections was 9.6 ± 1.82 weeks in TAE group. Thirty five (%85) of eyes of could be extended after reaching a formal loading dose of 3 injections and recurrence was observed in 12 (%27) patients. The mean number of clinic visit was 4± 1.21 in TAE group, 6± 1.09 in PRN group. The TAE regimes showed 32% reduction in the number of clinic visits.
Conclusions :
The treat and extend protocol and PRN regime provided benefit for patients with DME for at least 1 year. This treatment models are sustainably improve the vision and improved macular edema in patients with DME. TAE treatment increased the number of injections and decreased the number of visits. In order to investigate the long-term effect of this condition, long-term and more number of cases are needed.
This is a 2020 ARVO Annual Meeting abstract.