Abstract
Purpose :
To evaluate patients with choroidal neovascularization (CNV), retinal vein occlusion (RVO), or diabetic macular edema (DME) transitioned from a pro re nata (PRN) to a treat-and-extend (TAE) protocol.
Methods :
Retrospective chart review of patients treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections initially on a PRN protocol transitioned to a TAE protocol for at least 6 months of follow-up. Best corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography were collected.
Results :
Eighty-one eyes from 74 patients treated for 211.5±43.7 and 43.5±1.3 weeks on PRN and TAE protocols, respectively. Overall, BCVA improved from 0.61±0.07 to 0.57±0.06 logMAR following this transition (p=0.22). Eyes with a worse BCVA at initiation of the TAE protocol (<20/70; n=32) were noted to have a significant improvement from 1.17±0.11 to 0.92±0.10 logMAR (p < 0.01). Among different disease cohorts, the RVO eyes (n=17) experienced the greatest improvement in visual acuity 0.84±0.16 to 0.67±0.13 logMAR (p=0.18). A significant improvement in CFT was noted following the transition, 341.2±13.6 to 261.0±8.3 µm (p << 0.001). The number of anti-VEGF injections per year increased from 3.2±0.3 to 9.5±0.3 following the transition from the PRN to TAE protocol (p << 0.001). Six patients were lost to follow-up due to frustration with the TAE protocol and 2 patients elected to restart a PRN protocol after attempting the TAE protocol.
Conclusions :
Transitioning from a PRN to a TAE protocol offers most patients significant anatomic benefits with less robust functional benefits. Interestingly, in a small sample size the RVO eyes experienced the most substantial BCVA improvement. An important consideration in this transition is the increased annual injection burden, which may be met with objection by certain patients who prefer the PRN protocol.
This is a 2021 ARVO Annual Meeting abstract.