Spectral-Domain Optical Coherence Tomography-Driven Treat-and-Extend and Pro Re Nata Regimen in Patients with Macular Oedema due to Retinal Vein Occlusion: 24-Month Evaluation and Outcome Predictors

Abstract

Purpose: To analyse the efficacy and outcome predictors of ranibizumab using a spectral-domain optical coherence tomography (SD-OCT)-driven treat-and-extend regimen (TER) versus SD-OCT-driven pro re nata regimen (PRN) in patients with cystoid macular oedema (CME) due to branch or central retinal vein occlusion (BRVO, CRVO). Methods: Retrospective, consecutive case series. Evaluation included best corrected visual acuity (BCVA), morphological parameters on SD-OCT, and treatment frequency. Results: From baseline to months 12, 18, and 24, BCVA improved by 16.6 ± 13.1, 15.5 ± 14.4, and 16.6 ± 15.8 letters, respectively, in TER (n = 45), compared to 11.3 ± 17.0, 11.0 ± 15.0, and 10 ± 20.5 letters in PRN (n = 31) (p = 0.152, p = 0.237, p = 0.172). The mean reduction in central retinal thickness was –261 ± 189, –272 ± 188, and –264 ± 158 μm, respectively, in TER, compared to –130 ± 196, –140 ± 210, and –166 ± 207 μm in PRN (p = 0.006, p = 0.017, p = 0.064). 59% (53%) of TER and 22% (17%) of PRN patients showed no intra- or subretinal fluid on SD-OCT at 12 (24) months. Using TER, the maximum recurrence-free treatment interval increased from 8.9 ± 2.3 weeks at 12 months to 9.8 ± 2.3 and 10.5 ± 2.7 weeks at 18 and 24 months, respectively. The number of injections was significantly higher in the TER than in the PRN group. Conclusions: In CME, due to BRVO/CRVO, TER provides better morphological outcome using more injections than PRN.

Changes in metamorphopsia after the treat-and-extend regimen of anti-VEGF therapy for macular edema associated with branch retinal vein occlusion

“…This could include instituting maximum treatment intervals greater than 12 weeks or prolonging treatment with a 12-week interval for a longer period, as done for the TAE regimen used in patients with age-related macular degeneration [ 16 ]. A previous study demonstrated the mean number of injections within 12, 18, and 24 months was significantly higher in the TAE regimen than in the PRN regimen in the treatments for retinal vein occlusion patients [ 17 ]. In fact, the mean number of injections within 12 months (6.6 ± 1.7, median: 7 [IQR, 5–7]) in our TAE regimen was higher than the mean number of injections within 12 months (4.0 ± 1.8) reported in the previous study with the PRN regimen [ 8 ].…”

Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study

“…The mean number of clinic visits was similar to that in the TAE regimen [ 18 , 19 ]. Many previous studies investigated PRN and TAE regimens for BRVO [ 7 , 8 , 10 , 11 , 18 , 19 , 22 ], but this mTAE regimen is the first to combine the best features of PRN and TAE regimens.…”

Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era

“…28 In addition, the TAE and as-needed approaches have been compared in eyes with all types of RVO, with no significant differences in VA found at 12 months. 29…”

“…Guichard et al 29 compared the TAE and as-needed approaches, each initiated after 1 ranibizumab injection at baseline, in eyes with macular edema associated with any type of RVO and found that mean number of injections in the first 12 months was 9.6 ± 2.0 and 4.2 ± 1.8 for TAE and as-needed approaches, respectively. Other studies have found similar results, with 1-year injection counts of 8 to 10 for the TAE approach of CRVO.…”