Comparison of 1 year results of using a treat and extend regimen without a loading phase with ranibizumab or aflibercept in patients with treatment-naive diabetic macular edema

Session Details

Session Title: Free Paper Session 2: Vascular Diseases & Diabetic Retinopathy I

Session Date/Time: Thursday 07/09/2017 | 09:00-10:30

Paper Time: 09:54

Venue: Room 117

First Author: : P.Arendt SWITZERLAND

Co Author(s): :    A. Ebneter   S. Wolf   M. Zinkernagel                       

Abstract Details


To evaluate real-life outcomes including best-corrected visual acuity (BCVA), central retinal thickness (CRT) and treatment intensity in treatment-naive patients with diabetic macular edema (DME) treated with anti-vascular endothelial growth factor (VEGF) agents using a treat and extend regimen without a loading phase.


Retrospective interventional study at a tertiary hospital.


Treatment-naive patients with DME starting treatment with injections of ranibizumab or aflibercept between January 1, 2014 and December 31, 2015 were identified in our institutional database of the Department of Ophthalmology at the University Hospital Bern, Switzerland. All eyes were treated as per a treat and extend protocol without initial loading phase. BCVA (letters score using the Early Treatment in Diabetic Retinopathy Study charts) and CRT measured on OCT at baseline and after 1 year of treatment were analyzed. Subgroup analysis adjusted for baseline characteristics was performed to compare intervals and the number of injections between patients receiving ranibizumab or aflibercept.


Sixty-one eyes of 49 patients met the inclusion criteria and were followed up for 1 year. Baseline BCVA was 68.1 ±13.6 letters and CRT 431 ± 142 µm. After 1 year there was a significant gain in BCVA with a mean of +5.8 ± 7.5 letters (paired t-test: <0.0001) and a significant decrease in CRT with a mean of -117 ± 142 µm (paired t-test: <0.0001). The mean number of anti-VEGF injections was 10.1 ± 1.4 (range 8 - 12). The maximum interval between injections was 59 ± 21 days (range 28 - 111) and the mean interval 42 ± 8 days (range 28 - 62). Subgroup analysis did not reveal any differences in the number of injections, maximum or mean interval duration between patients treated with ranibizumab or aflibercept.


To our knowledge, this is the first report presenting real-life outcomes using a treat and extend regimen with ranibizumab or aflibercept without a loading phase for patients with treatment-naive DME. The mean number of injections as well as maximum intervals were similar to the reported TREX-DME 1 year outcomes, using a treat and extend regimen with ranibizumab with a loading phase of three monthly injections. However, the TREX-DME study reported a higher gain in BCVA (9.6 letters) and CRT reduction (146 µm) with an average of 10.7 injections. A possible explanation for these discrepancies in outcomes of BCVA and CRT are differences in disease severity (baseline characteristics) and demographic composition.

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