First Author: V.Lages PORTUGAL
Co Author(s): L. Malheiro J. Coelho A. Carolina M. Macedo F. Maria Joao M. Lume
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To compare anatomical and functional outcomes of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO) treated with intravitreal anti-VEGF either with pro re nata (PRN) or treat-and-extend (TAE) regimens in our clinical practice.
Department of Ophthalmology of a tertiary referral centre in Porto, Portugal - Centro Hospitalar do Porto.
Retrospective case series analysis of 38 eyes of 38 patients, diagnosed with ME secondary to CRVO, between January 2010 and June 2016. On one hand, 24 eyes (9 male, 15 female, mean age 70.3 ± 12.1 years) were treated with bevacizumab or ranibizumab using a PRN regimen. On the other hand, 14 eyes (7 male, 7 female, mean age 68.4 ± 12.2 years) were treated with bevacizumab or ranibizumab using a TAE regimen. The main outcome measures were: change in letters from baseline best corrected visual acuity (BCVA), change from baseline central retinal thickness (CRT); mean number of injections; prevalence of anti-VEGF therapy switch during follow-up; prevalence of laser photocoagulation and/or intravitreal corticosteroids (IV-CCT) adjuvant treatments; incidence of retinal neovascularization (RNV) and neovascular glaucoma (NVG).
There were no statistically significant differences regarding demographic factors, pre-treatment BCVA, CRT and phakic status between both groups. The mean follow-up was 34.0 ± 16.3 and 20.3 ± 8.8 months in PRN and TAE, respectively, (p=0.01). Mean visual gain was 8,3 (median 3.00; range -25 to 60) and 11,1 (median 8.00; range -35 to 60) letters (ETDRS) in PRN and TAE, respectively, (p>0.05). Mean CRT decrease was of 281.2 (median -249.0; range -1089 to 251) and 338.4 (median -278.5; range -780 to 134) micras in PRN and TAE, respectively, (p>0,05). The mean number of injections in the first year was 5.9 ± 2.1 and 8.4 ± 1.2 in PRN and TAE, respectively, (p<0,001). There was no statistically significant difference regarding the prevalence of anti-VEGF therapy switch (50.0% vs 35.7%), IV-CCT (33.3% vs 42.9%) and laser photocoagulation (16.6% vs 21.4%) adjuvant treatments nor regarding the incidence of RNV and NVG (14.2% vs 8.3%) between PRN and TAE, respectively.
In our study, there was no statistically significant differences regarding anatomical and functional outcomes between PRN and TAE regimens for the treatment of macular edema secondary to CRVO. However, it is important to underline that our sample size limited the statistical power of the study, compromising effective conclusions.