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Changing from pro re nata treatment regimen to a treat and extend regimen in neovascular age-related macular degeneration: 6 month results

Session Details

Session Title: AMD III

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:36

Venue: Hall G1 (Level 2)

First Author: K.Hatz SWITZERLAND

Co Author(s):    C. Pruente              

Abstract Details


To evaluate the differences between pro re nata (PRN) treatment regimen and treat and extend (TE) regimen with intravitreal ranibizumab in neovascular age-related macular degeneration (AMD) regarding visual outcome, course of visual acuity (VA), frequency of injections, and frequency of visits.


Retrospective, interventional, consecutive case series at Vista Klinik Binningen, Switzerland.


Results of 185 eyes treated in a TE regimen with intravitreal ranibizumab for neovascular AMD were analyzed. In 142 eyes the PRN pre-treatment period was directly compared to the following TE period. Further the TE results of 43 treatment-naïve eyes were analyzed. PRN treatment was based on monthly optical coherence tomography (OCT) evaluation; retreatment was applied in case of reoccurrence of intra- or subretinal fluid or hemorrhages. In the TE regimen treatment intervals were sequentially lengthened by 2 weeks, starting at 4 weeks, until signs of exudation recurred.


After changing from PRN to TE regimen mean Snellen VA continuously improved from 20/42 (0.47±0.22) at TE baseline to 20/36 (0.55±0.23) at 6 months follow-up. The proportion of eyes that lost any VA during TE was 1.6%. During the PRN maintenance phase (after 3 monthly loading doses) mean VA dropped from 20/36 (month 3; 0.56±0.21) to 20/42 (0.47±0.22) at last PRN follow-up (= Baseline TE). The mean difference of maximal and minimal reached VA during the follow-up period was significantly bigger for the PRN maintenance phase (0.30±0.17) than for the TE period (0.10±0.09 for PRN pretreated eyes, 0.11±0.10 all TE eyes; p=0.002). The mean number of injections/month was 0.47 (PRN) and 0.76 (TE), respectively. With the TE regimen the mean maximum period of extension without recurrence was 7.07±2.28 weeks. About 20% of the treated lesions failed to stay stable with an extension interval of ≥ 6 weeks. The number of visits attended per month was significantly higher in the PRN than in the TE period (1.10±0.10 vs. 0.76±0.17, both including baseline and exit visit, p=0.008).


Eyes with neovascular AMD experienced significant better visual stabilization in the maintenance phase, but with more injections, after changing from PRN to a TE regimen. The TE treatment approach also was associated with significantly fewer patient visits compared with monthly OCT monitoring such as in the PRN regimen.

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