Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital.
Department of Public Health, College of Medicine, Taipei Medical University.
Retina. 2023 Mar 1;43(3):420-432. doi: 10.1097/IAE.0000000000003690.
To compare the visual and anatomical outcomes between strict pro re nata (strict PRN) and treat-and-extend (T&E) anti-vascular endothelial growth factor (anti-VEGF) regimens for neovascular age-related macular degeneration (nAMD).
A meta-analysis of 1-year and 2-year changes between strict PRN and T&E anti-VEGF regimens were conducted in both randomized controlled trials (RCTs) and real-world studies (RWSs). The best-corrected visual acuity (BCVA), central retinal thickness (CRT), and weighted mean numbers of visits and injections were evaluated.
A total of 19 RCTs and 23 RWSs (2,530 eyes in strict PRN and 4,399 eyes in T&E) were included. Mean BCVA change in strict PRN group in both 1-year and 2-year (5.95 and 5.78, respectively) was noninferior to the T&E group (7.85 and 5.96, respectively). Mean CRT changes were also similar in both strict PRN and T&E groups. Mean number of visits were significantly more in the strict PRN group, whereas mean number of injections was significantly more in the T&E group.
The strict PRN regimen demonstrates a noninferior BCVA improvement to the T&E regimen, achieving fewer injections, and may be both economically and medically beneficial. Both selections should be provided to patients with an overall consideration.
比较严格按需（strict pro re nata，strict PRN）与治疗-延长（treat-and-extend，T&E）抗血管内皮生长因子（anti-vascular endothelial growth factor，anti-VEGF）方案治疗新生血管性年龄相关性黄斑变性（neovascular age-related macular degeneration，nAMD）的视力和解剖学结局。
对严格 PRN 和 T&E 抗 VEGF 方案的 1 年和 2 年随机对照试验（randomized controlled trials，RCT）和真实世界研究（real-world studies，RWS）的变化进行了荟萃分析。评估了最佳矫正视力（best-corrected visual acuity，BCVA）、中心视网膜厚度（central retinal thickness，CRT）以及加权平均就诊和注射次数。
共纳入 19 项 RCT 和 23 项 RWS（严格 PRN 组 2530 只眼，T&E 组 4399 只眼）。严格 PRN 组在 1 年和 2 年的平均 BCVA 变化分别为 5.95 和 5.78，均不劣于 T&E 组（分别为 7.85 和 5.96）。严格 PRN 和 T&E 组的 CRT 变化也相似。严格 PRN 组的平均就诊次数明显更多，而 T&E 组的平均注射次数明显更多。
严格 PRN 方案显示出与 T&E 方案相似的 BCVA 改善，注射次数更少，在经济和医学上可能都具有优势。应该综合考虑为患者提供这两种选择。
