OUTCOMES OF PRO RE NATA VERSUS TREAT-AND-EXTEND ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS FOR MYOPIC MACULAR NEOVASCULARIZATION IN MULTIETHNIC PATIENTS IN THE UNITED STATES.

PURPOSE

To compare visual outcomes and recurrence rates between pro re nata (PRN), treat-and-extend and stop (TES), and treat-and-extend with chronic maintenance dosing (TEM) regimens of anti-vascular endothelial growth factor (vascular endothelial growth factor) injections for myopic macular neovascularization (MNV) in multiethnic patients.

METHODS

This retrospective study included patients treated with PRN, TES, or TEM for myopic MNV using intravitreal bevacizumab or ranibizumab. The primary outcome measure was visual improvement at 12 months.

RESULTS

Overall, 127 eyes of 117 patients (75 women and 42 men) were included. The mean follow-up duration was 37.9 months. The outcomes of PRN (47 eyes [37%]), TES (52 eyes [41%]), and TEM (28 eyes [22%]) were compared. All groups showed significant visual improvement at 12 months and at the final follow-up (all P < 0.05). Visual outcomes did not differ significantly between the three groups at 12 months and the final follow-up (all P > 0.05). However, the number of eyes with recurrences was significantly higher in the PRN group and significantly lower in the TEM group during the follow-up (38%, 21%, and 11% in the PRN, TES, and TEM groups, respectively; P = 0.020). The PRN group received the fewest injections during follow-up (5.3, 10.9, and 19.9 injections in the PRN, TES, and TEM groups, respectively; P < 0.001).

CONCLUSION

Comparing myopic MNV treatment regimens, anti-VEGF injections with PRN, TES, or TEM are effective for myopic MNV and have comparable visual outcomes. Because PRN provides favorable outcomes with fewer injections, it should be the first-line approach. However, a treat-and-extend approach with TES and TEM may be an option given individual patient factors.