As important as anti-VEGF has become for the treatment of retinal conditions from diabetic retinopathy to AMD to vein occlusion, optimal treatment regimens are still highly patient-dependent. For inflammatory choroidal neovascularization (CNV), researchers believe they are one step closer to understanding what is necessary to stymie progression. They found a PRN treatment course from the beginning was just as effective as more formalized treatment intervals.

An international team of researchers looked at the two-year outcomes of CNV patients treated with two different anti-VEGF regimens: (1) eyes treated with a loading phase of three monthly injections and then re-treated as needed (loading group, 42 eyes) and (2) eyes treated as needed immediately from the outset (PRN group, 40 eyes).

When the team compared visual acuity (VA), number of injections and CNV recurrences at 24 months, they found all eyes had improved VA after the initial three months of treatment (an average of +14.8 letters in the loading group, +11.2 letters in the PRN group). The improvement continued throughout the study period, and they noted no difference between the loading and PRN group at 24 months (72.3 vs. 74.7 letters). As for the number of injections, the loading group received significantly more, between three and seven, compared with the PRN group, which had between two and 3.2 injections. The CNV recurrences were similar in both groups, the investigators report.

Ultimately, the team determined “the loading phase did not confer any advantage in terms of outcomes,” they wrote in their paper.

Invernizzi A, Pichi F, Symes R, et al. Twenty-four-month outcomes of inflammatory choroidal neovascularisation treated with intravitreal anti-vascular endothelial growth factors: a comparison between two treatment regimens. Br J Ophthalmol. November 19, 2019. [Epub ahead of print].