Treat-and-extend vs pro re nata regimens of aflibercept in diabetic macular edema

Objective The aim of the present study was to compare between two regimens of intravitreal injection of aflibercept in diabetic macular edema (DME): treat-and-extend (T and E) vs pro re nata (PRN). Background T and E and PRN (as needed) regimens of intravitreal antivascular endothelial growth factor treatment have been found to reduce the injection burden on patients and improve the cost-effectiveness of the treatment of macular edema. Patients and methods This prospective randomized comparative study was conducted on patients with DME, who were randomly divided into two groups. Eyes in group I were treated with T and E regimen of intravitreal injection of aflibercept and eyes in group II were treated with PRN regimen of intravitreal injection of aflibercept. Results The mean baseline best-corrected visual acuity (BCVA) was 0.833 ± 0.159 logarithm of the minimum angle of resolution (logMAR) units in patients with T and E protocol and 0.880 ± 0.077 logMAR units in patients with PRN protocol; after the loading dose, the BCVA was improved to 0.673 ± 0.103 logMAR units in patients with T and E protocol and 0.700 ± 0.093 logMAR units in patients with PRN protocol; and after resolving edema, the BCVA was 0.353 ± 0.106 logMAR units in patients with T and E protocol and 0.407 ± 0.096 logMAR units in patients with PRN protocol, with no statistically significant differences between the groups. However, there was a highly statistically significant difference between the groups regarding number of injections (P = 0.005). Conclusion Overall, an individualized T and E regimen has the potential to reduce clinic burden and improve patient compliance, while still maintaining effectiveness and providing well-tolerated treatment for DME.