Intravitreal injections are a mandatory treatment for macular edema due to nAMD, DME and RVO. These chronic diseases usually need chronic treatment using intravitreal injections with anti-VEGF agents. Thus, many trials were performed to define the best treatment interval using pro re nata regimes (PRN), fixed regimes or treat-and-extend regimes (TE). However, real-world studies reveal a high rate of losing patients within a 2-year interval of treatment observation causing worse results. In this study we analyzed retrospectively 2 years of real-world experience with an individualized treat-and-extend injection scheme. Since 2015 our treatment scheme for intravitreal injections has been switched from PRN to TE. Out of 102 patients 59 completed a follow up time of 2 years. Every patient received visual acuity testing, SD-OCT and slit lamp examination prior to every injection. At each visit an injection was performed and the treatment interval was adjusted mainly on SD-OCT based morphologic changes by increasing or reducing in 2-week steps. Individual changes of the treatment protocol by face-to-face communication between physician and patient were possible. After 1 year of treatment visual acuity gain in nAMD was 7.4 ± 2.2 ETDRS letters (n = 34; injection frequency: 7.4 ± 0.4) respectively 6.1 ± 4.7 in DME (n = 9; injection frequency: 8.4 ± 1.1) and 9.7 ± 4.5 in RVO (n = 16; injection frequency: 7.6 ± 0.5). After 2 years of treatment results were as following: nAMD: visual acuity gain 6.9 ± 2.1 (injection frequency: 12.6 ± 0.7); DME: 11.1 ± 5.1 (injection frequency: 14.0 ± 1.0); RVO: 7.5 ± 5.0 (injection frequency: 11.2 ± 0.9). Planned treatment exit after 2 year was achieved in 29.4% of patients in nAMD (0% after 1 year); 0% in DME (0% after 1 year); and 31.3% in RVO (0% after 1 year). Patients’ persistence was 94.1% during the follow-up. Using a consequent and individualized TE regime in daily practice may lead to a high patients’ persistence and visual acuity gains nearly comparable to those of large prospective clinical trials. Crucial factors are face-to-face communication with the patient as well as a stringent management regime. At this time TE may be the only instrument for proactive therapy which should therefore be regarded as a first-line tool in daily practice.

中文翻译：

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个性化的治疗和扩展方案可优化现实世界的视力结果并改善患者的持久性

玻璃体内注射是由于nAMD，DME和RVO引起的黄斑水肿的强制治疗。这些慢性疾病通常需要使用玻璃体内注射抗VEGF药物进行慢性治疗。因此，进行了许多试验来确定使用前列腺素治疗方案（PRN），固定治疗方案或治疗延长治疗方案（TE）的最佳治疗间隔。但是，现实世界的研究表明，在治疗观察的2年间隔内，流失率很高的患者会导致更糟糕的结果。在这项研究中，我们回顾了2年使用个性化治疗和扩展注射方案的实际经验。自2015年以来，我们的玻璃体内注射治疗方案已从PRN改为TE。在102位患者中，有59位完成了2年的随访时间。每个病人都接受视力测试，每次注射前都要进行SD-OCT和裂隙灯检查。在每次访视时进行注射，并且主要通过基于SD-OCT的形态变化，通过增加或减少2周的步骤来调整治疗间隔。通过医师与患者之间的面对面交流，可以对治疗方案进行个别更改。治疗1年后，nAMD的视敏度分别为7.4±2.2 ETDRS字母（n = 34；注射频率：7.4±0.4）分别为DME中的6.1±4.7（n = 9；注射频率：8.4±1.1）和9.7±4.5以RVO（n = 16;注入频率：7.6±0.5）为单位。经过2年的治疗，结果如下：nAMD：视力获得6.9±2.1（注射频率：12.6±0.7）；DME：11.1±5.1（注入频率：14.0±1.0）；RVO：7.5±5.0（注入频率：11.2±0.9）。nAMD 29.4％的患者在2年后实现了计划的治疗退出（1年后为0％）；DME中为0％（1年后为0％）；RVO为31.3％（1年后为0％）。随访期间患者的坚持率为94.1％。在日常实践中使用相应的个体化TE方案可能会导致高患者的坚持和视力获得，几乎可以与大型前瞻性临床试验相媲美。关键因素是与患者的面对面交流以及严格的管理制度。目前，TE可能是唯一的积极治疗手段，因此应被视为日常实践中的一线工具。在日常实践中使用相应的个体化TE方案可能会导致高患者的坚持和视力获得，几乎可以与大型前瞻性临床试验相媲美。关键因素是与患者的面对面交流以及严格的管理制度。目前，TE可能是唯一的积极治疗手段，因此应被视为日常实践中的一线工具。在日常实践中使用相应的个体化TE方案可能会导致高患者的坚持和视力获得，几乎可以与大型前瞻性临床试验相媲美。关键因素是与患者的面对面交流以及严格的管理制度。目前，TE可能是唯一的积极治疗手段，因此应被视为日常实践中的一线工具。