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07.10.2016 | Retinal Disorders | Ausgabe 3/2017

Graefe's Archive for Clinical and Experimental Ophthalmology 3/2017

Comparison of two individualized treatment regimens with ranibizumab for diabetic macular edema

Graefe's Archive for Clinical and Experimental Ophthalmology > Ausgabe 3/2017
Andreas Ebneter, Dominik Waldmeier, Denise C. Zysset-Burri, Sebastian Wolf, Martin Sebastian Zinkernagel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00417-016-3502-z) contains supplementary material, which is available to authorized users.
Andreas Ebneter and Dominik Waldmeier contributed equally to this work.



To compare outcomes between an as-needed and a treat-and-extend regimen in managing diabetic macular edema with intravitreal ranibizumab.


This was a retrospective, single-centre, comparative case series on 46 treatment naive patients with diabetic macular edema. Twenty-two patients were treated following an optical coherence tomography guided treat-and-extend protocol (OCTER), and 24 patients were treated according to a visual acuity guided pro re nata regimen (VAPRN) at a tertiarry referral centre. The main outcome measures were best-corrected visual acuity, central retinal thickness, and the number of ranibizumab injections, as well as visits after 12 months of treatment.


After 12 months, the mean gain in best-corrected visual acuity (± standard deviation) was 8.3 ± 6.7 versus 9.3 ± 8.9 letters in the VAPRN and OCTER group, respectively (p = 0.3). The mean decrease in central retinal thickness was 68.1 ± 88.0 μm in the VAPRN group and 117.6 ± 114.4 μm in the OCTER group (p = 0.2). The mean number of ranibizumab injections was significantly different between the VAPRN (5.9 ± 1.8) and the OCTER protocol (8.9 ± 2.0) (p < 0.001).


The visual acuity driven retreatment regimen resulted in a similar visual acuity outcome like optical coherence tomography guided retreatment for diabetic macular edema. Although the number of visits was similar in both groups, patients in the VAPRN group received significantly fewer intravitreal injections than patients in the OCTER group.

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Supplemental Figure Number of ranibizumab injections in patients treated according to the visual acuity guided as-needed (VAPRN, red) regimen and the OCT guided treat-and-extend (OCTER, blue) protocol.Boxplot (A) of mean numbers of injections: Vertical bars are standard deviations (SD). P values from unpaired t-test.Density plot for injection likelihood (B): Graphical display of the likelihood estimate that a patient will be given intravitreal ranibizumab treatment at a specific time point after the start of the treatment depending on the treatment regimen. These kernel density plots were created based on the scatterplots shown in (C) and (D), using the function ‘density(x)’ from the software R (accessible at: representing single injections administered to individual patients in the VAPRN (red; C) and OCTER (blue; D) group over 12 months. Each dot represents an injectionVAPRN group: n = 24, OCTER group: n = 22.(JPG 2417 kb)
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