[Pro re nata anti-VEGF treatment results for neovascular age-related macular degeneration in routine clinical treatment: comparison of single with triple injections]

Ophthalmologe. 2019 May;116(5):441-446. doi: 10.1007/s00347-018-0747-4.
[Article in German]


Background: Different injection regimens from continuous to pro re nata (PRN) have been proposed for treatment of neovascular age-related macular degeneration (nAMD). So far the PRN single injection on reactivation regimen has not been compared to the PRN triple injection on reactivation regimen (IVAN scheme).

Objective: Comparison of the two nAMD PRN injection regimens with single and triple injections on reactivation in a real-world setting in a retrospective case series in two German treatment centers.

Material and methods: Naïve nAMD patients, who started treatment according to either the single or triple injection regimen were included. Endpoints were best corrected visual acuity (LogMAR), central retinal thickness on optical coherence tomography (μm) and number of injections, all at 3, 6, 12, 18 and 24 months after treatment initiation.

Results: A total of 146 patients with single injection and 148 patients with triple injection regimens were included. There were no significant differences between the two treatment regimens in best corrected visual acuity (single vs. triple injection scheme: 0.50 ± 0.42 vs. 0.56 ± 0.42, p = 0.14), central retinal thickness (303 ± 76.2 vs. 306 ± 110, p = 0.79) and number of injections (13 ± 4.4 vs. 12 ± 5.4, p = 0.31). This was the case for all analyzed time points.

Conclusion: There were no significant functional or morphological differences between the two PRN injection regimens with single and triple injections on reactivation after 24 months. For evaluation of long-term therapy results further studies are warranted.

Keywords: Age-related macular degeneration; Health care; IVAN treatment regimen; Real world evidence; Single injection treatment regimen; Triple injection treatment regimen.

MeSH terms

  • Angiogenesis Inhibitors
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections
  • Macular Degeneration*
  • Ranibizumab
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A
  • Visual Acuity


  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A
  • Ranibizumab