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Klin Monbl Augenheilkd 2018; 235(01): 39-46
DOI: 10.1055/s-0042-118184
Übersicht
Eigentümer und Copyright ©Georg Thieme Verlag KG

Umstellung des Therapieschemas pro re nata (PRN) auf Treat and Extend (T&E) in der intravitrealen Therapie mit Anti-VEGF-Medikamenten in der Praxis oder kleineren Institutionen

Switching the Treatment Regime from PRN (pro re nata, as needed) to T&E (Treat and Extend) for Intravitreal Therapy with Anti-VEGF Agents in Private Practice or Small Institutions
P. Imesch
1   Ophthalmologie, Augenzentrum Dr. Imesch, Bern, Schweiz
,
G.-M. Sarra
2   Ophthalmologie, Augenpraxis Emme, Burgdorf, Schweiz
› Author Affiliations
Further Information

Publication History

eingereicht 06 July 2016

akzeptiert 26 September 2016

Publication Date:
13 December 2016 (online)

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Zusammenfassung

Im klinischen Alltag ist das Pro-re-nata-Regime (PRN) weniger gut planbar, bedarf häufigerer Termine und bringt weniger gute klinische Ergebnisse als Treat and Extend (T&E). Aktuelle Literatur spricht für den Nutzen eines Regimewechsels, jedoch fehlt eine praktische Richtlinie. „Best-Practice“-Empfehlungen für die Praxis oder kleinere Institutionen werden hier für alle 3 Phasen angeboten: a) Vorbereitungsphase mit Ändern der Terminorganisation, Schulung von Personal und Patienten, Definieren von Qualitätsparametern, Definieren des Umstellungsschemas (Umstellung für alle zu Termin X oder individuell bei Verschlechterung); b) Umstellungsphase (erhöhter Ressourcenbedarf durch zunächst verkürzte Behandlungsintervalle) und c) Folgephase (Qualitätskontrolle).

Abstract

In everyday practice, intravitreal therapy in an “as needed” regimen (pro re nata, PRN) is less predictable and requires more visits (monitoring and injections taken together) with poorer functional results than with the treat and extend (T&E) regimen. Current literature supports the benefit of a switch. However, practical advice is still missing. This article provides “best practice” recommendations for private practice or smaller institutions for the change from PRN to T&E. The requirements are organisational adjustments, staff training, definition of the scenario triggering the switch (A – functional or anatomical deterioration; B – general switch at a predefined date), counselling of the patients, defining benchmarks for the follow-up of the switch and preparing for higher capacity utilisation during the transition (shorter treatment intervals during the switching phase). Guidance is provided for each phase (a, preparation; b, transition; and c, follow-up).

Schlüsselwörter

anti-VEGF - Behandlungsregime - PRN - Treat and Extend - Umstellung - Algorithmus

Key words

anti-VEGF - treatment regimen - PRN - treat and extend - switch - algorithm
 

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