Monthly versus as-needed ranibizumab injections in patients with retinal vein occlusion: The SHORE study

Objective: To compare pro re nata (PRN) and monthly injections of 0.5 mg ranibizumab in retinal vein occlusion (RVO) patients stabilized by monthly injections. Design: Randomized, open-label, vision-examiner masked, 15-month study. Participants: Subjects with macular edema secondary to branch or central RVO. Methods: Subjects received monthly injections of 0.5 mg ranibizumab for 7 months and those meeting stability criteria between months 7 and 14 were randomized (1:1) to PRN injections versus continued monthly injections. Non-randomized (NR) subjects (never met stability criteria) received monthly injections. Main Outcome Measures: The primary endpoint was the slope of change in best-corrected visual acuity (BCVA) between months 7 and 15. Results: There was no significant difference in the slope of change in BCVA between months 7 and 15 in patients treated PRN versus those treated with monthly injections (P = 0.509). Mean (± standard deviation) change from baseline BCVA in Early Treatment Diabetic Retinopathy Study letter score at month 15 was 21.0±14.1 in the PRN group (n = 82) versus 18.7±14.1 in the monthly group (n = 80) and 14.5±14.7 in NR subjects (n = 13). The percentage of subjects who achieved BCVA ≥20/40 at month 15 was 76.8% in the PRN group, 71.3% in the monthly group, and 46.2% in NR subjects. The mean (± standard deviation) change from baseline central subfield thickness was -247.8±207.5 μm in the PRN group, -289.9±177.2 μm in the monthly group, and -93.2±225.2 μm in NR subjects. There were no significant differences in mean BCVA gains or central subfield thickness reductions at month 15 between the PRN and monthly injection groups (all > 0.05). Conclusions: After edema resolution from 7 or more monthly ranibizumab injections in RVO subjects, visual outcomes at month 15 were excellent and not significantly different in subjects treated PRN versus those who continued monthly injections.