Impact of initial visual acuity on anti-VEGF treatment outcomes in patients with macular oedema secondary to retinal vein occlusions in routine clinical practice.

Abstract

AIM:

To determine the impact of initial visual acuity (VA) on anti-vascular endothelial growth factor (VEGF) treatment outcomes in patients with macular oedema secondary to retinal vein occlusions in routine clinical practice.

METHODS:

A retrospective study was conducted at a single academic institution to identify 177 treatment naïve patients with macular oedema secondary to branch retinal vein occlusion (BRVO), hemiretinal vein occlusion (HRVO) and central retinal vein occlusion (CRVO) treated with intravitreal anti-VEGFs. Exclusion criteria included prior intravitreal injection or presence of active confounding ocular disease. Patients were stratified by initial VA; main outcomes measured were average change in VA and mean absolute change in central subfield thickness (CST) at 6 and 12 months.

RESULTS:

Patients with BRVO with initial VA of 20/40 or better had no significant changes in average letters gained and CST from baseline (+2.6 letters, p=0.42; -48.94 µm, p=0.12) compared with patients with initial VA between 20/50 and 20/300 (+13.2 letters, p<0.001; -98.20 µm, p<0.001) after 12 months. Patients with CRVO/HRVO with initial VA of 20/320 or worse had the most improvement in average letters gained and CST from baseline (+42.2 letters, p<0.001; -182.84 µm, p=0.004) with anti-VEGF therapy compared with patients with initial VA between 20/50 and 20/300 (+9.4 letters, p=0.016; -160.87 µm, p<0.001) and patients with initial VA of 20/40 or better (-9.6 letters, p=0.14; -47.92 µm, p=0.38).

CONCLUSIONS:

For macular oedema secondary to retinal vein occlusion, anti-VEGF treatment can result in a greater improvement in average letters gained and in CST for those with poor initial VA compared with those with better initial VA.

• Authors: Karen M Wai, Mehnaz Khan, Sunil Srivastava, Aleksandra Rachitskaya, Fabiana Q Silva, Ryan Deasy, Andrew P Schachat, Amy Babiuch, Justis P Ehlers, Peter K Kaiser, Alex Yuan, Rishi P Singh
• Journal: The British journal of ophthalmology (Br J Ophthalmol) Vol. 101 Issue 5 Pg. 574-579 (05 2017) ISSN: 1468-2079 [Electronic] England
• PMID: 27503394 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Chemical References

• Angiogenesis Inhibitors
• Vascular Endothelial Growth Factor A
• Bevacizumab
• Ranibizumab

Topics

• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (therapeutic use)
• Bevacizumab
• Female
• Follow-Up Studies
• Humans
• Intravitreal Injections
• Macular Edema (drug therapy, etiology, physiopathology)
• Male
• Middle Aged
• Ranibizumab
• Retinal Vein Occlusion (complications, drug therapy, physiopathology)
• Retrospective Studies
• Tomography, Optical Coherence
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity (physiology)