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Karen M Wai, Mehnaz Khan, Fabiana Silva, Sunil K Srivastava, Justis P Ehlers, Aleksandra Rachitskaya, Peter K Kaiser, Andrew Schachat, Amy Babiuch, Alex Yuan, Rishi Singh; Impact of initial visual acuity on anti-VEGF treatment outcomes in patients with macular edema secondary to retinal vein occlusions. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
Clinical trials have shown that agents inhibiting vascular endothelial growth factor (VEGF) produce satisfactory outcomes in patients with macular edema secondary to retinal vein occlusions (RVO) albeit in a narrow visual acuity range. This retrospective study determined the impact of initial visual acuity on real world anti-VEGF treatment outcomes in patients with RVO.
An IRB approved analysis was conducted. 177 patients with macular edema secondary to hemi-retinal vein occlusions (HRVO), central retinal vein occlusions (CRVO), or branch retinal vein occlusions (BRVO) treated with anti-VEGF were identified. Exclusion criteria included prior treatment for macular edema such as intravitreal injections or presence of comorbid ocular disease. Patients were treated by investigator discretion until anatomically 'dry' by optical coherence tomography. Patients were grouped by initial visual acuity; main outcomes measured were mean change in best-corrected visual acuity (BCVA) and mean change in central subfield thickness (CST) at 6 and 12 months.
CRVO/HRVO patients with initial BCVA of 20/40 or better showed little change in BCVA and CST after 6 months (-6.7 letters, p=0.15; -90.95μm, p=0.03) and 12 months (-9.6 letters, p=0.14; -47.92μm, p=0.38) of anti-VEGF therapy. Patients with initial BCVA of 20/50-20/300 showed greater improvement at 6 months (+10.1 letters, p=0.001; -172.69μm, p<0.001) and 12 months (+9.4 letters, p=0.016; -160.87μm, p<0.001). CRVO/HRVO patients with initial BCVA of 20/320 or worse showed the most improvement in BCVA and CST at 6 months (+33.8 letters, p<0.001; -192.67μm, p<0.001) and 12 months (+42.2 letters, p<0.001; -182.84μm, p=0.004). BRVO patients with initial BCVA of 20/40 or better had no significant changes in BCVA or CST at 6 months (+3.3 letters, p=0.21; -28.54μm, p=0.28) or 12 months (+2.6 letters, p=0.42; -48.94μm, p=0.12) after anti-VEGF therapy compared to patients with initial BCVA of 20/50-20/300 after 6 months (+11.8 letters, p<0.001; -102.87μm, p<0.001) and 12 months (+13.2 letters, p<0.001; -98.20μm, p<0.001). A study drawback is that treatment frequency was determined by investigator discretion rather than protocol.
For macular edema secondary to RVO, patients with worst initial visual acuities have the greatest potential improvement in terms of change in BCVA and CST with anti-VEGF treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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