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Varun Chaudhary, Ramin Tadayoni, E Zangvil; 5 Pearls of Early Treatment in BRVO. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3676. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Branch retinal vein occlusion (BRVO) is a retinal vascular disease associated with macular edema (ME) and consequential vision loss. In the past, a ‘watchful waiting’ approach has been advocated in early stage BRVO to allow for possible spontaneous resolution of ME. However, data from the BRAVO study suggest that delaying treatment with anti-vascular endothelial growth factor (VEGF) in BRVO may limit visual acuity (VA) gains. Here we present an exploratory analysis from the 24-month BRIGHTER study on the impact of disease duration and baseline VA in BRVO patients treated with ranibizumab with or without laser, or with laser alone.
BRIGHTER (NCT01599650) was a 24-month, phase IIIb, open-label, randomized, active-controlled, three-arm multi-center study that enrolled 455 patients with BRVO across 81 sites in Europe, Australia and Canada.
1) Irrespective of baseline VA and duration, ranibizumab treatment (with or without laser) of all BRVO patients resulted in a significant increase in VA over 24 months (fig.1).2) Patients with high baseline VA (≥60 letters) achieved significant VA gains (mean best corrected VA change [BCVA] of +12.1 and +11.8 letters, respectively) with ranibizumab treatment (with or without laser) compared with those treated with laser alone (mean BCVA change of +3.3 letters).3) For patients with low baseline vision (≤39 letters), treatment with ranibizumab resulted in a greater letter gain (+23.2 letters) than patients with high baseline vision; however, high baseline vision patients achieved better absolute vision at study end (79.4 vs 56.8 letters for highest vs lowest baseline VA, respectively).4) For patients with a short disease duration (<12 months), ranibizumab treatment resulted in a mean BCVA gain of 17.3 letters, while patients with a longer disease duration (≥12 months) had a mean BCVA gain of 8.4 letters (fig. 2).5) For patients with a shorter disease duration (<12 months), ranibizumab monotherapy resulted in a gain of ≥15 letters in a shorter time (85 days) compared with patients treated with ranibizumab plus laser (118 days) or laser alone (266 days).
These results show that ranibizumab intervention earlier, and in those with a higher VA, provides better VA outcomes over 24 months than with laser. Delaying treatment may have a significant negative impact on patient quality of life.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Mean change in VA over 24 months, by baseline VA categories
Mean change in VA over 24 months, by disease duration
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