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Ryan Constantine, Akshay Thomas, Duncan Berry, Sandra S Stinnett, Sharon Fekrat; Epidemiologic Data and Visual Outcomes in Patients with Central Retinal Vein Occlusion in the Anti-VEGF Era. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1506. doi: https://doi.org/.
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Both the Central Vein Occlusion Study (CVOS) and the Eye Disease Case-Control Study (EDCCS) have previously identified potential risk factors for and reported the natural history of central retinal vein occlusion (CRVO). These studies however, were prior to the advent of anti-vascular endothelial growth factor (VEGF) therapy. The purpose of this study was to identify risk factors and evaluate the effect of anti-VEGF therapy on visual outcomes in a cohort of patients with CRVO.
We performed a retrospective cohort study of CRVO patients seen by a retina specialist at our institution between January 1, 2009 and July 1, 2016. Charts were abstracted for risk factors, demographic data, treatment patterns and visual outcomes.
We identified 250 CRVO patients of which 39% were perfused (pCRVO), 36% were non-perfused (nCRVO) and 21% had indeterminate type of CRVO (iCRVO). We observed a similar gender distribution for all subtypes of CRVO with Caucasian patients more frequently affected. Risk factors previously identified in the CVOS and EDCCS were also identified in this cohort with 78% of patients having hypertension, 31% having diabetes, 30% having hyperlipidemia, and 29% having glaucoma. The mean presenting logMAR visual acuity (VA) was 0.96 (SD 0.76). Among treatment naïve patients, anti-VEGF therapy was first line in 83.7% of patients and was eventually used in 95.6%. The anti-VEGF agents used include bevacizumab (69%), ranibizumab (19%) and aflibercept (12%). 25% of patients had neovascularization (NV) at the time of presentation and only 2% of patients developed NV over long-term follow-up following anti-VEGF treatment. At the time of presentation, 8% of patients had received pan-retinal photocoagulation (PRP) with 21% receiving PRP as part of their management. The mean logMAR VA at the final visit was 1.16 (SD 0.92).
We identified a large cohort of patients with CRVO who were treated with anti-VEGF therapy. The most commonly identified risk factors were hypertension, diabetes, glaucoma and hyperlipidemia. Visual outcomes were variable and highly dependent on CRVO type and visual acuity at the time of presentation as was previously noted in natural history studies conducted before the advent of anti-VEGF therapy. Additionally, complications such as NV were less common in our cohort given the use of anti-VEGF as a therapeutic mainstay for patients with CRVO.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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