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Peter A Campochiaro, Raafay Sophie, Ann Clark, Na Lu, Carlos Quezada-Ruiz; Different characteristics predict good visual outcomes in patients with CRVO vs BRVO; hypertension is associated with good outcome in CRVO but not BRVO. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4626.
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© ARVO (1962-2015); The Authors (2016-present)
To identify patient characteristics that predict visual and anatomic outcomes in patients with RVO treated with ranibizumab.
Patients who completed month (M) 12 of HORIZON (N=386, 205 branch RVO [BRVO] and 181 central RVO [CRVO]) were included. Forty-two variables were analyzed by univariate logistic regression for correlation with 3 outcomes at HORIZON M12: BCVA≥20/40, change from baseline (BL) BCVA≥15 letters, and CFT≤250µm. Variables with overall effect p-values<0.20 were evaluated by multivariable logistic regression using backward selection.
In BRVO patients, good BL BCVA (P<0.0001, odds ratio (OR)=1.09), male gender (P=0.0147, OR=2.48), and normal BL hematocrit (Hct; P=0.0050, high vs normal OR=0.82 and low vs normal OR=0.26) predicted BCVA≥20/40; high BL CFT (P=0.0016, OR=1.003) and normal BL Hct (P=0.0041, high vs normal OR=0.33 and low vs normal OR=0.31) modestly predicted gain in BCVA≥15 letters; and large amount of subretinal fluid modestly predicted CFT≤250µm (P=0.398, OR=1.01). In CRVO patients, good BL BCVA (P<0.0001, OR=1.10), never smoker (P=0.0108, OR=2.80), and young age (P=0.0023, OR=0.95) predicted BCVA≥20/40; hypertension (P=0.0024, OR=4.47), never smoker (P=0.0405, OR=2.13), young age (P<0.0001, OR=0.91), and reduced diastolic ocular perfusion pressure (OPP) at HORIZON M12 (P=0.0027, OR=0.91) predicted gain in BCVA≥15 letters; and young age (P=0.0089, OR=0.96), increased systolic OPP at HORIZON M12 (P=0.0065, OR=1.05), and lower mean Hct (P=0.450, high vs normal OR=0.45 and low vs normal OR=2.81) predicted CFT≤250µm.
There is very little overlap between predictors of good visual outcomes or edema resolution in BRVO and CRVO patients, suggesting important differences between these two disease processes that are often grouped together. For CRVO but not BRVO, young age and never smoking predicted good outcomes. A possible explanation is that factors associated with atherosclerosis (older age and smoking) may be detrimental. Paradoxically, hypertension was associated with good visual outcome in CRVO, possibly because it helps to promote perfusion (supported by beneficial effect of high systolic OPP). Additional studies are needed to evaluate whether acute lowering of blood pressure has a negative impact on visual outcomes in patients with CRVO during anti-VEGF treatment.
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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