Real-world outcomes in patients with macular oedema secondary to central retinal vein occlusion receiving intravitreal anti-VEGF therapy in a UK public hospital setting

Abstract

Purpose : To assess real-world outcomes of intravitreal anti-VEGF therapy for macular oedema secondary to central retinal vein occlusion in a UK public hospital setting.

Methods : We performed a prospective, observational study of all treatment naïve patients receiving intravitreal aflibercept or ranibizumab monotherapy for macula oedema secondary to central retinal vein occlusion (CRVO) at the Royal Free London NHS Foundation Trust (RFLNFT). Fight Retinal Blindness! software was used to record real-world outcomes including visual acuity (VA), central subfield thickness (CST) at baseline and 12 months as well as adverse events (AEs) and number of injections over 12 months. A sensitivity analysis excluded eyes that had vitreoretinal surgery or cataract surgery during the observation period. P-values were obtained using paired t-tests.

Results : There were 28 eyes from 28 patients completing 12 months of monotherapy for CRVO. At 12 months, the mean (SD) VA improved from 40.3(19.4) to 49.8 (25.2) letters, an improvement of 9.5 letters (95%CI: 1.5, 17.5; p=0.024). Mean (SD) CST reduced from 573 (115) to 290 (148) µm, a reduction of 283µm (95%CI: -359, -207; p<0.001). There was a median (Q1, Q3) of 6 (5, 7) injections administered over 12 months. There were 2 eyes that experienced anterior segment neovascularization.
The 15 eyes on aflibercept monotherapy gained a mean of 13 (95%CI: 2.6, 23.4; baseline VA: 41.9) letters and CST changed by -324µm (95%CI: -430, -218; baseline CST: 577) after a median (Q1, Q3) of 6 (5, 7.5) injections at 12 months.
The 13 eyes on ranibizumab monotherapy gained a mean of 5.5 (95%CI: -8.2, 19.3; baseline VA: 38.4) letters and CST changed by -243µm (95%CI: -363, -122; baseline CST: 570) after a median (Q1, Q3) of 5 (5, 7) injections at 12 months. These real-world results were compared with the GALILEO (aflibercept for CRVO) and CRYSTAL (ranibizumab for CRVO) randomized clinical trials (Table 1).

Conclusions : Patients receiving intravitreal anti-VEGF therapy in a real-world setting can achieve good VA and anatomical outcomes. However, the size of the benefit was less than in randomized clinical trials, likely related to reduced injection frequency.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Table 1: Comparison of 12 month outcomes of intravitreal aflibercept or ranibizumab therapy for CRVO in the real world versus randomized clinical trials