Factors associated with visual outcomes and treatment discontinuation in eyes with retinal vein occlusion and macular edema in real-world settings

Abstract

Purpose : Frequent intraocular injections for eyes with retinal vein occlusions (RVO) and macular edema are a clinical burden, but few studies have evaluated the factors associated with stopping these treatments. In this study, we evaluate clinical and anatomic predictors of 1) long-term visual outcomes and 2) successful discontinuation of intravitreal injections across 5 U.S. academic centers in real-world settings.

Methods : We performed a retrospective review of clinical records from patients diagnosed with RVO and macular edema with a minimum follow-up of 2 years at 5 U.S. academic centers between 2011-2015. Eyes with other retinal conditions or intraocular surgeries beside cataract extraction were excluded. We recorded demographic and clinical factors at baseline, as well as visual acuity (VA), central subfield thickness (CST), and cumulative treatments including anti-VEGF, steroid, and laser therapies at 3, 6, 12, and 24 months. Multivariate regression analyses were performed to identify factors associated with VA outcomes and successful treatment discontinuation for at least 6-months over the 2-year follow-up period.

Results : 214 eyes were evaluated in this study (mean age 69.8 ±11.9 years), including 38.3% branch, 52.3% central, and 9.3% hemi-retinal vein occlusions. Initial treatments included intravitreal anti-VEGF (89.7%), steroid (1.9%), and macular laser (0.9%). Patients received a median of 3 injections at month 3, 4 at month 6, 7 at month 12, and 10 at month 24, with 36.9% successfully stopping treatment. At 2 years, VA improved from mean logMAR 0.66 ±0.48 (Snellen 20/91) to 0.46 ±0.48 (Snellen 20/58), and mean CST improved from 486 ±174 μm to 323.5 ±114 μm. VA outcomes at 2 years were associated with VA at 6 months (P < 0.001) and BRVOs (P = 0.048). Successful discontinuation of treatment was associated with lower CST (P = 0.001) and fewer cumulative injections at 6 months (P = 0.001).

Conclusions : Intravitreal injections for RVO and macular edema in real-world settings produce less VA improvement than those observed in randomized clinical trials. Early VA gains predict visual outcomes at 2 years, while early reduction in CST may be associated with successful discontinuation of treatment.

This is a 2020 ARVO Annual Meeting abstract.