Abstract
Purpose :
Anti-vascular endothelial growth factor (anti-VEGF) agents have emerged as a mainstay of therapy for macular edema secondary to retinal vein occlusion (RVO). While reductions in retinal thickness have been associated with a response to therapy and subsequent improvement in visual acuity (VA), few studies have examined fluctuations in retinal thickness and their relationship to VA outcomes. This retrospective, observational cohort study tests the hypothesis that patients with larger fluctuations in retinal thickness have poorer visual outcomes.
Methods :
This study evaluated 134 treatment-naïve RVO (71 branch RVO/hemi-RVO, 63 central RVO) eyes seen at Cole Eye Institute, Cleveland Clinic, from January 1, 2012 to October 30, 2019 over 12 months of anti-VEGF treatment. From optical coherence tomography scans (OCT), central subfield thickness (CST) was collected at baseline, 3, 6, 9, and 12 months. Eyes were excluded if confounding maculopathy was present or if they received steroid or laser treatment during the study period. Eyes were divided into quartiles based on CST standard deviation (SD) and 12-month VA was compared. A mixed effects regression model was used to examine the relationship between the CST SD and 12-month VA, while adjusting for baseline CST, baseline VA, and number of injections.
Results :
Mean CST SD for the cohort was 114.1±7.0 µm (mean±SD). Initial CST was 488.6±165 µm and final CST was 334.3±131.9 µm (p<0.001). Mean number of injections was 7.4±2.2. Initial and final VA were 52.8±20.9 and 65.9±17.3 ETDRS letters, respectively (p<0.001). Mixed effects regression revealed that CST SD had a significant, negative association with 12 month VA (p=0.012) when adjusting for baseline factors and injections.
Conclusions :
Larger fluctuations in retinal thickness are associated with poorer visual outcomes in patients with RVO who are treated with anti-VEGF agents. Ongoing work will explore other measures of retinal thickness, such as cube volume and cube average thickness, and relationships between thickness fluctuations and morphologic outcomes such as persistence of macular fluid on OCT.
This is a 2020 ARVO Annual Meeting abstract.