Abstract
Purpose :
Anti-vascular endothelial growth factor (VEGF) injections are first-line therapy for retinal vein occlusion (RVO). However, it is challenging for patients to maintain appropriate care due to the high frequency of injections required for anti-VEGF therapy. This study examines the response of retinal biomarkers to lapses in anti-VEGF treatment in RVO patients.
Methods :
A retrospective chart review evaluated patients with branched retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) at the Cleveland Clinic from January 2012 to June 2020. Patients 18 or older were divided into two cohorts: RVO patients with no lapse in anti-VEGF treatment (control group) and RVO patients with a lapse ≥3 months (lapse group). Notably, patients on treat-and-extend or pro re nata protocols were excluded. Central subfield thickness (CST) and visual acuity (VA) were collected at baseline, the first appointment post-lapse, and at 3, 6, and 12 month follow up appointments. Relationships between continuous variables were assessed using t-tests while relationships between categorical variables were assessed using Pearson Chi-Square or Fisher Exact tests.
Results :
Lapse patients (n=69) and control patients (n=69) had similar baseline CST (347.7±127.8µm vs 365.6±139.4µm, p=0.436) and VA (64.1±20.6 ETDRS vs 58.9±20.2 ETDRS, p=0.588). Lapse patients experienced a significant increase in CST after discontinuing anti-VEGF therapy (lapse: 398.7±191.3µm, control 338.9±119.9µm, p=0.034). This persisted 12 months post-lapse and after re-initiation of anti-VEGF agents (lapse: 381.6±161.1µm, control: 307.5±95.4µm, p=0.017). Lapse patients also experienced a decrease in VA after lapse (lapse: 54.5±25.0 ETDRS, control: 64.7±17.5 ETDRS, p<0.001) that recovered after 6 months.
Conclusions :
Patients with BRVO or CRVO with any lapse in treatment are at risk for poorer outcomes. Though VA normalizes upon treatment resumption, patients experience a statistically and clinically significant increase in CST that does not recover. Further analysis may focus on the impact of persistent anatomic change present 1 year after anti-VEGF resumption.
This is a 2021 ARVO Annual Meeting abstract.