June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
36-month outcomes of VEGF inhibitors for treatment-naïve Central Retinal Vein Occlusion: Data from the Fight Retinal Blindness! registry.
Author Affiliations & Notes
  • Adrian Hunt
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
    Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
  • Vuong Nguyen
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Sanjeeb Bhandari
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
    National Eye Institute, Bethesda, Maryland, United States
  • Jennifer J Arnold
    Marsden Eye Specialists Laser LASIK Eye Cataract Glaucoma Eyelid & Oculoplastic, Parramatta, New South Wales, Australia
  • Ian McAllister
    Lions Eye Institute, Nedlands, Western Australia, Australia
  • Hemal Mehta
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Alessandro Invernizzi
    Ospedale Luigi Sacco-Polo Universitario, Milano, Lombardia, Italy
  • David Squirrell
    Auckland District Health Board, Auckland, Auckland, New Zealand
  • Theodorus Ponsioen
    Isala, Zwolle, Overijssel, Netherlands
  • Pierre-Henry GABRIELLE
    Department of Ophthalmology, François Mitterrand Hospital, Dijon University Hospital, Dijon, Bourgogne-Franche-Comté, France., France
  • Louise O’ Toole
    Mater Private Healthcare Group, Dublin, Leinster, Ireland
  • Javier Zarranz-Ventura
    Universitat de Barcelona, Barcelona, Catalunya, Spain
  • Daniel Barthelmes
    UniversitatsSpital Zurich, Zurich, Switzerland
  • Mark C Gillies
    The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Adrian Hunt None; Vuong Nguyen None; Sanjeeb Bhandari None; Jennifer J Arnold Novartis, Code C (Consultant/Contractor), Bayer, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor); Ian McAllister Novartis, Code C (Consultant/Contractor), Bayer, Code C (Consultant/Contractor); Hemal Mehta None; Alessandro Invernizzi None; David Squirrell None; Theodorus Ponsioen None; Pierre-Henry GABRIELLE None; Louise O’ Toole None; Javier Zarranz-Ventura None; Daniel Barthelmes Novartis, Code F (Financial Support); Mark Gillies Novartis, Code C (Consultant/Contractor), Bayer, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor)
  • Footnotes
    Support  This work was supported by a grant from the Royal Australian NZ College of Ophthalmologists Eye Foundation (2007-2009) and a grant from the National Health and Medical Research Council, Australia (NHMRC 2010-1012).
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2674. doi:
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      Adrian Hunt, Vuong Nguyen, Sanjeeb Bhandari, Jennifer J Arnold, Ian McAllister, Hemal Mehta, Alessandro Invernizzi, David Squirrell, Theodorus Ponsioen, Pierre-Henry GABRIELLE, Louise O’ Toole, Javier Zarranz-Ventura, Daniel Barthelmes, Mark C Gillies; 36-month outcomes of VEGF inhibitors for treatment-naïve Central Retinal Vein Occlusion: Data from the Fight Retinal Blindness! registry.. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2674.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We performed a retrospective analysis of a large prospectively specified observational database of patients with central retinal vein occlusion (CRVO) treated with vascular endothelial growth factor (VEGF) inhibition from routine practice.

Methods : We identified 527 treatment-naïve patients with CRVO that commenced VEGF inhibitors between January 1, 2010-2018, with a mean (SD) age of 71 years (12), visual acuity (VA) of 41 letters (25). The primary outcome was mean change in VA from baseline to 36 months. Adjusted VA and central subfield thickness (CST) outcomes compared VEGF agents with generalised mixed effects models.

Results : In all eyes, mean VA change (95% CI) was +10 (7, 12) letters, 44% gained and 14% lost ≥15 letters, 37% had final VA ≥70 and 30% ≤35 letters. Mean CST change was -306µm. The adjusted mean VA change was similar with each VEGF inhibitor (+12 letters) despite significant difference in adjusted mean CST change with aflibercept (-310µm), ranibizumab (-258µm) or bevacizumab (-216µm; P < 0.001). VEGF switchers (19%) gained +11 letters like non-switchers (69%) but with more injections (20 vs. 10; P < 0.001). Eyes that were switched to steroid (12%) had lower mean baseline VA 38 letters, 46% had final VA ≤35 letters and no mean change in VA from baseline. Mean VA change in eyes with trial-eligible baseline VA (19-73 letters, 356/527, 68%) was +7 letters. Eyes outside this range with very-poor baseline VA (<19 letters, 129/527, 24%) gained +22 letters and eyes with very-good baseline VA (>73 letters, 42/527, 8%) lost vision by -7 letters. Completers (257/527, 49%) had a median of 18 injections over 26 visits. Suspension of therapy >180 days occurred in 141/527 (27%) eyes but only 62 (12%) eyes had no macular oedema during that time. Treatment status was known in 356/527 (68%) eyes – 55% were still receiving injections at 3 years while 45% had suspended therapy.

Conclusions : Patients with CRVO that commenced VEGF inhibitors in routine care had VA improvements of around 10 letters at three years - almost matching the outcomes of extension studies that followed RCTs. The choice of VEGF inhibitor influenced CST but not VA outcomes. Half of all eyes were still being treated at 36-months.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

 

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