Assessing Disorganization of Retinal Inner Layers in Long Term Follow Up of SCORE2 Trial

Abstract

Purpose : To determine the association of disorganization of the retinal inner layers (DRIL) with central subfield thickness (CST) and visual acuity letter score (VALS) among participants of the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2) trial over 5 years.

Methods : Participants with central (CRVO) or hemiretinal vein occlusion (HRVO) were treated with anti-VEGF per protocol for 12 months, then treated per investigator discretion and examined at 4 annual visits. DRIL and CST was assessed on spectral domain optical coherence tomography (SD-OCT) at months 1 (M01), 6 (M06), 12 (M12) and annual visits through month 60 (M60). DRIL was graded within and outside of the 1mm central subfield.

Results : 355/362 (98%) of SCORE2 participants had SD-OCT images at M01; of those, 34% had no DRIL, 33% had DRIL without cysts and 30% had DRIL with cysts. The distribution of DRIL at M01 in the 109/355 (31%) of participants who completed the 5-year follow-up, was 40%, 29% and 30%, respectively. Among participants with no DRIL at M01, DRIL was present in 52% at M12 and 82% by M60. All eyes with DRIL (with or without cysts) at M01 had DRIL at M60 and had significantly higher CST and lower VALS at all visits (p<0.001) compared to eyes without DRIL at M01. Although participants with DRIL at M01 had DRIL at M60, DRIL improved in about 20% of these participants at M06 while they were still on SCORE2 anti-VEGF protocol.

Conclusions : Presence of DRIL at M01 was associated with higher CST and worse VALS throughout 5-year follow-up. Most participants with no DRIL at M01 developed DRIL during follow-up while those with DRIL at M01 had persistence or recurrence of DRIL by M60. This suggests real world management of CRVO or HRVO with anti-VEGF does not protect against development of DRIL.

This abstract was presented at the 2023 ARVO Imaging in the Eye Conference, held in New Orleans, LA, April 21-22, 2023.

 

Figure 1: Month 1 OCT showed entire loss of inner retinal layers of the right half of the 1 mm foveal center compared to the left where some inner retinal layers remained visible on OCT. Month 60 showed further loss of these inner retinal layers. On the right, loss of the layers extended much further outside the foveal center. Similarly on the left, only one interface remains visible within the foveal center and there is increased loss of the retinal layers.