Ophthalmology Retina

Three-year outcomes of vascular endothelial growth factor inhibitors in naïve branch retinal vein occlusion: Fight Retinal Blindness!

Socorro Alforja, Adrian Hunt, Vuong Nguyen, Louise O’Toole, Pierre-Henry Gabrielle, Alessandro Invernizzi, Hemal Mehta, Theodorus Leonardus Ponsioen, David Squirrell, Ricardo P Casaroli-Marano, Daniel Barthelmes, Mark C Gillies, Javier Zarranz-Ventura; Fight Retinal Blindness (FRB) users group

Abstract

Purpose: To evaluate the 3-year outcomes of vascular endothelial growth factor (VEGF) inhibitors in the treatment of cystoid macular oedema (CME) due to branch retinal vein occlusion (BRVO) in an international multicenter cohort of eyes.

Design: Multicenter, international, BRVO database study.

Subjects: Seven hundred forty-seven patients (760 eyes) undergoing intravitreal therapy for BRVO for 3 years in a multicenter international setting.

Methods: Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) letters, central subfield thickness (CST), treatments, number of injections and visits data was collected using a validated web-based tool.

Main outcome measures: Visual acuity (VA) gain at 3 years in LogMAR letters. Secondary outcome measures included anatomical results, treatment pattern and percentage of completers. A subgroup analysis by study drug was conducted for clinical outcomes.

Results: Mean adjusted VA change was +11 letters (95% CI 9,13), mean adjusted change in CST was -176μm (-193, -159). Median number of injections/visits was 16/24 at 3 years of follow-up. Most eyes received VEGF inhibitors exclusively (89%, n=677) and as a monotherapy in 71% (n=538). Few eyes were switched to steroids (11%, n=83). Suspensions in treatment >180 days occurred in 26% of study eyes. Aflibercept showed greater CST reductions (-147 vs -128 vs -114μm; p< 0.001) and significantly lower switching rates (14% vs 38% vs 33%, p< 0.001) compared with ranibizumab and bevacizumab, respectively. Conclusions: This international study of 3-year BRVO outcomes after starting treatment with VEGF inhibitors found adequate visual and anatomical results in routine clinical care. Visual outcomes were similar amongst the different initiating VEGF inhibitors, although eyes starting with aflibercept had better anatomical outcomes and a lower switching rate. Keywords: Branch retinal vein occlusion; Fight Retinal Blindness; VEGF inhibitors; aflibercept; bevacizumab; international database; macular oedema; outcomes; ranibizumab; visual acuity.