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Central Retinal Vein Occlusion 36-Month Outcomes with Anti-VEGF: The Fight Retinal Blindness! Registry
Adrian Hunt1, Vuong Nguyen2, Sanjeeb Bhandari3
1The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Westmead Hospital, New South Wales, Australia.
Insights
Patients with central retinal vein occlusion (CRVO) treated with VEGF inhibitors showed modest visual acuity gains over 3 years. Treatment choice impacted retinal thickness but not vision outcomes, with many patients continuing therapy.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Vascular Disorders
Background:
- Central retinal vein occlusion (CRVO) is a significant cause of vision loss.
- Vascular Endothelial Growth Factor (VEGF) inhibitors are a primary treatment for CRVO-related complications.
Purpose of the Study:
- To evaluate the 3-year outcomes of VEGF inhibitor treatment for CRVO in a real-world clinical setting.
- To analyze changes in visual acuity and retinal thickness over time.
Main Methods:
- An observational database study of 527 treatment-naïve CRVO eyes treated with VEGF inhibitors.
- Longitudinal analysis of visual acuity (VA) and central subfield thickness (CST) changes over 36 months.
Main Results:
- Mean VA improved by 10 letters at 36 months, with a mean CST reduction of 306 μm.
- VEGF inhibitor choice affected CST reduction but not VA outcomes.
- Approximately 49% of patients completed the study, with a median of 18 injections.
Conclusions:
- VEGF inhibitors provide modest VA improvements in CRVO patients in routine practice.
- Treatment continuation rates were around 50% at 36 months.
- Further research is needed to address the high rate of patients lost to follow-up.
Purpose:
To analyze the 3-year outcomes in a broad population of patients starting VEGF inhibitors for central retinal vein occlusion (CRVO) in routine clinical practice.
Design:
Observational database study.
Participants:
Overall, 527 treatment-naïve CRVO eyes that commenced VEGF inhibitors between December 1, 2010 and 2018 were tracked in the Fight Retinal Blindness! registry.
Methods:
Longitudinal models were used to plot changes in visual acuity (VA) and central subfield thickness (CST).
Main Outcome Measures:
Mean change in VA from baseline to 36 months, injections, visits, completion, switching, and suspensions of therapy > 180 days at the final review.
Results:
Overall (527 eyes) mean VA change (95% confidence interval [CI]) was + 10 (7, 12) letters, 37% had final VA ≥ 70 and 30% ≤ 35 letters, mean CST changed -306 μm. Completers (257/527, 49%) had mean 36-month changes in VA and CST of + 12 letters and -324 μm with a median of 18 injections at 26 visits. The adjusted mean VA change was similar to each VEGF inhibitor (mean, + 11.4 letters) despite a greater reduction in CST with aflibercept (-310 μm) versus ranibizumab (-258 μm) versus bevacizumab (-216 μm; P < 0.001). Eyes with baseline VA that was trial-eligible (19-73 letters; 356/527, 68%) gained 7 letters, very poor (< 19 letters; 129/527, 24%) gained 22 letters, or very good (> 73 letters; 42/527, 8%) lost 7 letters. Switching (160/527, 30%) was most often to aflibercept (79 eyes). By using suspensions and discontinuation reasons, we identified similar proportions had ceased therapy (154/527, 29%) and were still receiving it at 36 months (165/527, 31%). Only 62/527 eyes (12%) had resolution of macular edema without treatment for > 6 months.
Conclusions:
Patients with CRVO that commenced VEGF inhibitors in routine care for whom follow-up was available had VA improvements of around 12 letters at 3 years, but with > 50% lost to follow-up, the VA outcome for the entire group was likely worse. The choice of VEGF inhibitor influenced CST but not VA outcomes. We estimated that around half of the eyes were still receiving injections after 36 months.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found after the references.
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