Suspending vascular endothelial growth factor inhibitors in eyes with retinal vein occlusion

To identify predictors of continued discontinuation of vascular endothelial growth factor (VEGF) inhibitors for retinal vein occlusion (RVO) after it has been suspended.

Eyes with RVO were identified in the Fight Retinal Blindness! registry that suspended VEGF inhibitors for ≥180 days when visual acuity (VA) was ≥35 letters, from 1 December 2011-2021. The primary outcome was not resuming therapy through 24 months which defined success.

Half (186/362 (51%)) of the eligible 6-month suspensions successfully continued through 24 months. Successful cessation attempts began earlier (9 vs 14 months; p=0.001), after greater VA improvement (mean, +12.6 vs +8.5 letters; p=0.01) following more injections in the first 6 months (median, 5 vs 4; p<0.001) and more intensive treatment than unsuccessful attempts (176/362 (49%)). At month 6 without treatment, the mean (95% CI) changes in VA and central subfield thickness (CST) were in successful attempts +1.8 letters (+0.4 to +3.1) and -20 µm (-34 to -6); unsuccessful attempts +0.5 letters (-1.1 to 2.0) and -2 µm (-22 to +18). When therapy resumed in unsuccessful attempts (median, 9.5 months), VA and CST had deteriorated by -3.5 letters (-5.6 to -1.4) and +38 µm (+20 to +57) since suspension. These trends were more pronounced in eyes with central retinal vein occlusion.

Eyes with RVO that achieve good outcomes early, following more intensive VEGF inhibition and that improve further over 6 months without therapy are likely to achieve sustained, treatment-free quiescence through 24 months.