Anti-VEGF treatment of macular edema associated with retinal vein occlusion: patterns of use and effectiveness in clinical practice (ECHO study report 2)

Abstract

PurposeTo evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) antagonists in the treatment of macular edema secondary to retinal vein occlusion (RVO) in clinical practice.Patients and methodsA multicenter retrospective study of the medical records of 165 patients (95 branch RVO, 70 central RVO) treated with at least three anti-VEGF injections in the study eye was conducted. Available data collected for at least 6 months after the first injection included Snellen best-corrected visual acuity (BCVA), central retinal thickness (CRT) by time-domain optical coherence tomography (TD-OCT) or spectral-domain optical coherence tomography (SD-OCT), anti-VEGF injections, other treatments/procedures for RVO, and adverse events.ResultsAt baseline prior to anti-VEGF treatment, mean BCVA was 20/80 Snellen equivalent and mean CRT was 499 μm. Mean number of anti-VEGF injections received was 7.1 during the first year, 5.4 during the second year, and 5.9 during the third year; 51.3% (842/1,641) of injections were ranibizumab, 44.1% (724/1,641) were bevacizumab, and 4.6% (75/1,641) were aflibercept. One in five patients received concomitant focal laser treatment. The percentage of patients achieving both BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) was 26.1% (30/115) after the first anti-VEGF injection and ranged from 20.0% (7/35) to 36.7% (11/30) after the first 16 injections. After each anti-VEGF injection from the 1st to the 16th, <60% of patients achieved 20/40 or better BCVA and ≤70% of patients achieved CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT. The most common treatment-related adverse event was blurry or cloudy vision.ConclusionIn this real-world study, a mean of five to seven anti-VEGF injections was administered yearly, and the response to anti-VEGF therapy was suboptimal in many patients. Anti-VEGF therapy was well tolerated.

Micropulse Laser Treatment of Retinal Diseases

“…That is why the present ophthalmological standard recommends intravitreal antiVEGF or steroids in the treatment of macular edema secondary to RVO [88,89]. However, the functional results of such a treatment are not always satisfactory.…”

Use of biomaterials for sustained delivery of anti-VEGF to treat retinal diseases

“…This, in addition to the issue of patient compliance, results in a problem of inadequate treatment. It has been shown that patients generally received less injections than that given in clinical trials for n-AMD [30,31], DMO and RVOs [31][32][33]. This limits the effectiveness of anti-VEGF therapy in retinal vascular diseases [30][31][32][33][34][35][36].…”

Bevacizumab for Retinal Vein Occlusion

“…Although baseline BCVA in BRVO group is worse than other studies, the final BCVA outcome in BRVO ( 0.25 + 0.11 logMAR equivalent to Snellen 20/40) is comparable to other literatures, even with PRN regime and low frequency of injection. [16][17][18][19] This is probably because BRVO had more benign nature of the disease and also younger age compared to CRVO.…”