Baseline Factors Associated With 6-Month Visual Acuity and Retinal Thickness Outcomes in Patients With Macular Edema Secondary to Central Retinal Vein Occlusion or Hemiretinal Vein Occlusion

Abstract

IMPORTANCE Macular edema (ME) is the leading cause of decreased visual acuity (VA) associated with retinal vein occlusion (RVO). Identifying factors associated with better outcomes in RVO eyes treated with anti-vascular endothelial growth factor (VEGF) therapy may provide information useful in counseling patients.OBJECTIVE To investigate baseline characteristics associated with 6-month VA and central subfield thickness (CST) outcomes in participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2). DESIGN, SETTING, AND PARTICIPANTSA total of 362 patients with central RVO or hemi-RVO were enrolled between September 17, 2014, and November 18, 2015, and randomized 1:1 in a masked fashion to receive bevacizumab or aflibercept. At month 6, 348 participants (96%) had VA outcomes measured and 335 participants (93%) had spectral domain optical coherence tomography outcomes measured. The current data analysis was conducted from February 27, 2017, to April 7, 2017.INTERVENTIONS Eyes were randomly assigned to receive an intravitreal injection of bevacizumab, 1.25 mg, or aflibercept, 2.0 mg, at baseline and every 4 weeks, with the primary outcome measured at 6 months. MAIN OUTCOMES AND MEASURESChange from baseline in VA letter score (VALS), VALS gain of 15 or more, change from baseline in CST, CST less than 300 μm, and resolution of ME. Baseline factors associated with 6-month outcome at the 0.05 level in univariate regressions were included in multivariate regressions, with those significant after multiplicity control by the Hochberg method reported. RESULTSThe mean (SD) age of patients was 69 (12) years, and 43% were women. Younger patient age (odds ratio [OR], 0.95 per year of age; 95% CI, 0.93-0.98; P = .007) and lower baseline VALS (OR, 0.96 per letter; 95% CI, 0.94-0.98; P < .001) were associated with a 6-month VALS gain of 15 or greater. Compared with bevacizumab, aflibercept treatment was associated with a higher odds of ME resolution (OR, 3.59; 95% CI, 2.22-5.80; P < .001) and CST less than 300 μm (OR, 5.30; 95% CI,; P = .001), but not with a better VA outcome. Macular edema was less likely to resolve in eyes that received anti-VEGF treatment prior to study participation (OR, 0.33; 95% CI, 0.17-0.64; P = .03). CONCLUSIONS AND RELEVANCEIn eyes treated with bevacizumab or aflibercept, younger age and worse baseline VALS were associated with better 6-month VA outcomes. Aflibercept treatment was associated with more favorable spectral domain optical coherence tomography outcomes but not VA outcomes. These findings may be useful in assessing expected response at month 6 after monthly injection of anti-VEGF agents for treating ME due to CRVO and HRVO.

Effect of funding source on reporting bias in studies of intravitreal anti‐vascular endothelial growth factor therapy for retinal vein occlusion

“…); 2 by Allergan PLC (Scott et al. ,); and 1 by Envision Healthcare (Campochiaro et al. ) and 19 of 46 (41%) studies received no industry funding (Russo et al.…”

Longitudinal Assessment of Ellipsoid Zone Mapping Parameters in Retinal Venous Occlusive Disease With Associated Macular Edema

“…The most significant predictor for final visual outcome was baseline visual function, which previous research had highlighted as a significant contributor. 6,13,16 Following anti-VEGF therapy, VA improvement significantly correlated with improvement of EZ partial attenuation, EZ total attenuation, and improved central foveal EZ-RPE area and volume. In regression analysis, no baseline EZ characteristic predicted functional visual improvements at 12 months.…”

Predictors of Visual Acuity Outcomes after Anti–Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Central Retinal Vein Occlusion

“…Previous reports have only studied short-term outcomes of best-corrected visual acuity (BCVA) predictors in CRVO-related ME. 8 , 9 This report describes analyses of visual outcomes in the LEAVO participants based on baseline VA and Spectralis OCT (Heidelberg Engineering) parameters to better understand treatment benefit by 100 weeks. The 52-week outcome is reported as a secondary outcome.…”