Efficacy and timing of adjunctive therapy in the anti-VEGF treatment regimen for macular oedema in retinal vein occlusion: 12-month real-world result

Abstract

Purpose Various combination treatment regimens have been tried to improve the short-term efficacy of intravitreal monotherapy for the treatment of macular oedema (MO) secondary to retinal vein occlusion (RVO). Our study introduces the RandOL protocol (Ranibizumab and Ozurdex with Laser photocoagulation) of initial anti-VEGF therapy, controlling recurrent nonischaemic MO with an intravitreal steroid and applying laser therapy to non-perfused retina. We describe our 12-month follow-up experience on timing for adjunctive therapy and real-world effectiveness and safety data. Methods A retrospective analysis was carried out on 66 consecutive treatment-naive RVO patients with MO who received our RandOL treatment regimen. Baseline visual acuity (VA) and central retinal thickness (CRT) were compared with 12-month result. Results At 12 months, 77% had significant VA improvement, 52% had ≥ 3-line improvement, and 15% were worse. Significant improvements in CRT were observed in 97% (baseline median CRT = 531 μm (IQR 435-622) reduced to 245 μm (IQR 221-351, Po0.001) at 12 months); 76% achieved a dry fovea at 1 year. Mean number of total injections required was 5.5 (range 2-11) and 6% required ≥ 9 injections in 1 year. Although 70% received additional Ozurdex, 82% received ≥ 1 sessions of laser therapy. The BRVO subgroup achieved better VA and CRT improvement at 1 year, but small numbers limit definitive statistical conclusions.Conclusions Our real-world results using a combination treatment protocol for RVOrelated MO achieved similar desirable anatomical and visual outcomes as with a single-agent therapy with less intravitreal re-treatment rates at first year. Randomised controlled studies are needed to evaluate the role of laser and the ideal timing of combination therapy.

<p>Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice</p>

“…We previously reported the real-world results based on RVO patients treated with this combined treatment regimen which was associated with good Year 1 visual and anatomical outcomes in a wide spectrum of clinical severities of RVO patients with MO. 4 The present paper now extends the follow-up of this same cohort to 3 years.…”

“…This analysis provides additional long-term data supporting our previous 1-year follow-up but with less intravitreal re-treatment rates. 4 Although the VA stability was unchanged in each year, percentage of VA improvement was still maintained at 63% in Year 3 compared to 77% in Year 1. In contrast, the percentage of patients experiencing worse vision increased to 6%, perhaps due to the "more stable patients" discharged from the cohort follow-up, thus leaving the more severe RVO patients whose visual stability was very much dependant on on-going repetitive treatment.…”

“…Patients' demography and the study design were already mentioned in our previous publication. 4 In our centre, we follow a local protocol of combination therapy regimen, namely RandOL (Ranibizumab and Ozurdex, Laser) protocol for easier understanding of chronological introduction of the treatment modalities. 4 The combined therapy (RandOL Protocol flow-chart 4 ) and timing/procedure of choice are summarised as follows.…”

Kombinierte intravitreale Therapie mit Dexamethason und Bevacizumab bei Strahlenoptikopathie und -retinopathie

“…Den Autoren ist keine Studie bekannt, die den kombinierten intravitrealen Einsatz von Anti-VEGF und (lang wirksamen) Steroiden bei Strahlenoptikopathie beschreibt. Die kombinierte Therapie von Anti-VEGF und lang wirksamen Steroiden wurde prospektiv in Patienten mit venösen Verschlüssen beschrieben und führte zu einer deutlichen Reduktion der Anti-VEGF-Injektionsfrequenz über 12 Monate im Vergleich zur Monotherapie [17].…”

Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era

“…Studies have used claims data to examine treatment patterns of bevacizumab, ranibizumab, and aflibercept. 11,12 In addition, many international groups, such as those in Germany, 13 Denmark, 14 Portugal, 15 and the United Kingdom, 16 have studied the real-world practice and efficacy of anti-VEGF use in CRVO. A recent multicenter study in the United States of patients with acute RVO-associated macular edema reports that anti-VEGF injections given in clinical settings were administered less frequently and with less efficacy than in controlled trial settings.…”