Real-world outcomes with ranibizumab in branch retinal vein occlusion: The prospective, global, LUMINOUS study

Objective To assess the long-term visual outcomes in eyes with symptomatic diabetic macular oedema (DME) under intravitreal treatment (IVT) in a clinical routine setting. Methods Patients with newly diagnosed DME were included in this retrospective study if they had received at least three IVTs and a follow-up period ≥ 2 years. Due to altered treatment patterns since the approval of ranibizumab for DME in 2012, patients were subdivided according to their first IVT before 2013 (group 1) or thereafter (group 2). The primary outcome measure was the evolution of best-corrected visual acuity (BCVA) over time. Results Of 217 eyes (191 patients) with DME, 151 eyes (117 patients) fulfilled the inclusion criteria (63 eyes in the first period, 88 in the second period). Mean follow-up time was 7.9 ± 3.1 (group 1) and 4.1 ± 1.4 years (group 2; p < 0.001). Visual gains were similar in the first year (group 1: + 5.3 ± 15.5, group 2: + 7.3 ± 12.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letters; p = 0.44), but not thereafter (after 2 years in group 1: + 4.4 ± 15.0, group 2: + 8.3 ± 13.0 ETDRS letters; p = 0.038). During the first year, group 1 patients received less clinical examinations (group 1: 6.6 ± 3.3, group 2: 7.5 ± 2.1; p = 0.007) and less injections (group 1: 3.6 ± 2.7, group 2: 6.1 ± 2.7; p < 0.001). Conclusion A greater visual gain, in response to more intensive treatment during the first year, was maintained for at least 5 years in group 2 subjects. Our data confirm that in a real-world setting, early intensive treatment results in satisfying long-term visual outcomes.

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“…This is well in line with treatment experience in other retinovascular disorders, i.e. retinal vein occlusion [31,32].…”

Section: Discussionsupporting

confidence: 85%

Long-term outcomes of intravitreal therapy for symptomatic diabetic macular oedema in a real-world setting in Switzerland

Zirpel

Pfister

Gerhardt

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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“…In LUMINOUS study, mean letter gains in BRVO were better in patients who received 3 loading doses versus those who did not (14 vs 7 letters). [ 25 ] Also, visual gains were greater with greater treatment frequency which is also reflected in our study. Sub-optimal visual gain may be due to undertreatment in real-world setting.…”

Section: Discussionsupporting

confidence: 82%

Long-term real-world outcomes in retinal vein occlusions: How close are we to the trials?

Shah

Shanmugam

Vora

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To assess and analyze the visual outcomes of patients with retinal vein occlusions in a real-world setting with a long-term follow-up of more than 5 years. Methods: Retrospective analysis of 56 patients having retinal vein occlusions from a tertiary eye center, with a mean follow-up of 7 years was performed. Primary outcome measures were mean change in best-corrected visual acuity (BCVA) from baseline at 6 months, 1 year, 2 years, 3 years, and final visit (≥5 years), proportion of patients having BCVA better than 20/40 and worse than 20/200, and mean number of injections. Secondary outcome measures were change in central macular thickness (CMT), development of subsequent retinal vein occlusion (RVO) in same eye or the other eye, and development of neovascular complications. Results: The mean change in letter score was + 11.84 in branch RVO (BRVO), +7.14 in non-ischemic central RVO (CRVO), and −9.5 in ischemic CRVO at 1 year, which changed to + 8.57, −5 and − 24, respectively, at the end of follow-up. CMT had improved from 506 ± 98.8 µm, 576.44 ± 149 µm, and 618 ± 178.27 µm, respectively, at baseline to 267 ± 94 µm, 345.20 ± 122.61 µm, and 265.50 ± 107.75 µm, respectively, in BRVO, non-ischemic, and ischemic hemi RVO (HRVO)/CRVO groups. The total mean number of injections given in BRVO, non-ischemic CRVO, and ischemic CRVO groups were 4.6, 6.6, and 4.1, respectively. None of the patients with BRVO developed neovascular glaucoma (NVG). Non-ischemic to ischemic HRVO/CRVO conversion was noted in 4/11 eyes at a mean duration of 12.6 months. NVG was noted in 7/9 eyes (77.8%) in initial ischemic CRVO/HRVO group and 3/4 (75%) converted eyes. Conclusion: Patients with BRVO have good visual outcomes with anti-VEGF, while in CRVO results may vary considerably owing to patient compliance and treatment burden on long-term follow-up in a real-world setting.

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“…However, patients with BRVO with lower baseline VA exhibited statistically larger VA improvements at 12 and 24 months, according to the BRAVO and BRIGHTER trials ( 35 , 37 ). In keeping with these findings, quantitatively larger VA increases were reported among the LUMINOUS research in patients with BRVO with baseline VA of 39– < 60 letters ( 36 ). Patients with a baseline VA of 60– < 74, on the other hand, maintained their VA at 12 months with appropriate ranibizumab therapy.…”

Section: Ocular Factorssupporting

confidence: 59%

“…In the LUMINOUS research, higher injection frequency was related to higher VA increases in the worldwide population across all enrolling nations ( 36 ). The good mean letter gains shown in Year 1 imply that patients with BRVO may not require as many ranibizumab injections as patients with other retinal disorders (such as DME and nAMD) to attain satisfactory visual results ( 36 , 39 , 40 ). Nevertheless, it does confirm the need of maintaining a proper dose to get excellent BCVA results.…”

Section: Ocular Factorsmentioning

confidence: 99%

Potential Prognostic Indicators for Patients With Retinal Vein Occlusion

et al. 2022

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The second most prevalent cause of retinal vascular disease is retinal vein occlusion (RVO). RVO raises intravascular pressure in the capillary and veins, triggering vessel barrier collapse and subsequent leaking of blood or plasma components into the tissue (edema). Macular edema (ME) is a major complication of RVO that results in significant visual impairment. Laser therapy, intravitreal steroid injections, and vascular endothelial growth factor (VEGF) inhibitors are the major therapeutic techniques. Different therapies reduce ME of RVO and improve visual activity. However, some people have no impact on the resolution of ME, while others have a poor visual prognosis despite full ME cure. There are many investigators who studied the relationship between indicators of various instruments with visual activity. However, a summary of those findings is currently lacking. Therefore, we will focus on the predictive factors of different studies associated with positive visual activity outcomes, which would be very useful and important to help address both treatment expectations and methods for patients with RVO.

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Real-world outcomes with ranibizumab in branch retinal vein occlusion: The prospective, global, LUMINOUS study

Cited by 22 publications

References 25 publications

Long-term outcomes of intravitreal therapy for symptomatic diabetic macular oedema in a real-world setting in Switzerland

Long-term outcomes of intravitreal therapy for symptomatic diabetic macular oedema in a real-world setting in Switzerland

Long-term real-world outcomes in retinal vein occlusions: How close are we to the trials?

Potential Prognostic Indicators for Patients With Retinal Vein Occlusion

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