Patterns and Predictors of Successful Treatment Discontinuation in Retinal Vein Occlusions with Macular Edema in the Real World
Therlinder Lo, Lent-Schochet D, Luu KY, Kuriyan AE, Weiss MY, Rachitskaya AV, Singh RP, Wai KM, Campbell JP, Gupta K, Nudleman E, Chen KC, Yiu G. Patterns and Predictors of Successful Treatment Discontinuation in Retinal Vein Occlusions with Macular Edema in the Real World. OSLI Retina 2021; 52(2):84-92.
The purpose of this study was to identify factors associated with successful treatment discontinuation in eyes with retinal vein occlusions (RVOs) and macular edema (ME) in real-world clinical settings. While multiple prospective randomized control trials have shown the efficacy of anti-vascular endothelial growth factor (VEGF) agents for RVO with ME, few studies have evaluated characteristics of eyes associated with successful discontinuation of therapy without edema recurrence.
The authors perform a multi-center, retrospective analysis of 214 eyes with RVO and ME from five academic centers during a study period of January 2011 to September 2015. Using regression analysis, they analyze clinical and anatomic markers associated with sustained discontinuation of treatment for at least 6 months without ME recurrence, and best-corrected visual acuity (BCVA) at 24 months. Inclusion criteria were 1) new diagnosis of central, hemi, or branch RVO (CRVO, HRVO, BRVO, respectively) within 3 months, 2) presence of center involving ME as defined on spectral domain optical coherence tomography (SD-OCT), 3) follow-up for at least 24 months after initial visit, and 4) age of 18 years or older. BCVA and central subfield thickness (CST) were recorded from visits at baseline, 6, 12, and 24 months.
Of 214 eyes, 52.3% had CRVO, 9.3% had HRVO, and 38.3% had BRVO. Eyes were most commonly treated with intravitreal anti-VEGF therapy. Similar to other real-world studies, patients received approximately 4 anti-VEGF injections during the first 6 months, and approximately 6 anti-VEGF injections during months 6-24. Bevacizumab was the most commonly used anti-VEGF agent, and aflibercept and ranibizumab were used increasingly at later time points during the course of treatment. 9% of eyes received intravitreal steroids, and 9% of eyes received focal laser.
40% of eyes with BRVO and 35% of eyes with CRVO/HRVO demonstrated treatment discontinuation for at least 6 months during the 2 year follow up period. The median time to treatment discontinuation was 6 months for eyes with BRVO and 7 months for eyes with CRVO/HRVO. There were no clinical or anatomic factors significantly associated with treatment discontinuation in eyes with BRVO. Lower CST at 6 months was significantly associated with greater likelihood of treatment discontinuation without fluid recurrence in eyes with CRVO/HRVO. Better BCVA at 6 months was associated with better BCVA at 24 months for all RVO subtypes.
The take-away from this paper is that the anatomic response of CST, not BCVA, at 6 months was associated with successful treatment discontinuation.