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Impact of initial visual acuity on anti-VEGF treatment outcomes in patients with macular oedema secondary to retinal vein occlusions in routine clinical practice
  1. Karen M Wai,
  2. Mehnaz Khan,
  3. Sunil Srivastava,
  4. Aleksandra Rachitskaya,
  5. Fabiana Q Silva,
  6. Ryan Deasy,
  7. Andrew P Schachat,
  8. Amy Babiuch,
  9. Justis P Ehlers,
  10. Peter K Kaiser,
  11. Alex Yuan,
  12. Rishi P Singh
  1. Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Rishi P Singh, 9500 Euclid Avenue, Desk i32, Cleveland, OH 44195, USA; drrishisingh{at}gmail.com

Abstract

Aim To determine the impact of initial visual acuity (VA) on anti-vascular endothelial growth factor (VEGF) treatment outcomes in patients with macular oedema secondary to retinal vein occlusions in routine clinical practice.

Methods A retrospective study was conducted at a single academic institution to identify 177 treatment naïve patients with macular oedema secondary to branch retinal vein occlusion (BRVO), hemiretinal vein occlusion (HRVO) and central retinal vein occlusion (CRVO) treated with intravitreal anti-VEGFs. Exclusion criteria included prior intravitreal injection or presence of active confounding ocular disease. Patients were stratified by initial VA; main outcomes measured were average change in VA and mean absolute change in central subfield thickness (CST) at 6 and 12 months.

Results Patients with BRVO with initial VA of 20/40 or better had no significant changes in average letters gained and CST from baseline (+2.6 letters, p=0.42; −48.94 µm, p=0.12) compared with patients with initial VA between 20/50 and 20/300 (+13.2 letters, p<0.001; −98.20 µm, p<0.001) after 12 months. Patients with CRVO/HRVO with initial VA of 20/320 or worse had the most improvement in average letters gained and CST from baseline (+42.2 letters, p<0.001; −182.84 µm, p=0.004) with anti-VEGF therapy compared with patients with initial VA between 20/50 and 20/300 (+9.4 letters, p=0.016; −160.87 µm, p<0.001) and patients with initial VA of 20/40 or better (−9.6 letters, p=0.14; −47.92 µm, p=0.38).

Conclusions For macular oedema secondary to retinal vein occlusion, anti-VEGF treatment can result in a greater improvement in average letters gained and in CST for those with poor initial VA compared with those with better initial VA.

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