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Multicentre study of 4626 patients assesses the effectiveness, safety and burden of two categories of treatments for central retinal vein occlusion: intravitreal anti-vascular endothelial growth factor injections and intravitreal Ozurdex injections
  1. Richard Gale1,2,
  2. Claire Gill1,2,
  3. Maria Pikoula3,
  4. Aaron Y Lee4,
  5. Rachel L W Hanson1,
  6. Spiros Denaxas3,
  7. Catherine Egan5,
  8. Adnan Tufail6,
  9. Paul Taylor3,
  10. UK EMR Database Users Group
  1. 1 Academic Unit of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
  2. 2 Department of Health Sciences, University of York, York, UK
  3. 3 Institute of Health Informatics, University College London, London, UK
  4. 4 Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  5. 5 Moorfields Eye Hospital, London, UK
  6. 6 Moorfields Eye Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Richard Gale, Academic Unit of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK; richard.gale{at}york.nhs.uk

Abstract

Background/Aims To assess the effectiveness, burden and safety of two categories of treatment for central retinal vein occlusion (CRVO): intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) and dexamethasone (Ozurdex).

Methods A retrospective analysis of Medisoft electronic medical record (EMR) data from 27 National Health Service sites in the UK identified 4626 treatment-naive patients with a single mode of treatment for macular oedema secondary to CRVO. Statistics describing the overall CRVO patient cohort and individual patient subpopulations stratified by treatment type were generated. Mean age at baseline, gender, ethnicity, social deprivation and visual acuity (VA) follow-up was reported. Absolute and change in VA using ETDRS are used to describe treatment effectiveness, the number of injections and visits used to describe treatment burden and endophthalmitis rates as a marker of treatment safety.

Results Mean VA was 47.9 and 45.3 EDTRS letters in the anti-VEGF and Ozurdex groups, respectively. This changed to 57.9/53.7 at 12 months, 58.3/46.9 at 18 months and 59.4/51.0 at 36 months. Mean number of injections were 5.6/1.6 at 12 months, 6.0/1.7 at 18 months and 7.0/1.8 at 36 months. Endophthalmitis rates were 0.003% (n=4) for the anti-VEGF group and 0.09% (n=1) for the Ozurdex group.

Conclusions VA improvements were greater and more sustained with anti-VEGF treatment. Lower starting acuity resulted in bigger gains in both groups, while higher starting acuity resulted in higher VA at 36 months. Although treatment burden was greater with anti-VEGF, Ozurdex was associated with higher rates of endophthalmitis.

  • Macula
  • Retina
  • Treatment Medical
  • Vision

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Footnotes

  • Twitter Richard Gale @EyeResearchYork, Rachel Hanson @RachelLWHanson and Paul Taylor @paul3548.

  • Contributors CE, RG, AL and AT designed the study. CE, PT and AT organised the collection of the data. The EMR Database Users Group provided the data. SD, AL and MP performed the analyses. All authors contributed significantly to the creation of the manuscript.

  • Funding AYL is supported by NIH/NEI K23EY029246 and an unrestricted grant from Research to Prevent Blindness.

  • Competing interests PT received a grant from Novartis Pharmaceuticals. AT is a consultant to Allergan, Bayer, Heidelberg Engineering, Kanghong Pharmaceuticals, Novartis, Oxurion. CE is a consultant to Heidelberg Engineering. AL reports being an employee of the US Food and Drug Administration (US FDA), and received grants from Santen, Carl Zeiss Meditec and Novartis, personal fees from Genentech, Topcon and Verana Health, outside the submitted work. This article does not reflect the opinions of the US Government or of the US FDA.

  • Ethics approval Appropriate institutional review board approval was obtained by PT at the UCL Institute of Health Informatics (reference, ROAD 14/023). Signed permission was returned from the lead clinician and Caldicott guardian (the clinician responsible for data protection in an NHS trust) at each participating trust. The study is registered on a list of studies using anonymised data at the lead clinician’s home institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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