OBJECTIVE: To evaluate whether baseline demographic, clinical and optical coherence tomography (OCT) characteristics predict visual acuity outcomes in patients receiving anti-VEGF therapy for ME (macular edema) due to CRVO (central retinal vein occlusion).
DESIGN: Post-hoc analysis of the randomized noninferiority trial (Lucentis, Eylea, Avastin in CRVO) - LEAVO Study from December 12, 2014, through December 16, 2016 carried out across 44 UK National Health Service ophthalmology departments.
PARTICIPANTS: Data on 267 participants with baseline best corrected mean visual acuity (BCVA) range of 19-78 Early Treatment Diabetic Retinopathy Study (ETDRS) letter score (approximate Snellen equivalent, 20/32 to 20/320) who had central subfield thickness (CST) ≥ 320μm on Spectralis OCT (Heidelberg Engineering, Germany) were analysed.
INTERVENTIONS: Study participants were randomised to receive repeated intravitreal injections of ranibizumab [0.5mg/50μl], aflibercept [2.0mg/50μl] or bevacizumab [1.25-mg/50μl], and a protocol driven pro-re-nata (PRN) re-treatment regimen at 4-8 weekly was followed up to week 100 after four mandated 4-weekly loading injections.
MAIN OUTCOMES AND MEASURES: Change in BCVA, percentage of patients gaining ≥ 10 letters and achieving BCVA letter score >70 letters at 52 and 100 weeks.
RESULTS: The analysis was adjusted for treatment effects and confirmed by sensitivity analysis. Age ≥75 years is a poor predictor for all 3 visual outcomes. Lower baseline BCVA predicted 10 letter gainers and higher gains in BCVA although it is a poor predictor of achieving >70 ETDRS letters. None of the baseline OCT morphological characteristics except ellipsoid zone integrity influenced any visual outcomes. Both baseline CST and total macular volume showed a non-linear relation to 10 letter gainers, with CST >900um being a poor prognostic indicator. Baseline CST and macular volume did not predict mean change in BCVA or BCVA>70 letters at 52 and 100 weeks.
CONCLUSIONS: At presentation, younger age, higher baseline BCVA and a definitely intact subfoveal ellipsoid zone are predictors of BCVA score >70 letters at 100 weeks.