Predictors of visual acuity outcomes following anti-VEGF treatment for macular edema secondary to central retinal vein occlusion

Piyali Sen; Sarega Gurudas; Jayashree Ramu; Namritha Patrao; Shruti Chandra; Rajna Rasheed; Luke Nicholson; Tunde Peto; Sobha Sivaprasad; Philip Hykin

doi:10.1016/j.oret.2021.02.008

Predictors of visual acuity outcomes following anti-VEGF treatment for macular edema secondary to central retinal vein occlusion

Piyali Sen, Sarega Gurudas, Jayashree Ramu, Namritha Patrao, Shruti Chandra, Rajna Rasheed, Luke Nicholson, Tunde Peto, Sobha Sivaprasad, Philip Hykin

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Journal	Opthalmology Retina
Early online date	18 Feb 2021
DOIs	https://doi.org/10.1016/j.oret.2021.02.008
Publication status	Early online date - 18 Feb 2021

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@article{066fd9f928484cef8e7577b499fa4379,

title = "Predictors of visual acuity outcomes following anti-VEGF treatment for macular edema secondary to central retinal vein occlusion",

abstract = "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.",

author = "Piyali Sen and Sarega Gurudas and Jayashree Ramu and Namritha Patrao and Shruti Chandra and Rajna Rasheed and Luke Nicholson and Tunde Peto and Sobha Sivaprasad and Philip Hykin",

note = "Copyright {\textcopyright} 2021. Published by Elsevier Inc.",

year = "2021",

month = feb,

day = "18",

doi = "10.1016/j.oret.2021.02.008",

language = "English",

journal = "Opthalmology Retina",

issn = "2468-6530",

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Predictors of visual acuity outcomes following anti-VEGF treatment for macular edema secondary to central retinal vein occlusion. / Sen, Piyali; Gurudas, Sarega; Ramu, Jayashree; Patrao, Namritha; Chandra, Shruti; Rasheed, Rajna; Nicholson, Luke; Peto, Tunde; Sivaprasad, Sobha; Hykin, Philip.

In: Opthalmology Retina, 18.02.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Predictors of visual acuity outcomes following anti-VEGF treatment for macular edema secondary to central retinal vein occlusion

AU - Sen, Piyali

AU - Gurudas, Sarega

AU - Ramu, Jayashree

AU - Patrao, Namritha

AU - Chandra, Shruti

AU - Rasheed, Rajna

AU - Nicholson, Luke

AU - Peto, Tunde

AU - Sivaprasad, Sobha

AU - Hykin, Philip

PY - 2021/2/18

Y1 - 2021/2/18

N2 - 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.

AB - 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.

U2 - 10.1016/j.oret.2021.02.008

DO - 10.1016/j.oret.2021.02.008

M3 - Article

C2 - 33610836

JO - Opthalmology Retina

JF - Opthalmology Retina

SN - 2468-6530

ER -