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

Research output: Contribution to journalArticlepeer-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 languageEnglish
JournalOpthalmology Retina
Early online date18 Feb 2021
DOIs
Publication statusEarly online date - 18 Feb 2021

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