First Author: A.Brara UK
Co Author(s): P. Aspinall P. Cackett A. Al Ani B. Dhillon S. Borooah
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Clinical trials have shown that anti-vascular endothelial growth factor (anti-VEGF) therapy can restore anatomical structure and preserve vision in patients with retinal vein occlusion (RVO). We aim to investigate the long-term real-world outcomes of anti-VEGF therapy in a cohort of RVO patients in south-east Scotland.
Princess Alexandra Eye Pavilion, Edinburgh, Scotland
Patients were identified from a clinic register of an RVO clinic from November 2014 to June 2015. The primary outcome measure was best-corrected visual acuity (BCVA) at latest follow up. The secondary outcome measure was central retinal thickness (CRT) at latest follow up. A logistic regression was performed to identify factors predicting change in BCVA and CRT following treatment.
72 eyes of 68 patients were included. The mean age of patients was 68.9 (range 43-92) years and eyes were treated with an average of 6.8 (SD 4.2) injections. The mean time from symptom onset to ophthalmology referral was 24.2 (SD 45.3) days and from referral to first ophthalmology clinic appointment was 16.1 (SD 23.4) days. The mean time from clinic to first injection was 111.2 (SD 168.5) days. Latest follow up was an average of 512.4 days (approximately 17 months) from the first injection. There was no significant change in BCVA between latest follow up and baseline (p=0.8300). The mean CRT was significantly reduced at latest follow up when compared with baseline (p<0.001). In branch retinal vein occlusions (BRVOs), we found that higher baseline CRT, LogMAR BCVA and cholesterol, as well as shorter times from symptom onset to referral, first clinic to first injection and last injection of first treatment to latest follow up predicted a greater improvement in BCVA. In central retinal vein occlusion (CRVO), non-smoking, lower final LogMAR BCVA and smaller CRT were linked with greater improvements in BCVA. In both BRVO and CRVO, higher baseline CRT predicted a greater reduction in mean CRT.
Anti-VEGF therapy was found to successfully improve anatomical derangements following RVO. However, visual function as measured by BCVA does not improve but does stabilise with anti-VEGF therapy. This study also adds to evidence supporting the link between early treatment with anti-VEGF therapy and improved visual outcomes. In addition, we have identified two novel predictors: non-smoking as a predictor for visual acuity improvement change in CRVO and cholesterol level as a predictor for visual acuity change in BRVO.