Central Retinal Vein Occlusion 36-Month Outcomes with Anti-VEGF: The Fight Retinal Blindness! Registry

Adrian Hunt; Vuong Nguyen; Sanjeeb Bhandari; Theodorus Ponsioen; Ian L McAllister; Jennifer Arnold; Stephanie Young; Pierre-Henry Gabrielle; Hemal Mehta; Louise O' Toole; Socorro Alforja; Javier Zarranz-Ventura; Daniel Barthelmes; Mark Gillies

doi:10.1016/j.oret.2022.11.001

Central Retinal Vein Occlusion 36-Month Outcomes with Anti-VEGF: The Fight Retinal Blindness! Registry

Ophthalmol Retina. 2023 Apr;7(4):338-345. doi: 10.1016/j.oret.2022.11.001. Epub 2022 Nov 9.

Authors

Affiliations

¹ The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Westmead Hospital, New South Wales, Australia. Electronic address: adrianhunt@eyesurgeonsmiranda.com.au.
² The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
³ The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; National Eye Institute, Bethesda, Maryland.
⁴ Department of Ophthalmology, Isala, Zwolle, the Netherlands.
⁵ Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Perth, Western Australia, Australia.
⁶ Marsden Eye Specialists, Parramatta, New South Wales, Australia.
⁷ Gladesville Eye Specialists, Gladesville, New South Wales, Australia.
⁸ The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Dijon University Hospital, Dijon, France.
⁹ The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Ophthalmology Department, Royal Free London NHS Foundation Trust, London, United Kingdom.
¹⁰ Mater Private Hospital, Dublin, Ireland.
¹¹ Institute Clínic of Ophthalmology (ICOF), Hospital Clinic, Barcelona, Spain.
¹² The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland.

PMID: 36371040
DOI: 10.1016/j.oret.2022.11.001

Abstract

Purpose: To analyze the 3-year outcomes in a broad population of patients starting VEGF inhibitors for central retinal vein occlusion (CRVO) in routine clinical practice.

Design: Observational database study.

Participants: Overall, 527 treatment-naïve CRVO eyes that commenced VEGF inhibitors between December 1, 2010 and 2018 were tracked in the Fight Retinal Blindness! registry.

Methods: Longitudinal models were used to plot changes in visual acuity (VA) and central subfield thickness (CST).

Main outcome measures: Mean change in VA from baseline to 36 months, injections, visits, completion, switching, and suspensions of therapy > 180 days at the final review.

Results: Overall (527 eyes) mean VA change (95% confidence interval [CI]) was + 10 (7, 12) letters, 37% had final VA ≥ 70 and 30% ≤ 35 letters, mean CST changed -306 μm. Completers (257/527, 49%) had mean 36-month changes in VA and CST of + 12 letters and -324 μm with a median of 18 injections at 26 visits. The adjusted mean VA change was similar to each VEGF inhibitor (mean, + 11.4 letters) despite a greater reduction in CST with aflibercept (-310 μm) versus ranibizumab (-258 μm) versus bevacizumab (-216 μm; P < 0.001). Eyes with baseline VA that was trial-eligible (19-73 letters; 356/527, 68%) gained 7 letters, very poor (< 19 letters; 129/527, 24%) gained 22 letters, or very good (> 73 letters; 42/527, 8%) lost 7 letters. Switching (160/527, 30%) was most often to aflibercept (79 eyes). By using suspensions and discontinuation reasons, we identified similar proportions had ceased therapy (154/527, 29%) and were still receiving it at 36 months (165/527, 31%). Only 62/527 eyes (12%) had resolution of macular edema without treatment for > 6 months.

Conclusions: Patients with CRVO that commenced VEGF inhibitors in routine care for whom follow-up was available had VA improvements of around 12 letters at 3 years, but with > 50% lost to follow-up, the VA outcome for the entire group was likely worse. The choice of VEGF inhibitor influenced CST but not VA outcomes. We estimated that around half of the eyes were still receiving injections after 36 months.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Keywords: Aflibercept; Bevacizumab; CRVO; Ranibizumab.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Angiogenesis Inhibitors
Blindness / chemically induced
Humans
Intravitreal Injections
Registries
Retinal Vein Occlusion* / drug therapy
Vascular Endothelial Growth Factor A

Substances

Vascular Endothelial Growth Factor A
Angiogenesis Inhibitors