Anti-VEGF treatment of macular edema associated with retinal vein occlusion: patterns of use and effectiveness in clinical practice (ECHO study report 2)

• Published in: Clinical ophthalmology (Auckland, N.Z.) N.Z.), 2018-01, Vol.12, p.621-629
• Main Authors: Jumper, J Michael, Dugel, Pravin U, Chen, Sanford, Blinder, Kevin J, Walt, John G
• Format: Article
• Language: English
• Subjects: Aflibercept; Bevacizumab; branch retinal vein occlusion; central retinal vein occlusion; Clinical medicine; Edema; Endothelial growth factors; Endothelium; FDA approval; Immunotherapy; Medical imaging; Medical lasers; Medical records; Medical research; Monoclonal antibodies; Ophthalmology; Original Research; Patients; Ranibizumab; Registration; Regulatory approval; Retinal diseases; Studies; Tomography; Vascular endothelial growth factor; visual acuity
• ISSN: 1177-5467; 1177-5483; 1177-5483
• DOI: 10.2147/OPTH.S163859

To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) antagonists in the treatment of macular edema secondary to retinal vein occlusion (RVO) in clinical practice. A multicenter retrospective study of the medical records of 165 patients (95 branch RVO, 70 central RVO) treated with at least three anti-VEGF injections in the study eye was conducted. Available data collected for at least 6 months after the first injection included Snellen best-corrected visual acuity (BCVA), central retinal thickness (CRT) by time-domain optical coherence tomography (TD-OCT) or spectral-domain optical coherence tomography (SD-OCT), anti-VEGF injections, other treatments/procedures for RVO, and adverse events. At baseline prior to anti-VEGF treatment, mean BCVA was 20/80 Snellen equivalent and mean CRT was 499 μm. Mean number of anti-VEGF injections received was 7.1 during the first year, 5.4 during the second year, and 5.9 during the third year; 51.3% (842/1,641) of injections were ranibizumab, 44.1% (724/1,641) were bevacizumab, and 4.6% (75/1,641) were aflibercept. One in five patients received concomitant focal laser treatment. The percentage of patients achieving both BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) was 26.1% (30/115) after the first anti-VEGF injection and ranged from 20.0% (7/35) to 36.7% (11/30) after the first 16 injections. After each anti-VEGF injection from the 1st to the 16th,