Loss of Peak Vision in Retinal Vein Occlusion Patients Treated for Macular Edema

• Published in: American journal of ophthalmology 2019-09, Vol.205, p.17-26
• Main Authors: Iftikhar, Mustafa, Mir, Tahreem A., Hafiz, Gulnar, Zimmer-Galler, Ingrid, Scott, Adrienne W., Solomon, Sharon D., Sodhi, Akrit, Wenick, Adam S., Meyerle, Catherine, Jiramongkolchai, Kim, Liu, T.Y. Alvin, Arevalo, J. Fernando, Singh, Mandeep, Kherani, Saleema, Handa, James T., Campochiaro, Peter A.
• Format: Article
• Language: English
• Subjects: Angiogenesis Inhibitors - administration & dosage; Clinical trials; Diabetes; Diabetic retinopathy; Disease; Disease Progression; Edema; Follow-Up Studies; Intravitreal Injections; Macular Edema - drug therapy; Macular Edema - etiology; Macular Edema - physiopathology; Pilot Projects; Prospective Studies; Ranibizumab - administration & dosage; Retina; Retinal Vein Occlusion - complications; Retinal Vein Occlusion - physiopathology; Thrombosis; Time Factors; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Veins & arteries; Visual Acuity
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2019.03.029

To evaluate long-term visual and anatomic outcomes in patients with retinal vein occlusion (RVO) treated with anti–vascular endothelial growth factor (VEGF) agents. Prospective, interventional case series. Patients with central RVO (CRVO) or branch RVO (BRVO). Number of anti-VEGF injections and improvement from baseline best-corrected visual acuity (BCVA) and central subfield thickness (CST) were prospectively recorded in 40 eyes of 39 CRVO patients and 50 eyes of 47 BRVO patients. Mean follow-up was 58 months for BRVO and 78 months for CRVO. Within 6 months of last follow-up, 58% of BRVO patients and 75% of CRVO patients required anti-VEGF injections to control edema. Analysis of the course of each patient over time showed that for BRVO patients, BCVA letter score increased by a mean of 24, from baseline of 52 (20/100) to peak of 76 (20/32), and subsequently decreased by 13, to 63 (20/50), at final visit; and for CRVO patients, BCVA letter score increased by a mean of 26, from baseline of 48 (20/100) to peak of 74 (20/32), and subsequently decreased by 18, to 56 (20/80), at last follow-up. Loss from peak BCVA occurred primarily owing to persistent/recurrent edema and related foveal damage. Patients with RVO showed large improvements in BCVA after initiation of anti-VEGF injections, but in many patients some visual gains were lost over time owing to bouts of recurrent edema. Sustained suppression of VEGF may help to provide optimal outcomes in RVO and reduce treatment burden. •Retinal vein occlusion (RVO) is a chronic disease.•Repeated anti–vascular endothelial growth factor (VEGF) injections are needed for many years.•With anti-VEGF injections, vision improves, peaks, and then declines over time.•Decline in vision occurs owing to bouts of recurrent edema and their consequences.•New treatments that provide sustained suppression of VEGF are needed in RVO.