Navigated laser and aflibercept versus aflibercept monotherapy in treatment‐naïve branch retinal vein occlusion: A 12‐month randomized trial

• Published in: Acta ophthalmologica (Oxford, England) England), 2022-11, Vol.100 (7), p.e1503-e1509
• Main Authors: Frederiksen, Katrine Hartmund, Vestergaard, Jesper Pindbo, Pedersen, Frederik Nørregaard, Vergmann, Anna Stage, Sørensen, Torben Lykke, Laugesen, Caroline Schmidt, Kawasaki, Ryo, Peto, Tunde, Grauslund, Jakob
• Format: Article
• Language: English
• Subjects: Acuity; aflibercept; Aged; Angiogenesis Inhibitors; branch retinal vein occlusion; Edema; Humans; Intravitreal Injections; Lasers; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - etiology; macular oedema; navigated central retinal laser; Occlusion; Original; Patients; randomized clinical study; Receptors, Vascular Endothelial Growth Factor; Recombinant Fusion Proteins - therapeutic use; Retina; Retinal Vein Occlusion - diagnosis; Retinal Vein Occlusion - drug therapy; Treatment Outcome; Vascular Endothelial Growth Factor A; vascular endothelial growth factor inhibition; Visual Acuity
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.15182

Purpose Angiostatic agents have proven effective in the treatment of macular oedema in patients with branch retinal vein occlusion (BRVO). However, treatment is inconvenient and expensive, and novel treatment regimens are warranted. We aimed to evaluate if combination treatment of navigated central retinal laser and aflibercept lowered the treatment burden in these patients. Methods Treatment‐naïve patients with BRVO and macular oedema were included at two centres and randomized 1:1 to three monthly injections of 2.0 mg aflibercept with (Group A) or without (Group B) navigated central laser, followed by aflibercept as needed from month 4 through 12. Re‐treatment need was evaluated, and secondary endpoints included functional and anatomical outcomes and safety evaluated by retinal microperimetry. Results We evaluated 41 eyes of 41 patients with a mean age of 69.6 years. Baseline median best‐corrected visual acuity (BCVA) was 70.0 letters, and median central retinal thickness (CRT) was 502 μm with no difference between Groups A (n = 21) and B (n = 20). Percentage of patients needing re‐treatment after month three was 71% and 80% (p = 0.72). At month 12, groups did not differ in number of injections after loading (1 versus 2, p = 0.43), change in BCVA (+12.8 versus +15.1 letters, p = 0.48), CRT (−195 versus −181 μm, p = 0.82), or retinal sensitivity (+3.3 versus +4.1 dB, p = 0.67). Conclusion In treatment‐naïve BRVO patients, addition of navigated central laser to aflibercept did not lower treatment burden or affect functional or anatomical outcomes. A low number of intravitreal injections were needed for successful outcome in both treatment arms.