Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser

• Published in: British journal of ophthalmology Vol. 105; no. 4; pp. 549 - 554
• Main Authors: Gale, Richard, Pikoula, Maria, Lee, Aaron Y, Denaxas, Spiros, Egan, Catherine, Tufail, Adnan, Taylor, Paul
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2021; BMJ Publishing Group
• Subjects: Age; Aged; Angiogenesis Inhibitors - administration & dosage; Cataracts; Clinical Science; Clinical trials; Dexamethasone - administration & dosage; Diabetes; Diabetic retinopathy; Drug Therapy, Combination; Edema; Epidemiology; Eye surgery; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Intravitreal Injections; Laser Therapy - methods; Lasers; Macula Lutea - drug effects; Macula Lutea - pathology; Macula Lutea - surgery; Macular Edema - diagnosis; Macular Edema - epidemiology; Macular Edema - etiology; Male; Patients; Retinal Vein Occlusion - complications; Retinal Vein Occlusion - diagnosis; Retrospective Studies; Steroids; Transplants & implants; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factors - antagonists & inhibitors; Veins & arteries; Visual Acuity; United Kingdom > UK; retina; Epidemiology
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2020-315836

Background/aimsClinical trials suggest anti-vascular endothelial growth factor is more effective than intravitreal dexamethasone as treatment for macular oedema secondary to branch retinal vein occlusion. This study asks if ‘real world’ data from a larger and more diverse population, followed for a longer period, also support this conclusion.MethodsData collected to support routine care at 27 NHS (National Health Service) Trusts between February 2002 and September 2017 contained 5661 treatment-naive patients with a single mode of treatment for macular oedema secondary to branch retinal vein occlusion and no history of cataract surgery either during or recently preceding the treatment. Number of treatment visits and change in visual acuity from baseline was plotted for three treatment groups (anti-vascular endothelial growth factor (anti-VEGF), intravitreal dexamethasone, macular laser) for up to 3 years.ResultsMean baseline visual acuity was 57.1/53.1/62.3 letters in the anti-VEGF/dexamethasone/macular laser groups, respectively. This changed to 66.72 (+9.6)/57.6 (+4.5)/63.2 (+0.9) at 12 months. Adequate numbers allowed analysis at 18 months for all groups (66.6 (+9.5)/56.1 (+3.0)/60.8 (-1.5)) and for anti-VEGF at 36 months (68.0, +10.9) Mean number of treatments were 5.1/1.5/1.2 at 12 months, 5.9/1.7/1.2 at 18 months for all three groups and 10.3 at 36 months for anti-VEGF.ConclusionsVisual acuity improvements were higher and more sustained with anti-VEGF. Higher treatment burden occurred with anti-VEGF but this reduced over 36 months. Patients with better vision at baseline than those in the clinical trials maintained high levels of vision with both anti-VEGF and dexamethasone.