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
Open Access
- 12 June 2020
- journal article
- research article
- Published by BMJ in British Journal of Ophthalmology
- Vol. 105 (4), 549-554
- https://doi.org/10.1136/bjophthalmol-2020-315836
Abstract
Background/aims Clinical 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. Methods Data 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. Results Mean 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. Conclusions Visual 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.Keywords
Funding Information
- National Institute for Health Research (Biomedical Research Centre for Ophthalmology at Mo)
- Novartis (UK EMR Medical Retina Collaboration)
- Foundation for the National Institutes of Health (NIH/NEI K23EY029246)
This publication has 18 references indexed in Scilit:
- Intravitreal Aflibercept for Macular Edema Following Branch Retinal Vein OcclusionOphthalmology, 2016
- Anti‐VEGF treatment in branch retinal vein occlusion: a real‐world experience over 4 yearsActa Ophthalmologica, 2015
- The Neovascular Age-Related Macular Degeneration Database: Multicenter Study of 92 976 Ranibizumab InjectionsOphthalmology, 2014
- BRANCH RETINAL VEIN OCCLUSIONRetina, 2013
- Dexamethasone Intravitreal Implant in Patients with Macular Edema Related to Branch or Central Retinal Vein Occlusion: Twelve-Month Study ResultsOphthalmology, 2011
- Sustained Benefits from Ranibizumab for Macular Edema Following Branch Retinal Vein Occlusion: 12-Month Outcomes of a Phase III StudyOphthalmology, 2011
- NOVEL METHOD FOR ANALYZING SNELLEN VISUAL ACUITY MEASUREMENTSRetina, 2010
- Natural History of Central Retinal Vein Occlusion: An Evidence-Based Systematic ReviewOphthalmology, 2010
- The Prevalence of Retinal Vein Occlusion: Pooled Data from Population Studies from the United States, Europe, Asia, and AustraliaOphthalmology, 2010
- Argon Laser Scatter Photocoagulation for Prevention of Neovascularization and Vitreous Hemorrhage in Branch Vein OcclusionAmerican Journal of Ophthalmology, 1986