Early anti-vascular endothelial growth factor (anti-VEGF) responders (ER) continue to maintain better visual acuity at 2 years than those who had a limited response, according to research published in Ophthalmology Retina. Patients whose best visual acuity (BVA) improves within the first 3 months of treatment for macular edema secondary to retinal vein occlusion (RVO) are more likely to have better BVA progress at 2 years compared with their peers, the study says.
In prior studies, researchers have found differences in the success in the first 3 months of anti-vascular endothelial growth factor (VEGF) treatment for patients with macular edema following RVO. One study found that eyes that responded better than other eyes in those 3 months, or early anti-VEGF responders, were more likely to have better BVA and central subfield thickness (CST) at 1 year compared with limited early responders (LER).
The researchers also took a closer look at the impact of cardiopulmonary, endocrine, and oncologic comorbidities.
The investigators retrospectively reviewed records of adult patients (mean age, 73.5 years, 58.6% women) with RVO-related macular edema who were treatment naïve. Patients received 3 monthly anti-VEGF doses in the first 3 months and then received treatment based on the severity of macular edema. LER eyes were those that experienced less than 10% reduction of CST or gained less than 5 ETDRS letters of BVA by 3 months.
At the start of the study, early anti-VEGF responders eyes (39% of central retinal vein occlusion [CRVO] patients 58% of branch retinal vein occlusion [BRVO] patients) had lower BVA and CST compared with those in the LER group (45.8±21.1 letters vs 62.9±16.7 letters; 525±168.8 µm vs 440±143.7 µm).
At 24 months and 36 months, differences in progress in BVA and CST recovery between the ER and LER groups were significant.
However, controlling for differences in baseline BVA and CST, the researchers found that at 24 months, across BRVO and CRVO, early anti-VEGF responder eyes (n=68) and LER (n=39) eyes had both experienced significant change in BVA, but CST changes were not significant between ER and LER. At 36 months (58 ER, 33 LER), change in BVA was not significant between ER and LER.
“Eyes with both BRVO and CRVO that had favorable initial BVA response continued to have better vision at 24 months than those that did not initially respond,” the researchers explain. “This suggests that the improved gains in ER compared to LER in BVA over 36 months and CST over both 24 and 36 months are somewhat attributable to the fact that ER eyes have worse baseline BVA and CST.”
Response status and recorded comorbidities were not linked. Limitations of the study include lack of analysis between timepoints.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Kailar RS, Kuo BL, Perkins SW, et al. Long-term outcomes in early vs. limited response to anti-VEGF treatment for retinal vein occlusion. Ophthalmol Retina. Published online August 16, 2023. doi:10.1016/j.oret.2023.08.005