Anti-VEGF Shows Robust Effect on Hemiretinal Vein Occlusion

Caroline Tate is injected with Lucentis to treat macular deg
Caroline Tate is injected with Lucentis to treat macular degeneration at Charlotte Eye, Ear, Nose and Throat Associates in Charlotte, North Carolina, September 7, 2006. (Photo by Diedra Laird/Charlotte Observer/Tribune News Service via Getty Images)
Changes in hemiretinal vein occlusion eyes after treatment are not equivalent to branch or central vein occlusion eyes, researchers report.

Hemiretinal vein occlusion (HRVO) eyes respond to treatment differently than either branch vein occlusion (BRVO) or central vein occlusion (CRVO) eyes, according to a database observational study published in the British Journal of Ophthalmology.

Researchers reviewed 79 eyes of 78 treatment-naïve patients with cystoid macular edema due to HRVO. All patients were treated with either 2 mg aflibercept, 1.25 mg bevacizumab, or 0.5 mg ranibizumab between 2010 and 2020. They compared the participants’ responses to therapy and healthcare utilization up to 12 months with a BRVO group (n=580; 590 eyes) and a CRVO group (n=344; 344 eyes).

The HRVO, BRVO, and CRVO cohorts were comprised of 48%, 51%, and 41% women; aged mean 71 (SD, 11), 70 (SD, 11), and 70 (SD, 12) years; with baseline acuities of 53.8 (SD, 17.7), 59.4 (SD, 14.9), and 51.9 (SD, 18.7) letters; and central subfield thicknesses of 550 (SD, 186), 482 (SD, 159), and 630 (SD, 223) μm, respectively. A similar proportion of patients received aflibercept, bevacizumab, and ranibizumab.

At baseline, the visual acuity of the HRVO cohort more closely resembled the CRVO cohort, but after the start of treatment, began to resemble the BRVO cohort. The change in visual acuity was greater at 12 months among the HRVO group (mean change, +16.4 letters) compared with either BRVO (mean change, +11.4 letters; P =.006) or CRVO (mean change, +8.5 letters; P <.001).

The investigators report that other visual outcomes of HRVO eyes were more similar to BRVO eyes than CRVO eyes. For example, final central subfield thickness was 319 μm for HRVO and 330 μm for BRVO eyes (P =.31) compared with 371 μm for CRVO eyes (P =.001).

The number of visits and median injections received did not differ significantly among groups.

The observed adverse events among the HRVO cohort included delivery of scatter retinal photocoagulation (n=23), decline in vision (n=4), and need for retinal laser for proliferative disease (n=1).

This study was limited by not having access to motivations for treatment decisions.

In general, patients with treatment-naïve HRVO had good visual and anatomic outcomes at 12 months of treatment. However, the observed patterns during treatment appeared to be unique to HRVO eyes and should not be considered as equivalent to BRVO or CRVO patient groups, indicating that these patients should not be pooled in clinical trials.

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Hunt AR, Nguyen V, Arnold JJ, et al. Hemiretinal vein occlusion 12-month outcomes are unique with vascular endothelial growth factor inhibitors: data from the Fight Retinal Blindness! Registry. Br J Ophthalmol. Published online January 25, 2022. doi:10.1136/bjophthalmol-2021-320482