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  • Prompt anti-VEGF therapy improves visual acuity in patients with RVO

    Retina/Vitreous

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    Review of: Outcomes in retinal vein occlusions presenting with poor visual acuity treated with anti-VEGF therapy

    Light J, Tian J, Wenick A. Ophthalmology Retina, September 2021

    Records of patients given anti-VEGF therapy for retinal vein occlusion (RVO) were assessed to determine the potential effectiveness of this treatment in those patients with poor visual acuity.

    Study design

    This was a retrospective chart review of patients seen over an 8-year period at a single US center presenting with an RVO within the prior 3 months and visual acuity worse than 20/320. Patients included in this review had at least 6 months of follow-up after treatment with anti-VEGF therapy. Fifty-two patients were included in the analysis, with the main outcome measure being change in visual acuity at 6 and 12 months.

    Outcomes

    The patients with central RVO (CRVO) gained a median of 20 letters at both 6 and 12 months and showed a corresponding decrease in central subfield thickness (mean change from baseline: −504.1 µm at 6 months and −552.3 µm at 12 months). Although only 13 patients with either branch RVO (BRVO) or hemiretinal RVO were included in the study, these patients gained a median of 45 and 57.5 letters at 6 and 12 months, respectively. A delay in treatment correlated with lower letter gains as well as a higher incidence of neovascular events. Most of the patients with CRVO or BRVO who achieved significant visual gain did so after one injection.

    Limitations

    The limitations of this study include the retrospective chart review design and the lack of a control group (i.e., patients with RVO and good visual acuity). In addition, there was variability in follow-up intervals and duration. Finally, the BRVO sample size was relatively small.

    Clinical significance

    Prior RVO studies have excluded patients with poor initial visual acuity. Although only 52 patients are included in this study, the results demonstrate that these patients gain both an anatomic and visual benefit from anti-VEGF therapy. These visual gains are typically seen shortly after treatment initiation, and a delay in treatment initiation can prevent these potentially significant gains. This study suggests that the optimal window for initiation of treatment is within a matter of weeks, rather than months.