Laser, Higher Drug Dose Add No Benefit in RVO Tx

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The best way to sum up the RELATE Trial?¹ More isn’t better. The trial researched 2 key questions. First, does a higher dosage of ranibizumab improve outcomes in chronic or recurrent edema from retinal vein occlusion (RVO)? To answer that question, patients were randomized to receive ranibizumab injections of 0.5 or 2 mg every 4 weeks for 24 weeks.

The patients were then re-randomized to compare pro re nata (PRN) ranibizumab plus scatter photocoagulation versus PRN ranibizumab alone to investigate the second question: Does treating the peripheral retina with scatter photocoagulation improve long-term outcomes and reduce treatment burden?

CRVO. The RELATE trial compared treatment options for patients with BRVO or CRVO, like the case shown here.

Unequivocal results. The study provided unequivocal answers to these 2 questions, said lead author Peter A. Campochiaro, MD, at the Wilmer Eye Institute.

1) Although there was a greater reduction of edema in patients with central (but not branch) RVO treated with the higher dose of ranibizumab over 6 months, the improvement in BCVA was similar between both dosage groups. 2) After 2.5 more years of follow-up, the researchers found that adding laser therapy to ranibizumab did not produce any clinically significant benefit in visual outcomes, edema resolution, or reduction in PRN injections.

Other potential approaches. The researchers did not study whether giving scatter photocoagulation therapy early in the disease would be beneficial. Dr. Campochiaro said that pursuing this would prove unproductive, in part because laser caused temporary exacerbation of macular edema and reductions in vision.

“It’s best to turn our attention to modes of sustained delivery of anti-VEGF therapy and steroids in appropriate patients,” he concluded.

—Annie Stuart

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1 Campochiaro PA et al. Ophthalmology. 2015;122(7):1426-1437.

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Relevant financial disclosures: Dr. Campochiaro—Aerpio Therapeutics: C; Alimera: C; Allergan: S; Genentech: S; Regeneron: S.

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