RVO-Related Macular Edema: Baseline Factors and Outcomes
JAMA Ophthalmology, June 2017
Declining visual acuity is a common complication of macular edema secondary to retinal vein occlusion (RVO). The Study of Comparative Treatments for RVO 2 (SCORE2) provided valuable data on bevacizumab versus aflibercept for treatment of vision loss and central subfield thickness (CST) on optical coherence tomography (OCT) in eyes with RVO-related macular edema. An additional analysis of data by Scott et al. revealed that younger age and poorer vision at baseline correlated with better visual acuity (VA) results at 6 months and that aflibercept produced more favorable CST (but not VA) outcomes.
In SCORE2, 304 patients with central RVO (CRVO) and 58 patients with hemi-RVO were assigned randomly (1:1) to receive 6 monthly treatments with repackaged (compounded) bevacizumab or aflibercept (1.25-mg and 2-mg intravitreal injections, respectively). VA assessments and spectral-domain OCT were performed monthly. For the primary outcome results, the mean change in VA from baseline in the bevacizumab group was noninferior to (not worse than) than in the aflibercept group.
Subsequent multivariate analyses demonstrated that, regardless of treatment, younger age and lower (worse) baseline VA were associated with a 6-month gain of ≥ 15 letters. Compared with bevacizumab, aflibercept was more likely to result in resolution of macular edema and CST below 300 μm. The odds of edema resolution were lower for eyes that received intravitreal injections before study entry than for treatment-naïve eyes.
The authors noted that the association of younger age and worse baseline vision with greater improvement in VA was consistent with outcomes in previously published research. These findings, coupled with the greater efficacy of aflibercept in reducing retinal thickness and resolving edema, may help clinicians predict responses to short-term therapy for macular edema caused by CRVO or hemi-RVO. However, the authors cautioned that SCORE2 results were based on excellent patient adherence to treatment and that the primary finding that bevacizumab was noninferior to aflibercept with respect to VA improvement at 6 months should be kept in mind. (Also see related commentary by Jennifer K. Sun, MD, MPH, in the same issue.)
The original article can be found here.