Long-term outcomes of anti-VEGF treatment of macular oedema due to retinal vein occlusions

Corazza, Paolo; D'Alterio, Francesco Maria; Savastano, Maria Cristina; Kabbani, Jamil; Duguid, Graham; Savastano, Alfonso; Younis, Saad

doi:10.1177/11206721221085870

Cited by 6 publications

(8 citation statements)

References 39 publications

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“…However, an important difference between the case of neovascular AMD and that of RVO is that there seems to be a continuing need for anti-VEGF therapy in eyes with neovascular AMD with a large proportion of patients remaining in active therapy for many years (Potapenko & la Cour, 2021); whereas for RVO, we find that only 52.1% of patients remains in active after the first year. Our findings are in line with other real-life studies of anti-VEGF therapy of RVO, which find that ~50% of patients remain in treatment after the first year (Corazza et al, 2022;Rezar et al, 2015). Furthermore, we also report that number of patients in active treatment decrease with 21.7% per following year; in other words, after 5 years <20% are expected to remain in active anti-VEGF therapy.…”

Section: Discussionsupporting

confidence: 92%

“…It can be further speculated that introduction of new anti‐VEGF formulations or treatment may also influence treatment burden (Chakraborty et al, 2022; Dugel et al, 2020; Ghanchi et al, 2022; Heier et al, 2022). However, for RVO, studies on Aflibercept and Ranibizumab have so far not shown any clear differences in the number of injections beyond the first year (Corazza et al, 2022). Another important aspect is that willingness to adhere to regular anti‐VEGF treatments is lower in patients with neovascular AMD ≥ 90 years (Subhi & Sørensen, 2017), and a reasonable speculation is that an increasing number of patients with RVO in the very old category may exhibit similar difficulties in adherence to therapy.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic modelling of number of patients with retinal vein occlusion in anti‐VEGF therapy

Subhi

Potapenko

Hajari

et al. 2023

Acta Ophthalmologica

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PurposeThe purpose of the study was to evaluate temporal changes in age‐ and sex‐stratified incidence rates of retinal vein occlusion (RVO) commenced in anti‐vascular endothelial growth factor (anti‐VEGF) treatment, proportion of patients remaining in active anti‐VEGF therapy over time, and to develop a forecasting model for future number of patients with RVO in active anti‐VEGF therapy.MethodsThis was a registry‐based study of patients with RVO in the Capital Region of Denmark from commenced in anti‐VEGF therapy from 1 January 2007 to 30 June 2022. Census data were extracted from Statistics Denmark for incidence rate analyses and forecasting data of future demographics.ResultsA total of 2641 patients with RVO were commenced in anti‐VEGF therapy, of which 2192 were later discontinued. Number of patients rose dramatically during the first years of introduction of anti‐VEGF therapy, after which growth was slower and followed the demographic changes. Trend analyses revealed that the COVID‐19 epidemics impacted with fewer referrals and more aggressive discontinuation practices. Annual incidence of RVO in 2012–2021 was 13.1 per 100 000 (95% CI: 12.6–13.6 per 100 000). Proportion of patients with RVO remaining in active anti‐VEGF treatment was 55.0%, 40.1%, 30.8% and 12.1% after Years 1, 2, 3 and 8, respectively. According to our forecast, number of patients with RVO in active anti‐VEGF therapy will grow slowly but continually at least until year 2035.ConclusionOur study reports incidence rates and provides prognostic modelling of number of patients with RVO in anti‐VEGF therapy.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Prognostic modelling of number of patients with retinal vein occlusion in anti‐VEGF therapy

Subhi

Potapenko

Hajari

et al. 2023

Acta Ophthalmologica

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“…In recent years, anti-VEGF drugs have been widely employed to treat fundus diseases such as nAMD, DME, and RVO, and have exhibited promising results. [9][10][11] Although it has been reported previously that intravitreal injection of anti-VEGF drugs might lead to complications such as vitreous hemorrhage, endophthalmitis and intraocular pressure increase, [12] there are few reports describing the possible influence of corneal nerve.…”

Section: Discussionmentioning

confidence: 99%

Effect of repeated intravitreal anti-vascular endothelial growth factor drugs on corneal nerves

Chen

Zhang

et al. 2023

Medicine

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To investigate the potential effect of repeated intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs on corneal nerves. A total of 64 patients were treated with intravitreal injection of anti-VEGF drugs. There were 19 cases of neovascular age-related macular degeneration (AMD), 20 cases of diabetic macular edema (DME) and 25 cases of retinal vein occlusion (RVO). Twenty-nine cases were treated with aflibercept (2 mg/0.05 mL) whereas 35 cases were managed with ranibizumab (0.5 mg/0.05 mL). A corneal confocal microscope was used to collect images of corneal subbasal nerve plexus, and Image J was used for image analysis. The changes in corneal nerve were compared between 1 month after each injection and before injection. There were no significant differences in the density and length of corneal nerve at specific time after the surgery in comparison with baseline in patients who were given 3 intravitreal injections. There was no significant correlation between the numbers of injections and the changes of the corneal nerves. After 3rd injection, the nerve length of the DME group was markedly lower than that of AMD and RVO groups, the difference was statistically significant (P < .05). The nerve density of the DME group was not significantly different from that of AMD and RVO groups, whereas the nerve length and nerve density of the AMD and RVO groups were not statistically significant between each other also. The corneal nerve length after the 2nd and 3rd injections of Aflibercept were lower than that before surgery, the difference was statistically significant. There were no significant differences in nerve density and nerve length at each time point after Ranibizumab injection. The length and density of the corneal nerve after multiple injections in contralateral eye displayed no significant changes compared with the baseline. Repeated intravitreal anti-VEGF drug can reduce the length of corneal nerves. For patients who need repeated intravitreal injections of anti-VEGF drugs, especially in DM, attention should be paid on the changes affecting the corneal nerves. It is also needed to strengthen the local anti-inflammatory therapy to avoid infection and to use artificial tears to protect the microenvironment of the ocular surface after the surgery.

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“…In this real-world retrospective study, we found that anti-VEGF plus DEX I treatment improved BCVA, CRT, and retinal vessel density in patients with BRVO-ME and CRVO-ME, after an average of 3 injections. Previous studies have shown that intravitreal injection of anti-VEGF drugs (5.5 injections in 1 year) or DEX I can relieve RVO-ME [ 17 , 18 ]. Additionally, our findings indicated that after combination therapy RVO-ME patients had functional effects, and the curative effect peaked at 2 months after injection.…”

Section: Discussionmentioning

confidence: 99%

Combination Therapy Using Anti-Vascular Endothelial Growth Factor (VEGF) Drugs and Steroids for Macular Edema in Retinal Vein Occlusions

et al. 2023

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Background Retinal vein occlusion-induced macular edema (RVO-ME) is a significant global cause of vision loss, with the effectiveness of combined anti-vascular endothelial growth factor (anti-VEGF) drugs and dexamethasone implantation (DEX I) being a relevant, yet not thoroughly explored, area of interest. The aim of this study was to evaluate the 1-year clinical efficacy of combination therapy using anti-vascular endothelial growth factor (VEGF) drugs and dexamethasone implantation (DEX I) in the treatment of macular edema secondary to retinal vein occlusion (RVO-ME). Material/methods This retrospective study analyzed data from 34 RVO-ME patients treated at the Inner Mongolia Chaoju Eye Hospital between January 2020 and December 2021. All patients underwent initial DEX I treatment, followed by the introduction of anti-VEGF drugs, and were observed for one year. Retinal structural and vascular changes were measured using spectral domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA). The study also evaluated shifts in best corrected visual acuity (BCVA) throughout the observation period. Results Following the combined therapy, patients showed significant improvements in BCVA, intraocular pressure (IOP), central retinal thickness (CRT), and retinal vessel density (VD) (all P <0.05). Upon stratifying the results by RVO type, patients with branch retinal vein occlusion (BRVO)-ME displayed more significant BCVA improvement and CRT reduction at various post-treatment intervals compared to those with central retinal vein occlusion (CRVO)-ME (all P <0.05). Conclusions The combined use of anti-VEGF drugs and DEX I showed promising one-year efficacy in treating RVO-ME, with greater improvements noted in patients with BRVO-ME compared to those with CRVO-ME. Despite the positive results, close monitoring of IOP elevation, a notable side effect, remains crucial.

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Long-term outcomes of anti-VEGF treatment of macular oedema due to retinal vein occlusions

Cited by 6 publications

References 39 publications

Prognostic modelling of number of patients with retinal vein occlusion in anti‐VEGF therapy

Prognostic modelling of number of patients with retinal vein occlusion in anti‐VEGF therapy

Effect of repeated intravitreal anti-vascular endothelial growth factor drugs on corneal nerves

Combination Therapy Using Anti-Vascular Endothelial Growth Factor (VEGF) Drugs and Steroids for Macular Edema in Retinal Vein Occlusions

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