<p>Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice</p>

Abstract

To report long-term efficacy and treatment outcomes of the combination therapy for treating macular oedema (MO) in retinal vein occlusions (RVOs) from a real-world UK practice. Methods: The initial reported 66 RVO patients with MO treated with combination therapy (initial Ranibizumab, later optional addition of Ozurdex and laser) were followed up to Year 3: visual acuity (VA) and central retinal thickness (CRT) were analysed against baseline and previous Year 1 results. Safety and adverse events were also recorded. Results: Baseline LogMAR VA of 0.71 (Snellen 6/30) improved to 0.48 (Snellen 6/18) at Year 3 (p=0.006); 63% experienced VA improvement (40% improved ≥3 lines), 27% had worse vision. Stability of mean VA (6/18) was already achieved at first post-loading phase review and was maintained in each subsequent year. Statistically significant CRT improvement was noted in each year (Year 3 median CRT=264µm) compared to baseline (median CRT=531µm). There was a reduction in the mean number of total injections to 2.5 in Year 3 (vs 5.5 in Year 1). Comparing Year 3 against Year 1, mean Ranibizumab injection frequency was 2.1 vs 4.3; mean Ozurdex injection frequency was 0.2 vs 1.1. In Year 3, 39.6% of patients did not require any form of injections, laser frequency was also reduced to 22.9% (vs 81.8% in Year 1). There was no endophthalmitis in the cohort, one progressed to neovascular glaucoma in Year 2 and mortality rate was recorded as 6%. Conclusion: Our real-world clinical practice for RVO patients using a combined therapy is associated with good long-term VA and anatomical outcomes with less intravitreal retreatment rates.

Long-term outcomes for patients treated for macular oedema secondary to retinal vein occlusion: a systematic review

“…Nineteen studies used the Heidelberg Spectralis OCT machine 24. Thirteen studies used the Cirrus HD-OCT, Carl Zeiss Meditec OCT machine25 and two used the 3D-OCT 2000 OCT machine 26 27. The other studies did not specify what equipment was used.…”

Dexamethasone Intravitreal Implant for the Treatment of Macular Edema and Uveitis: A Comprehensive Narrative Review

“… ≤90 days duration of ME had the best visual outcomes. 19.9% received other adjunctive treatments Horner et al (2020) 53 Retrospective, real-world, single site, UK 66 Initial RZB, later DEX/laser Change in BCVA and CST Year 1 and 3 40% gained ≥3 lines at year 3 Diminished need for injections in year 3 compared to year 1 (2.5 v 5.5) Kim et al (2021) 54 Prospective, multicenter, real-world, S Korea 700 DEX implant at baseline. Subsequent treatment per physician's discretion Change in BCVA, responder rate, side effects Month 1, 2, 4 and 6 Peak benefit at 2 months (approx.…”

“…Another real-world study from the UK showed that the need for injections diminished in year 3 compared to year 1 for both ranibizumab and DEX implant while maintaining visual gain and CRT improvement. 53 …”

The Efficacy of Simultaneous Injection of Dexamethasone Implant and Ranibizumab Into Vitreous Cavity on Macular Edema Secondary to Central Retinal Vein Occlusion

“…Other drug delivery systems are developing such as nanosystems to deliver drugs to the back of the eye ( Amadio et al, 2016 ). Despite the efficacy of the monotherapy patients can experience recurrence ( Pielen et al, 2013 ) and need multiple and ongoing injections ( Horner et al, 2020 ). Therefore, patients have difficulty in follow-up; in addition national health systems, medical insurances and/or patients themselves also face a certain degree of economic pressure.…”