Study: Anti-VEGF Helps Recover About Two Lines of VA After BRVO, CRVO

At the end of the first year, less than 6% of RVO eyes received corticosteroid therapy, while at month 60, this number jumped to 14%, suggesting adjunctive therapy may be used with time along anti-VEGF treatment in attempt to decrease treatment burden, reduce retinal thickening seen with OCT or to improve vision outcomes in management of macular edema associated with vision loss. Photo: Topcon. Click image to enlarge. Following either a branch (BRVO) or central retinal vein occlusion (CRVO), individuals may be faced with lasting effects. One study recently published in Ophthalmology Retina had researchers investigate how macular edema following one of these events may be helped with anti-VEGF injections. The authors of the paper looked at long-term visual acuity (VA) outcomes, retrospectively using the Vestrum Health Retina database to collect and analyze information.Included for analysis were treatment-naïve eyes with diagnosis of macular edema following either BRVO or CRVO; all had to have one or more intravitreal anti-VEGF injections and three or more months of follow-up, extending as far as five years. A total of 22,365 BRVO and 18,064 CRVO eyes were acceptable for analysis. Around 70% had ≥12 months of follow-up and around 10% had ≥60 months follow-up. Mean number of anti-VEGF injections was 6.9 in year one and 3.7 in year five for BRVO; for CRVO, this yielded averages of 7.0 and 3.9, respectively. Mean gains in VA from baseline for BRVO were 11.5 letters at month 12 and 8.2 letters at month 60, while for CRVO, the same time periods resulted in averages of 9.7 and 5.3 letters, respectively.For both conditions, eyes that received fewer injections resulted in lower VA gains in comparison to those that received more. Of cases that had follow-up at 60 months, 68% of BRVO eyes and 71% or CRVO ones received ≥1 anti-VEGF injection. Finally, 24% of BRVO and 5% of CRVO eyes received focal/grid-pattern laser, and both 14% of BRVO and CRVO eyes received intravitreal corticosteroids at any time during 60 months of follow-up.Accordingly, the authors write that “the findings contribute to the body of evidence indicating that BRVO and CRVO with macular edema can be chronic and long-lasting conditions, which require continued active surveillance and treatment in many eyes, including those with BRVO.”Further discussion reveals that, on average, eyes with BRVO or CRVO received 2.7 injections after three months (~11 annualized), slightly more than four injections during the first six months (~8 annualized) and about seven injections during the first 12 months of treatment. It was also found that the mean number of injections was highest in year one, with just about seven for both BRVO and CRVO, but with eyes still receiving a mean of four injections per year from years two to five, and two-thirds of all eyes still needing injections in the fifth year.Lower treatment frequency over time may contribute to lower VA gains with longer follow-up. As well, eyes with higher injection ratios had greater VA gains at month 18. As the authors explain in their paper, “these findings highlight the need for more durable treatments that maintain disease control and VA improvement while minimizing treatment burden.”Although the reason for this is unclear, the investigators hypothesize that shorter follow-up times may indicate good VA outcomes, therefore the ability to stop treatment and monitoring earlier than those with worse visual outcomes. Consequently, eyes with poor VA outcomes may be overrepresented in groups with longer vs. shorter follow-up.The authors believe, based on their results, that “these data suggest that RVO is a chronic condition that, even with the availability of anti-VEGF therapy, achieving optimal outcomes remains a challenge.”Click here for the journal source. Ip M, Modi Y, Fekrat S, et al. Treatment patterns and long-term outcomes with anti-VEGF therapy for retinal vein occlusion: an analysis of the Vestrum Database. Ophthalmol Retina. May 27, 2025. [Epub ahead of print].