Treatment Patterns and Long-term Outcomes with Anti-VEGF Therapy for Retinal Vein Occlusion: An Analysis of the Vestrum Database.

PURPOSE: To evaluate anti-VEGF treatment patterns and long-term visual acuity (VA) outcomes in retinal vein occlusion (RVO) in routine clinical practice. DESIGN: Retrospective observational study of the Vestrum Health Retina database. SUBJECTS: Treatment-naïve eyes with a diagnosis of macular edema secondary to branch RVO (BRVO) or central RVO (CRVO) between January 2014 and November 2021. METHODS: Patient eyes were identified in the database using International Classification of Diseases, Clinical Modification, codes, and free text searches of Vestrum's "Exam Findings" field for macular edema. Eyes included for analysis were required to have ≥1 intravitreal anti-VEGF injection and ≥3 months of follow-up. MAIN OUTCOME MEASURES: Treatment patterns and VA outcomes up to 60 months (5 years) of follow-up. Mean VA change stratified by the tertile of the number of anti-VEGF injections received over 60 months. RESULTS: Notably, 22 365 BRVO and 18 064 CRVO eyes were included in the analysis; approximately 70% had ≥12 months of follow-up and approximately 10% had ≥60 months of follow-up. The mean numbers of anti-VEGF injections for BRVO and CRVO, respectively, were 6.9 and 7.0 in year 1 and 3.7 and 3.9 in year 5. Mean VA gains from baseline for BRVO and CRVO, respectively, were 11.5 and 9.7 ETDRS letters at month 12 and 8.2 and 5.3 letters at month 60. Branch RVO and CRVO eyes with fewer injections (tertile 1) tended to have lower VA gains compared with eyes that received more injections (tertile 3). Of available eyes at 60 months, 68% of BRVO and 71% of CRVO eyes had received ≥1 anti-VEGF injection in year 5 of follow-up. Overall, 24% of BRVO and 5% of CRVO eyes received focal/grid-pattern laser, whereas 14% of both BRVO and CRVO eyes received intravitreal corticosteroids at any time during follow-up over 60 months. CONCLUSIONS: In this retrospective analysis of the Vestrum database, VA gains were observed after anti-VEGF treatment. These were lower in patients with longer follow-up times and higher in patients who received a higher number of injections, suggesting a need for long-term monitoring of eyes with RVO. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Duke Scholars

Author Sharon Fekrat Ophthalmology, Vitreoretinal Diseases & Surgery