Delay to first anti-VEGF injection leads to worse visual outcomes

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A delay of >3 months from the time of diagnosis to treatment with first intravitreal aflibercept injection (IAI) was associated with lower visual gains in patients with macular edema due to central/branch retinal vein occlusion (MEfCRVO/MEfBRVO) compared to first treatment <1 month from diagnosis, according to a poster presented at AAO 2022.

In this post hoc analysis, patients with MEfCRVO from the COPERNICUS and GALILEO studies, and patients with MEfBRVO from the VIBRANT study were grouped according to time since diagnosis to first injection (<1, 1-3, or >3 months) to determine the impact of time to first IAI treatment on outcomes. Impact of baseline best corrected visual acuity was evaluated by tertiles in COPERNICUS and GALILEO.

At Week 24 the mean BCVA gains and central retinal thickness (CRT) changes in COPERNICUS were:

<1-month cohort
BCVA: 19.8 letters
CRT: −466.6 µm

1 to 3-month cohort
BCVA: 15.6 letters
CRT:−456.4 µm

3-month cohorts
BCVA: 11.9 letters
CRT: −479.2 µm

The study authors noted similar trends in the GALILEO and VIBRANT cohorts but the sample size was too small in the VIBRANT >3-month group.

Patients in COPERNICUS with baseline BCVA of ≤44 letters had greater BCVA gain but lower final BCVA at Week 100 than those with better baseline BCVA (>44- ≤58, and >58 letters).

“These findings highlight the importance of prompt treatment initiation in patients with MEfCRVO and may help manage patients’ and clinicians’ expectations during the management of MEfCRVO,” the authors concluded.

Sharma S, et al. Impacts of Time Since Diagnosis to Anti-VEGF Injection and Baseline BCVA on Outcomes in RVO. Poster presented at: AAO 2022.