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Persistent macular edema after anti-VEGF leads to worse outcomes in CRVO

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Persistent macular edema (ME) in patients with central retinal vein occlusion (CRVO) undergoing anti–vascular endothelial growth factor (VEGF) can result in suboptimal visual acuity outcomes, according to a study.

In this post hoc analysis of the prospective, 3-arm, double-masked, randomized noninferiority trial Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO), a total of 425 eyes from 425 adult patients with CRVO-related ME with BCVA Early Treatment Diabetic Retinopathy Study (ETDRS) letter score of 19 to 78 in the study eye, were included. In LEAVO patients received intravitreal aflibercept (2.0 mg/0.05 mL), bevacizumab (1.25-mg/0.05 mL), or ranibizumab (0.5 mg/0.05 mL) over 100 weeks.

By 100 weeks, 28.5% of eyes were persistently dry, 10.7% were persistently wet (with ME which was associated with worse VA when compared to dry macula and recurrent ME), and 60.8% had recurrent ME.

Persistent ME by 52 weeks resulted in poorer 100-week BCVA compared with patients with dry macula and recurrent ME.

By 100 weeks, 18.6% of eyes treated with bevacizumab had persistently wet macula compared with 5.2% of those treated with aflibercept and 8% of those treated with ranibizumab.

The authors concluded that “attempts should be made to maintain persistently fluid-free macula for optimal visual acuity outcomes.”

Gurudas S, Patrao N, Nicholson L, et al. Visual Outcomes Associated With Patterns of Macular Edema Resolution in Central Retinal Vein Occlusion Treated With Anti–Vascular Endothelial Growth Factor Therapy: A Post Hoc Analysis of the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) Trial. JAMA Ophthalmol. Published online January 06, 2022. doi:10.1001/jamaophthalmol.2021.5619