SCORE Study report #11: incidences of neovascular events in eyes with retinal vein occlusion

Abstract

Purpose: To investigate in The Standard Care versus COrticosteroid for REtinal Vein Occlusion (SCORE) Study: (1) incidences of neovascular events and retinal capillary nonperfusion (abbreviated as "nonperfusion"), and their relationship with treatment groups; (2) neovascular incidences by nonperfusion status; and (3) pertinent baseline factors for their potential risk for neovascular events.

Design: Two multicenter, randomized clinical trials, 1 evaluating participants with central retinal vein occlusion (CRVO) and the other evaluating participants with branch retinal vein occlusion (BRVO).

Participants: At 36 months, data were available for 81 participants with CRVO and 128 with BRVO.

Intervention: Standard care (observation or grid photocoagulation) versus 1 or 4 mg intravitreal triamcinolone.

Main outcome measures: Neovascularization of the iris (NVI), neovascular glaucoma (NVG), disc or retinal neovascularization (NVD/NVE), preretinal or vitreous hemorrhage (PRH/VH), and nonperfusion.

Results: The cumulative 36-month incidences for CRVO and BRVO eyes, respectively, were 8.5% and 2.4% for NVI or NVG; 8.8% and 7.6% for NVD/NVE or PRH/VH. There were no differences in incidences of neovascular events or risk of nonperfusion when comparing the 3 treatment groups within diseases. For CRVO at 36 months, 16.6% of eyes with ≥5.5 disc areas of nonperfusion versus 4.0% of eyes with <5.5 disc areas of nonperfusion developed NVG (P = 0.0003); for BRVO at 36 months, 14.6% versus 2.4% developed NVD/NVE (P<0.0001). Similar results were noted for most other neovascular events. Nonperfusion was the only significant baseline factor for neovascularization in BRVO, with the risk of a neovascular event increasing with greater disc areas of nonperfusion, and the highest risk noted at ≥5.5 disc areas.

Conclusions: In the SCORE Study, triamcinolone treatment was not associated with lower incidences of neovascular events or nonperfusion status compared with observation or grid photocoagulation. Cumulative 36-month incidences for most neovascular events were significantly higher for nonperfused than perfused eyes. Greater baseline disc areas of nonperfusion increased the risk of neovascularization in BRVO but not CRVO eyes, possibly owing to obscuration of retinal capillary details caused by dense hemorrhage at baseline for CRVO eyes. Increased risk of neovascularization was noted below the historical threshold of 10 disc areas of nonperfusion for retinal vein occlusion.

Figure 1

Plot of Kaplan-Meier Survival analysis on neovascularization of the iris or neovascular glaucoma (NVI/NVG) shows the lack of significant difference in the corresponding neovascular events among the 3 treatment groups (standard care [SC], 1 mg triamcinolone, and 4 mg triamcinolone) in the Standard Care versus COrticosteroid for REtinal Vein Occlusion-Central Retinal Vein Occlusion (SCORE-CRVO) trial.

Figure 2

Plot of Life-table analysis on disc or retinal neovascularization or pre-retinal or vitreous hemorrhage (NVD/NVE or PRH/VH) shows the lack of significant difference in the corresponding neovascular events among the 3 treatment groups (standard care [SC], 1 mg triamcinolone, and 4 mg triamcinolone) in the Standard Care versus COrticosteroid for REtinal Vein Occlusion-Branch Retinal Vein Occlusion (SCORE-BRVO) trial.

Figure 3

Plot from exploratory analyses based on Cox regression models showing the hazard ratios (HR) with 95% confidence intervals for specific cut-points to assess the hazard of a neovascular event, whereby each specific disc area or greater of retinal capillary nonperfusion compared with less than that specific disc area of retinal capillary nonperfusion at baseline (x-axis) is plotted against the corresponding hazard ratio (y-axis); the cut-points of capillary retinal capillary nonperfusion ranged from ≥1.0 disc area (compared with < 1.0) to ≥10.0 disc areas (compared with < 10) in increments of 0.5 disc areas in the Standard Care versus COrticosteroid for REtinal Vein Occlusion-Branch Retinal Vein Occlusion (SCORE-BRVO) trial.