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Multicenter Study
. 2021 Nov;105(11):1571-1576.
doi: 10.1136/bjophthalmol-2020-317306. Epub 2020 Sep 22.

Multicentre study of 4626 patients assesses the effectiveness, safety and burden of two categories of treatments for central retinal vein occlusion: intravitreal anti-vascular endothelial growth factor injections and intravitreal Ozurdex injections

Richard Gale  1   2 , Claire Gill  3   2 , Maria Pikoula  4 , Aaron Y Lee  5 , Rachel L W Hanson  3 , Spiros Denaxas  4 , Catherine Egan  6 , Adnan Tufail  7 , Paul Taylor  4 ; UK EMR Database Users Group
Affiliations
Multicenter Study

Multicentre study of 4626 patients assesses the effectiveness, safety and burden of two categories of treatments for central retinal vein occlusion: intravitreal anti-vascular endothelial growth factor injections and intravitreal Ozurdex injections

Richard Gale et al. Br J Ophthalmol. 2021 Nov.

Abstract

Background/aims: To assess the effectiveness, burden and safety of two categories of treatment for central retinal vein occlusion (CRVO): intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) and dexamethasone (Ozurdex).

Methods: A retrospective analysis of Medisoft electronic medical record (EMR) data from 27 National Health Service sites in the UK identified 4626 treatment-naive patients with a single mode of treatment for macular oedema secondary to CRVO. Statistics describing the overall CRVO patient cohort and individual patient subpopulations stratified by treatment type were generated. Mean age at baseline, gender, ethnicity, social deprivation and visual acuity (VA) follow-up was reported. Absolute and change in VA using ETDRS are used to describe treatment effectiveness, the number of injections and visits used to describe treatment burden and endophthalmitis rates as a marker of treatment safety.

Results: Mean VA was 47.9 and 45.3 EDTRS letters in the anti-VEGF and Ozurdex groups, respectively. This changed to 57.9/53.7 at 12 months, 58.3/46.9 at 18 months and 59.4/51.0 at 36 months. Mean number of injections were 5.6/1.6 at 12 months, 6.0/1.7 at 18 months and 7.0/1.8 at 36 months. Endophthalmitis rates were 0.003% (n=4) for the anti-VEGF group and 0.09% (n=1) for the Ozurdex group.

Conclusions: VA improvements were greater and more sustained with anti-VEGF treatment. Lower starting acuity resulted in bigger gains in both groups, while higher starting acuity resulted in higher VA at 36 months. Although treatment burden was greater with anti-VEGF, Ozurdex was associated with higher rates of endophthalmitis.

Keywords: Macula; Retina; Treatment Medical; Vision.

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Conflict of interest statement

Competing interests: PT received a grant from Novartis Pharmaceuticals. AT is a consultant to Allergan, Bayer, Heidelberg Engineering, Kanghong Pharmaceuticals, Novartis, Oxurion. CE is a consultant to Heidelberg Engineering. AL reports being an employee of the US Food and Drug Administration (US FDA), and received grants from Santen, Carl Zeiss Meditec and Novartis, personal fees from Genentech, Topcon and Verana Health, outside the submitted work. This article does not reflect the opinions of the US Government or of the US FDA.

Figures

Figure 1:
Figure 1:
CONSORT flow diagram, for entire CRVO patient population with the final allocation to the Anti-VEGF or Ozurdex treatment groups.
Figure 2:
Figure 2:
Visual acuity (VA) changes over time. Line graph showing the mean VA at monthly intervals on the left-hand side with the change in VA shown on the right-hand side. Results for the anti-VEGF group are plotted on the top row with the Ozurdex group shown on the bottom row. VA is plotted as the number of ETDRS letters, stratified by baseline VA. Numbers for the Oxurdex cohort are very low. For all four plots, values are carried forward between months where no measurement was made but not beyond the last measurement.
Figure 3:
Figure 3:
Kaplan-Meier estimation of the time to 15-letter loss stratified by treatment type. Estimates for treatment with anti-VEGF is shown in red with Ozurdex shown in blue.
See this image and copyright information in PMC

References

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