New research that looked into the efficacy, burden and safety of two treatments for central retinal vein occlusion (CRVO) found visual acuity (VA) improvements were greater and more sustained with anti-VEGF therapy compared with dexamethasone. Although the treatment burden was greater for patients who underwent this therapy, dexamethasone was linked to higher rates of endophthalmitis, the study authors wrote in their paper.

The investigators reviewed electronic medical records data from 27 National Health Service sites in the UK and identified 4,626 treatment-naive patients with a single mode of treatment for macular edema secondary to CRVO. The study considered patient age at baseline, gender, ethnicity, social deprivation and VA at follow-up.

Treatment efficacy was based on absolute and change in VA using ETDRS letters; the number of injections and doctor visits determined treatment burden; and endophthalmitis rates were the benchmark for treatment safety.

Mean VA was 47.9 and 45.3 EDTRS letters in the anti-VEGF and dexamethasone groups, respectively. This changed to 57.9 and 53.7 at 12 months, 58.3 and 46.9 at 18 month and 59.4 and 51.0 at 36 months, respectively.

Looking at treatment burden, the mean number of injections was 5.6 and 1.6 at 12 months, 6.0 and 1.7 at 18 months and 7.0 and 1.8 at 36 months, respectively. Endophthalmitis rates were 0.003% (n=4) for the anti-VEGF group and 0.09% (n=1) for the dexamethasone group.

Lower starting acuity resulted in bigger gains in both groups, while higher starting acuity resulted in higher VA at 36 months, the researchers noted.

Gale R, Gill C, Pikoula M, et al. Multi-center study of 4,626 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. Br J Ophthalmol. September. 22, 2020. [Epub ahead of print].