Although clinical trial data suggests anti-VEGF agents are more effective than intravitreal dexamethasone for treating macular edema secondary to branch retinal vein occlusion, real-world outcomes don’t always follow suit. Recently, researchers sought to incorporate a larger, more diverse sample population with a longer follow-up period to compared anti-VEGF agents, intravitreal dexamethasone and macular laser. 

The retrospective sample included 5,661 treatment-naïve patients who had received a single mode of treatment. Patients had no history of cataract surgery before treatment. The researchers compared the number of treatment visits and visual acuity changes from baseline up to three years for each of the three groups.

They found that visual acuity improved at 12 months for all three groups, with the anti-VEGF group seeing the greatest improvement with an average change of 9.6 letters. At 18 months, visual acuity was still improving from baseline for the anti-VEGF and dexamethasone groups but was declining for the macular laser group with a change of -1.5 letters.

The anti-VEGF group consistently had more treatments than the other groups at 12 and 18 months, averaging 5.1 and 5.9 treatments, respectively, whereas the dexamethasone and macular laser groups averaged less than two treatments at 12 months (1.5 and 1.2 treatments) and at 18 months (1.7 and 1.2 treatments).

“Visual acuity improvements were higher and more sustained with anti-VEGF,” the researchers concluded. They said that the anti-VEGF group had a higher treatment burden, but this reduced over 36 months (10.3 treatments). Additionally, “Patients with better vision at baseline than those in the clinical trials maintained high levels of vision with both anti-VEGF and dexamethasone.”

Gale R, Pikoula M, Lee AY, et al. Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser. Br J Ophthalmol 2020;0;1-6.