12-month outcomes of treatment-naïve retinal vein occlusion initially treated with either dexamethasone implants or vascular endothelial growth factor inhibitors: Data from the Fight Retinal Blindness! registry

Abstract

Abstract Aim: To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) initially treated with either dexamethasone implants (DEX) or vascular endothelial growth factor (VEGF) inhibitors where both are available as first-line therapy. Methods: Multi-centre study from European Fight Retinal Blindness! centres using the retinal vein occlusion module in routine clinical care. Results: Of 725 eligible eyes, only 10% received DEX initially with very frequent adjunctive VEGF inhibitors (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and VEGF inhibitors initiated groups were not statistically significantly different (BRVO: DEX +6.7, VEGF +10.6 letters; CRVO: DEX +2.8, VEGF +6.8 letters). DEX initiated eyes had fewer injections and visits than VEGF inhibitors initiated eyes but intraocular pressure required treatment more often in BRVO with DEX than VEGF inhibitors. We found the BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-VEGF eyes. The mean CST after the first three months was above 350μm in all but the BRVO-VEGF group, suggesting undertreatment in routine care. Conclusion:In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO and is often supplemented with VEGF inhibitors within the first year. The 12-month outcomes were similar, but DEX initiated eyes did have fewer injections and visits but more episodes of raised IOP compared with those starting VEGF inhibitors.