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Treatment for branch retinal vein occlusion

Treating patients with recent BRVO and with higher best corrected visual acuity (BCVA) leads to better results

Cheryl Guttman Krader

Posted: Friday, July 21, 2017

Ramin Tadayoni MD

Exploratory analyses of data collected in the BRIGHTER study support initiating anti-vascular endothelial growth factor (anti-VEGF) treatment for branch retinal vein occlusion (BRVO) early in order to optimise functional outcomes, according to Ramin Tadayoni MD, PhD.
“BRVO accounts for 70% of RVOs, and more and more often we are treating as soon as the diagnosis is made because a few small studies with short follow-up found treating early is better than treating late. BRIGHTER provides supplementary information from a large trial and also shows that treating patients with recent BRVO and with higher best corrected visual acuity (BCVA) led to better results. Proof of the benefit of early treatment, however, requires a randomised early-intervention study,” said Dr Tadayoni, Professor of Ophthalmology, Sorbonne Paris Cité, Paris, France.
BRIGHTER was a 24-month study randomising 455 patients to ranibizumab 0.5mg (Lucentis®), ranibizumab plus laser, or initial laser treatment with ranibizumab allowed after six months.
Analyses conducted with patients stratified into three subgroups by baseline ETDRS BCVA showed that vision was improved at month 24 compared with baseline in all treatment arms, irrespective of baseline BCVA. Additionally, within each treatment arm, patients in the subgroup with the lowest baseline BCVA demonstrated the greatest BCVA gain, but also the lowest final BCVA.
Among patients receiving ranibizumab from baseline, mean change from baseline BCVA was +23.2 letters for eyes with baseline BCVA ≤39 letters, +20.1 letters if baseline BCVA was 40-49 letters, and +12.1 letters for eyes entering with BCVA ≥60 letters.
Notably, patients who received ranibizumab after a six-month delay achieved final BCVA levels lower than those achieved in the group treated initially with ranibizumab, particularly when comparing the subgroups with the highest baseline BCVA, Dr Tadayoni said.
Most studies of BRVO treatment exclude patients with a longer duration of disease, but more than 15% of patients enrolled in BRIGHTER had a disease duration of at least 12 months, said Dr Tadayoni. A comparison of patients stratified by interval since BRVO diagnosis also indicated a benefit for earlier intervention with ranibizumab. It showed the BCVA gain after 24 months was greater among patients who entered the study with a disease duration of less than 12 months versus 12 months or more (17.3 versus 8.4 letters, respectively).
Interestingly, the median time to gain ≥15 letters after initiating ranibizumab was significantly shorter for patients with a shorter duration of BRVO (85 versus 183 days, respectively). “It is interesting to see in the analysis that disease duration influences response. The data also indicate, however, that one should not give up too early when treating patients with longer BRVO duration because it may take a longer time to evaluate the treatment effect,” he said.

Ramin Tadayoni: ramin.tadayoni@aphp.fr