Clinical Ophthalmology (Mar 2020)
Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice
Abstract
Faye Horner,* Peck Lin Lip,* Bushra Mushtaq, Randhir Chavan, Bashar Mohammed, Arijit Mitra Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, Birmingham B18 7QH, UK*These authors contributed equally to this workCorrespondence: Peck Lin LipBirmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital Dudley Road, Birmingham B18 7QH, UKTel +44 121 5543801Fax +44 121 5076791Email [email protected]: To report long-term efficacy and treatment outcomes of the combination therapy for treating macular oedema (MO) in retinal vein occlusions (RVOs) from a real-world UK practice.Methods: The initial reported 66 RVO patients with MO treated with combination therapy (initial Ranibizumab, later optional addition of Ozurdex and laser) were followed up to Year 3: visual acuity (VA) and central retinal thickness (CRT) were analysed against baseline and previous Year 1 results. Safety and adverse events were also recorded.Results: Baseline LogMAR VA of 0.71 (Snellen 6/30) improved to 0.48 (Snellen 6/18) at Year 3 (p= 0.006); 63% experienced VA improvement (40% improved ≥ 3 lines), 27% had worse vision. Stability of mean VA (6/18) was already achieved at first post-loading phase review and was maintained in each subsequent year. Statistically significant CRT improvement was noted in each year (Year 3 median CRT=264μm) compared to baseline (median CRT=531μm). There was a reduction in the mean number of total injections to 2.5 in Year 3 (vs 5.5 in Year 1). Comparing Year 3 against Year 1, mean Ranibizumab injection frequency was 2.1 vs 4.3; mean Ozurdex injection frequency was 0.2 vs 1.1. In Year 3, 39.6% of patients did not require any form of injections, laser frequency was also reduced to 22.9% (vs 81.8% in Year 1). There was no endophthalmitis in the cohort, one progressed to neovascular glaucoma in Year 2 and mortality rate was recorded as 6%.Conclusion: Our real-world clinical practice for RVO patients using a combined therapy is associated with good long-term VA and anatomical outcomes with less intravitreal re-treatment rates.Keywords: RandOL protocol, Ozurdex, ischaemia, laser, mortality, aspirin
