Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Eye (Lond). 2023 Oct;37(15):3203-3208. doi: 10.1038/s41433-023-02488-x. Epub 2023 Mar 22.
Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) are first-line therapy for macular oedema in retinal vein occlusion (RVO). Appropriate management for RVO with good visual acuity at diagnosis has not been evaluated. The purpose of this study is to analyse the visual and anatomic outcomes from anti-VEGF treatment among RVO patients with good vision at baseline.
This retrospective cohort study evaluated patients diagnosed with macular oedema secondary to RVO from January 2012 to February 2021 at a tertiary ophthalmic centre. Patients had a Snellen acuity of 20/32 or better at diagnosis. Three cohorts were compared: patients with no anti-VEGF treatment, delayed anti-VEGF treatment (initial injection >30 days post-diagnosis) and immediate anti-VEGF treatment (initial injection ≤30 days post-diagnosis). Central subfield thickness (CST) and best visual acuity (BVA) were collected at diagnosis and 6-, 12- and 24-month follow-up appointments.
Among 131 eyes, mean BVA values among treatment groups did not differ at 6-, 12- or 24-month follow up visits (P = 0.521, 0.426, 0.356, respectively). The percentage of eyes with at least a 5-letter BVA decrease at 24 months was 24.1%, 65.0% and 30.8% in the no treatment, delayed and immediate treatment groups respectively (P = 0.010). There was no significant difference in the percentage of eyes with at least a 10% decrease in CST at 24 months among groups (P = 0.095).
Close observation with initiation of treatment in patients with good visual acuity with macular oedema secondary to RVO as indicated has similar outcomes in the setting of routine clinical practice.
玻璃体内注射抗血管内皮生长因子（anti-VEGF）是治疗视网膜静脉阻塞（RVO）黄斑水肿的一线治疗方法。尚未评估诊断时视力良好的 RVO 的适当治疗方法。本研究的目的是分析基线视力良好的 RVO 患者接受抗 VEGF 治疗的视力和解剖结果。
本回顾性队列研究评估了 2012 年 1 月至 2021 年 2 月在一家三级眼科中心诊断为继发于 RVO 的黄斑水肿的患者。患者诊断时的 Snellen 视力为 20/32 或更好。比较了三组患者：无抗 VEGF 治疗组、延迟抗 VEGF 治疗组（初始注射>30 天）和即刻抗 VEGF 治疗组（初始注射≤30 天）。在诊断时以及 6、12 和 24 个月的随访时收集中央视网膜厚度（CST）和最佳视力（BVA）。
在 131 只眼中，治疗组在 6、12 和 24 个月的随访时的平均 BVA 值没有差异（P=0.521、0.426 和 0.356）。在 24 个月时，至少有 5 个字母 BVA 下降的眼的百分比分别为无治疗组 24.1%、延迟治疗组 65.0%和即刻治疗组 30.8%（P=0.010）。在 24 个月时，各组中 CST 至少减少 10%的眼的百分比没有差异（P=0.095）。
在常规临床实践中，对于继发于 RVO 的黄斑水肿且视力良好的患者，根据需要密切观察并开始治疗，其结果相似。
