Consequences of anti-vascular endothelial growth factor treatment lapse in patients with retinal vein occlusion

Background Anti-vascular endothelial growth factor (VEGF) treatments are the first-line treatment for Retinal Vein Occlusion (RVO). Although effectiveness and safety of these treatments is well documented, knowledge regarding the effect of lapses in anti-VEGF treatment among RVO patients is lacking. The purpose of this study is to analyse the anatomic and visual outcomes from a lapse in anti-VEGF treatment in patients with RVO. Methods This retrospective case-control study evaluated 136 patients diagnosed with RVO and treated with anti-VEGF between January 2012 and June 2020 at Cole Eye Institute, Cleveland Clinic. Patients were divided into two cohorts: RVO patients with no lapse in anti-VEGF treatment (control group) and RVO patients with a lapse >= 3 months (lapse group). Central subfield thickness (CST) and best corrected visual acuity (BCVA) were collected pre-lapse, the first appointment post-lapse, and at 3-, 6-, and 12-month follow-up appointments. Results Lapse patients (n = 68) and control patients (n = 68) had similar pre-lapse CST (p = 0.466) and BCVA (p = 0.303). Lapse patients experienced a significant increase in CST after discontinuing anti-VEGF therapy (lapse: 400.6 +/- 192.1 mu m, control: 333.0 +/- 111.1 mu m, p = 0.024). This persisted 12 months post-lapse after re-initiation of anti-VEGF agents (lapse: 381.6 +/- 161.1 mu m, control: 307.5 +/- 95.4 mu m, p = 0.030). Lapse patients also experienced a decrease in BCVA after lapse (lapse: 54.3 +/- 25.1 ETDRS, control: 64.4 +/- 17.8 ETDRS, p < 0.001) that recovered after 6 months of anti-VEGF treatment. Conclusions RVO patients with any lapse of anti-VEGF treatment are at risk for poorer anatomic and visual outcomes. Though BCVA normalizes upon treatment resumption, patients experience a statistically significant increase in CST that does not recover.

Automated summary

This study found that patients with Retinal Vein Occlusion (RVO) are at risk for poorer anatomical and visual outcomes after a lapse in anti-vascular endothelial growth factor (VEGF) treatment. Lapse patients experienced an increase in central subfield thickness (CST) that did not fully recover even after treatment was resumed. Additionally, lapse patients had a decrease in best corrected visual acuity (BCVA) after the lapse, but it recovered after 6 months of anti-VEGF treatment.