Study Finds Anti-VEGF Therapy Safer Before Steroids for Retinal Vein Occlusion

In results from a new study that was presented at EURETINA, Aflibercept and ranibizumab were found to be safer than dexamethasone intravitreal implants for the treatment of central retinal vein occlusion.



The incidence of central retinal vein occlusion ranges from about 0.5% to 0.8%. Both steroidal and anti-vascular endothelial growth-factor (VEGF) treatments have been shown to be effective, but, as per the presenting author, Dr Bejal Udani Shah of Moorfields Eye Hospital, London, there is no current consensus as to which agent should be used as first line treatment in CRVO, as well as there are no head-to-head trials that have indicated better outcomes of one over the other. The authors compared aflibercept, ranibizumab, and dexamethasone because they are the only treatments approved for this condition in the United Kingdom, as well as in the United States and other countries.

The researchers retrospectively compared 30 treatment-naive patients who attended the clinic over a 2-year period. Ten patients were treated with 2.5 mg, other 10 were treated with ranibizumab 0.5 mg, and the third group of 10 were treated with a dexamethasone implant 0.7 mg.

All three drugs reduced central retinal thickness, but the reduction was significant only with aflibercept and dexamethasone (P < .05). Although patients in the ranibizumab group experienced a mean improvement in logMAR visual acuity, the change was not significant (P = .06).

There were no reported adverse events in the anti-VEGF groups, but three of the 10 patients in the dexamethasone group experienced an increase in intraocular pressure.

From the preliminary results, the authors conclude that anti-VEGFs should be first line treatment, if there are no contraindications.

Dr Shah acknowledged that the study population is very small. The team is currently evaluating the retrospective population, while also looking at their ongoing patients.

Previous trials have shown that dexamethasone intravitreal implants are not as effective as aflibercept or ranibizumab after 3 months, as per a remark from an attendee, while Athanasios Nikolakopoulos, MD, from George Papanikolaou Hospital in Thessaloniki, Greece, remarked that most clinicians already use anti-VEGF treatments as their first-line option for central retinal vein occlusion, and if that does not work, go with dexamethasone.


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