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Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice

Authors Horner F, Lip PL, Mushtaq B, Chavan R, Mohammed B, Mitra A

Received 17 January 2020

Accepted for publication 6 March 2020

Published 27 March 2020 Volume 2020:14 Pages 955—965


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

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 work

Correspondence: Peck Lin Lip
Birmingham and Midland Eye Centre, Sandwell & West Birmingham NHS Trust, City Hospital Dudley Road, Birmingham B18 7QH, UK
Tel +44 121 5543801
Fax +44 121 5076791

Purpose: 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

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