Treat-and-Extend Regimen for Macular Edema Secondary to Central Retinal Vein Occlusion: 12-Month Results

Abstract

To determine treatment outcomes after 12 months of bevacizumab and ranibizumab therapy using a treat-and-extend regimen in patients with macular edema resulting from central retinal vein occlusion (CRVO). Retrospective, interventional, consecutive case series. Sixty eyes of 58 patients diagnosed with CRVO and associated macular edema between May 2010 and June 2014 were included. Eyes were treated with bevacizumab and/or ranibizumab for a minimum of 1year, using a treat-and-extend regimen. Outcome measures were change from baseline visual acuity (VA), proportion of eyes gaining/losing ≥3 VA lines, change from baseline central retinal thickness (CRT), mean number of injections administered, and the longest treatment-free interval attained between injections. At baseline, mean logMAR VA was 1.18±0.71 (Snellen equivalent: 20/302), which improved to 0.85±0.71 (Snellen equivalent: 20/142) after 12 months of therapy (P= 0.018). During this period, 44.9% of eyes had gained ≥15 letters, while 10.2% had lost ≥15 letters. The mean CRT improved from 564.7±219.3 μm at baseline to 302.8±115.8 μm at 12-month follow-up (P < 0.001). Patients received, on average, 8.1 injections during the first year of treatment, and the mean longest duration of successful extension between injections during year 1 was 9.3±4.4 weeks. Multivariable analyses revealed that change in CRT over the first 3 months oftherapy was significantly associated with the ability to extend injection intervals to at least 8 weeks' duration (P< 0.05). The treat-and-extend regimen is effective in achieving visual and anatomic improvements in patients with macular edema secondary to CRVO through the first year of therapy. Change in CRT during the first 3 months of treatment may help predict which patients will respond more favorably to an extension phase at or beyond 8 weeks.