Impact of anti-VEGF treatment-free interval during the first year on 5-year outcomes in eyes with branch retinal vein occlusion

ObjectivesThis study aims to analyze the impact of longest treatment-free interval (TFI) between anti-vascular endothelial growth factor (anti-VEGF) injections during the first year of treatment on 5-year best-corrected visual acuity (BCVA) and recurrence of macular edema (ME) in eyes with ME secondary to branch retinal vein occlusion (BRVO).MethodsA retrospective study including eyes with BRVO, minimum of 5-year follow-up, and available optical coherence topography (OCT) scans. Eyes underwent anti-VEGF loading dose therapy and were treated and monitored with an OCT-guided PRN regimen. Those with a history of ocular comorbidities were excluded.ResultsTotal of 60 patient eyes, with 40 females and average age of 71.75 ± 11.07 years. TFI among eyes was 1 month (20%); > 1-2 months (23%); > 2-3 months (18%); > 3-4 months (17%), and >4 months (22%). Forty-three (72%) eyes experienced ME recurrence during the five-year period. Multivariate linear regression shows that TFI (-0.02 [-0.03-0.00], <i>p</i> = 0.021) and baseline BCVA (0.37 [0.08-0.66], <i>p</i> = 0.014) are significant predictors of 5-year BCVA. TFI (Cox Proportional Hazard Ratio 1.34 [1.04-1.72], <i>p</i> = 0.023) and number of injections in the first year (Cox Proportional Hazard Ratio 1.76 [1.01-3.06], <i>p</i> = 0.045) were significant predictors of ME recurrence. Gender, age, type of injection, BCVA, and CMT did not influence recurrence.ConclusionFor eyes receiving anti-VEGF injections to treat ME secondary to BRVO, TFI is a significant predictor of 5-year BCVA and ME recurrence according to regression models. This study suggests more ME recurrence may be due to increased TFI or indicate more injections needed to treat severe BRVO.