Long-term disease control with anti-VEGF treat-and-extend treatment in macular edema due to retinal vein occlusion

This study aims to evaluate the long-term outcome of a treat-and-extend regimen (TER) in treatment-naïve patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). A retrospective analysis was conducted on a consecutive series of patients treated with either ranibizumab 0.5 mg or aflibercept 2 mg in a treat-and-extend regimen without a loading dose with follow-up of at least 12 months. The evaluation included best-corrected visual acuity (BCVA), central retinal thickness (CRT), other morphological parameters assessed by spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) as well as treatment frequency. n = 106 (mean age 72.2 ± 11.2 years) were included, 55 BRVO and 51 CRVO/Hemi-CRVO. Mean follow-up period 54.1 ± 30.7 months (range 12–142). 36 eyes discontinued treatment: 9 eyes due to success and 27 lost to follow-up/death and 2 switched to Faricimab. BCVA significantly increased from 57.4 ± 23.9 letters at baseline to 72.6 ± 13.8 (p < 0.001), 72.3 ± 15.2 (p < 0.001), 72.4 ± 15.6 (p < 0.001), and 73.3 ± 13.5 letters (p < 0.001) after 1, 2, 3 and 4 years respectively. CRT significantly decreased from 506 ± 195 μm at baseline to 281 ± 72 μm (p < 0.001), 282 ± 64 μm (p < 0.001), 279 ± 72 μm (p < 0.001), and 283 ± 89 μm (p < 0.001), after 1, 2, 3 and 4 years, respectively. At year 1, 46.2% of eyes showed a dry retina (no intra- or subretinal fluid); at year 2, 48.0%; at year 3, 54.4%; and at year 4, 44.0%. Mean number of injections was 9.8 ± 2.2, 8.2 ± 2.5, 7.5 ± 3.1, and 7.3 ± 2.2 at years 1, 2, 3, and 4, respectively. The mean maximal recurrence-free treatment interval was 6.4 ± 2.1, 8.1 ± 2.7, 8.7 ± 2.8, and 8.5 ± 2.6 weeks within years 1, 2, 3, and 4, respectively. Long-term treat-and-extend regimen treatment using ranibizumab or aflibercept in treatment-naïve patients with CME due to BRVO or CRVO led to statistically significant and sustained functional and morphological improvements.