Outcomes in Retinal Vein Occlusions Presenting with Poor Visual Acuity Treated with Anti–Vascular Endothelial Growth Factor Therapy: Prognosis and Predictive Factors

Purpose: To present visual acuity and OCT outcomes in patients with retinal vein occlusion (RVO) treated with anti–vascular endothelial growth factor (VEGF) agents demonstrating poor initial visual acuity. We aimed to identify relevant factors that may portend differential outcomes in this important patient population. Design: Retrospective chart review. Participants: Fifty-two patients with recent RVO treated with anti-VEGF therapy and demonstrating habitual corrected visual acuity of worse than 20/320 before any ocular therapy, with at least 6 months of follow-up. Methods: Visual acuity, spectral-domain (SD) OCT findings, injection details, and the development of neovascular sequelae or need for adjunct therapies were recorded for consecutive visits after meeting vision criteria (maximum of 16 visits). In the central retinal vein occlusion (CRVO) cohort, univariate and multivariate analyses were performed to identify factors predictive of outcomes, and the incidence of sequelae was studied with survival analysis. Main Outcome Measures: Change in approximate Early Treatment Diabetic Retinopathy Study (ETDRS) letter score at 6 and 12 months. Results: The CRVO patients (n = 39) gained a median of 20 letters relative to baseline at both 6 and 12 months and showed a change in central subfield thickness (CST) of –504.1 μm and –552.3 μm, respectively. Branch RVO and hemiretinal vein occlusion patients (n = 13) gained a median of +45 and +57.5 letters at 6 and 12 months, respectively, and showed reductions of 299.6 μm and 355.2 μm of CST on SD OCT. For CRVO patients, more time from symptom onset to first injection predicted less optimistic letter gains in unadjusted and adjusted models (P < 0.0001 for all measures). A delay from symptom onset to first injection of 30 days or more predicted higher incidence of both neovascular (hazard ratio, 11.036; 95% confidence interval [CI], 1.807–67.393) and total (hazard ratio, 11.425, 95% CI, 1.940–67.300) events. Conclusions: Patients with RVO demonstrating poor initial visual acuity showed visual and anatomic benefit with anti-VEGF therapy, most often observed shortly after initiation of treatment. In CRVO patients, even minor delays between symptom onset and first injection led to less optimistic vision gains and were associated with higher incidence of negative sequelae.