Recurrence of Macular Edema in Branch Retinal Vein Occlusion: A Comparison of Aflibercept and Ranibizumab in a Randomized Trial.

OBJECTIVE

To prospectively investigate the time to recurrence of macular edema (ME) in patients with branch retinal vein occlusion (BRVO) treated with intravitreal aflibercept or intravitreal ranibizumab injections, and the correlation between subfoveal choroidal thickness (SFCT) at disease onset and the time to edema recurrence.

DESIGN

Randomized, double-masked, controlled clinical trial.

PARTICIPANTS

One hundred ten patients with treatment-naïve BRVO and ME presenting between 2018 and 2021 at St. Erik Eye Hospital, Stockholm, Sweden.

METHODS

Eligible patients were randomized to receive intravitreal injections with aflibercept 2 mg (Eylea) (n = 55) or ranibizumab 0.5 mg (Lucentis) (n = 55). Macular edema and SFCT were assessed with OCT. The mean difference in SFCT (diffSFCT) between the study eyes and healthy fellow eyes was calculated. A minimum of 3 injections were administered monthly until complete resolution of the edema. Thereafter the patients were monitored for edema recurrence. Total follow-up time was 9 months.

MAIN OUTCOME MEASURES: Time to recurrence of ME after the initial edema resolution, number of injections required for the edema to resolve, and the correlation between SFCT at baseline and time to edema recurrence.

RESULTS

Mean time to recurrence of ME was significantly longer in the aflibercept group, with a mean time of 10.7 ± 2.9 weeks compared with 8.9 ± 1.5 weeks in the ranibizumab group (P < 0.001). There was no difference between the groups regarding the number of monthly injections required to obtain edema resolution, with a mean number of 2.1 injections in each group. Overall, a greater SFCT and diffSFCT at baseline was associated with a shorter time to edema recurrence. When analyzing the diffSFCT by quartiles, the mean time to recurrence was 9.2 ± 1.6 weeks in the top quartile (diffSFCT ≥99 μm) compared with 11.2 ± 3.0 weeks in the bottom quartile (diffSFCT ≤10 μm) (P = 0.017).

CONCLUSIONS

Time to recurrence of ME in BRVO was significantly longer in patients treated with aflibercept compared with those receiving ranibizumab. A greater SFCT and diffSFCT at baseline was associated with a shorter time to edema recurrence, suggesting that these parameters could serve as predictive OCT biomarkers in BRVO.

FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.