Change in Area of Intraretinal Macular Hemorrhages in Aflibercept- and Bevacizumab-treated Central Retinal and Hemiretinal Vein Occlusions: A SCORE2 Subanalysis
Year of Publication
Khurana, Rahul; Hendrick, Andrew; Van Veldhuisen, Paul; Scott, Ingrid U; Blodi, Barbara A; Ip, Michael S; Oden, Neal L
43rd Annual Macula Society
San Diego, CA
Bevacizumab-treated Central Retinal; Hemiretinal Vein Occlusions; Intraretinal Macular Hemorrhages in Aflibercept; SCORE2
Objective: To investigate the effect of aflibercept and bevacizumab on intraretinal macular hemorrhages in retinal vein occlusion. Purpose: To compare the change in intraretinal macular hemorrhages between aflibercept and bevacizumab from baseline to Month 6, examine the relationship between the presence of intraretinal macular hemorrhage and visual acuity letter score (VALS) outcomes and to assess if rapidity of retinal hemorrhage improvement influences 12- and 24-month visual acuity. Methods: This is a secondary analysis of the SCORE2 trial (involving the 180 patients treated with aflibercept and the 182 patients treated with bevacizumab) and the SCORE trial (involving the 88 patients randomized to observation). At Months 0, 6, 12 and 24, data were collected on best-corrected electronic Early Treatment Diabetic Retinopathy Study VALS. Color fundus photographs were also collected at these time points for assessment of intraretinal macular hemorrhage. Results: In the SCORE2 aflibercept group, 70.7% of study eyes had an improvement in area of intraretinal macular hemorrhage from baseline to Month 6 compared with 63.8% of the SCORE2 bevacizumab participants and 42.2% of the SCORE observation group. The mean Month 6 VALS improvement in those without a intraretinal macular hemorrhage at Month 6 was 8.0 higher (99% CI: 1.9, 14.2) than those with a retinal hemorrhage in the SCORE2 aflibercept group. In the SCORE2 bevacizumab group, mean Month 6 VALS improvement in those without a intraretinal macular hemorrhage at Month 6 was 3.2 higher (99% CI: -4.6, 11.0) than those with an intraretinal macular hemorrhage. Those with no intraretinal macular hemorrhage at Month 6 continued to have good visual acuity at Month 12, with VALS improvement of 24.6 in both the aflibercept and bevacizumab groups. This finding was markedly better than eyes with no Month 6 improvement of intraretinal macular hemorrhages over baseline, with Month 12 mean improvement over baseline in VALS of 12.6 and 16.5 in the aflibercept and bevacizumab groups, respectively. Conclusions: This analysis demonstrates that in individuals treated with intravitreal anti-VEGF injections for CRVO- or HRVO-associated macular edema, the clearing of the intraretinal macular hemorrhage after treatment had a positive impact on VALS. Eyes with resolution of hemorrhage at 6 months are associated with a more favorable visual acuity at 12 months compared to eyes with persistent macular hemorrhage at 6 months.