Guided central laser addition to aflibercept fails to improve outcomes in BRVO

Denmark: The addition of a guided central laser to aflibercept in branch retinal vein occlusion (BRVO) patients who had not previously received treatment had no effect on treatment burden or functional or anatomical outcomes, finds a study published in Acta Ophthalmologica.

Macular edema in patients with branch retinal vein blockage has been successfully treated with angiostatic medications. However, because treatment is costly and inconvenient, fresh treatment plans are necessary. In order to determine whether administering a guided central retinal laser and aflibercept together lessened the patients' treatment burden, Katrine Hartmund Frederiksen and her team carried out this study.

In this study, patients with BRVO and macular edema were enrolled at two centers and randomized 1:1 to receive three monthly injections of 2.0 mg of aflibercept with (Group A) or without (Group B) a navigated central laser. From month 4 through month 12, aflibercept was then administered as needed. Secondary endpoints were functional and anatomical outcomes, safety assessed by retinal microperimetry, and re-treatment need was assessed.

The key findings of this study were as follows:

1. With a mean age of 69.6 years, 41 eyes from 41 patients were assessed.

2. There was no difference between Groups A (n = 21) and B (n = 20) in the baseline median best-corrected visual acuity (BCVA) or central retinal thickness (CRT), which were both 502 m.

3. After three months, 71 and 80% of patients required repeat treatment; Number of injections after loading (1 versus 2), change in BCVA (+12.8 against +15.1 letters), CRT (195 versus 181 m), or retinal sensitivity (+3.3 versus +4.1 dB) did not differ between groups at month 12.

When treating macular edema caused by BRVO, navigated central laser in conjunction with aflibercept is not related to a decreased requirement for re-treatment than aflibercept monotherapy. 'In terms of functional and structural outcomes, combination therapy was comparable to anti-VEGF monotherapy, and microperimetry testing showed that it was safe in terms of retinal sensitivity,' concluded the Authors.

Reference:

Frederiksen, K.H., Vestergaard, J.P., Pedersen, F.N., Vergmann, A.S., Sørensen, T.L., Laugesen, C.S., Kawasaki, R., Peto, T. and Grauslund, J. (2022), Navigated laser and aflibercept versus aflibercept monotherapy in treatment-naïve branch retinal vein occlusion: A 12-month randomized trial. Acta Ophthalmol. https://doi.org/10.1111/aos.15182