SCORE2 Report 13: Intraretinal Hemorrhage Changes in Eyes with Central or Hemiretinal Vein Occlusion Managed with Aflibercept, Bevacizumab or Observation. Secondary Analysis of the SCORE and SCORE2 Clinical Trials.

Barbara Blodi // Publications // Aug 24 2020

PubMed ID: 32828880

Author(s): Hendrick A, VanVeldhuisen PC, Scott IU, King J, Blodi BA, Ip MS, Khurana RN, Oden NL; SCORE2 Investigator Group. SCORE2 report 13: intraretinal hemorrhage changes in eyes with central or hemiretinal vein occlusion managed with aflibercept, bevacizumab or observation. Secondary analysis of the SCORE and SCORE2 clinical trials. Am J Ophthalmol. 2020 Aug 20. pii: S0002-9394(20)30459-1. doi: 10.1016/j.ajo.2020.08.030. [Epub ahead of print] PMID 32828880

Journal: American Journal Of Ophthalmology, Aug 2020

PURPOSE To investigate the relationship between intraretinal macular hemorrhage and visual acuity outcomes in eyes with CRVO or HRVO managed with aflibercept, bevacizumab, or observation.

DESIGN Retrospective analysis of data from two randomized clinical trials.

METHODS 362 participants were randomized in the Study of COmparative Treatments for REtinal Vein Occlusion 2 and 88 participants randomized to observation in the Standard Care versus COrticosteroid in REtinal Vein Occlusion Study. Participants received monthly intravitreal aflibercept or bevacizumab through Month 6 or observation through Month 8. Main outcome was visual acuity letter score (VALS).

RESULTS Reduced area of hemorrhage by Month 6 was observed in 70.7% (116/164) of aflibercept-treated eyes, 63.8% (104/163) of bevacizumab-treated eyes, and 42.2% (27/64) of observation eyes by Month 8 (P<0.01). Relative to eyes with hemorrhage during follow-up: aflibercept-treated eyes without hemorrhage at Month 6 had a mean VALS improvement of 8.0 (99% CI: 1.9, 14.2); bevacizumab-treated eyes without hemorrhage at Month 6 had a mean VALS improvement of 3.2 (99% CI: -4.6, 11.0); observation eyes without hemorrhage at Month 8 had a mean VALS improvement of 13.5 (99% CI: 0.4, 26.5). At Month 6, presence of hemorrhage and change in central subfield thickness (CST) were significantly associated with change in VALS; however, CST was a more important predictor.

CONCLUSION Improvement in hemorrhage during follow-up was associated with visual acuity improvements and predicted visual acuity changes beyond what was explained by CST. These findings suggest intraretinal macular hemorrhage is an important indicator of disease severity in retinal vein occlusion.

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