Fluctuations in Macular Thickness in Patients with Retinal Vein Occlusion Treated with Anti-Vascular Endothelial Growth Factor Agents

Purpose: To evaluate macular thickness fluctuations in patients with retinal vein occlusions (RVOs) treated with anti-vascular endothelial growth factor (VEGF) agents and to assess whether patients with larger fluctuations have poorer visual outcomes. Design: Retrospective cohort study. Participants: Treatment-naive patients with RVO. Methods: Central subfield thickness (CST), cube volume (CV), and cube average thickness (CAT) were collected from OCT images obtained at baseline and 3, 6, 9, and 12 months, and standard deviations (SDs) across 12 months were calculated. Mixed-effects regression was performed to examine the relationship between macular thickness SD and 12-month visual acuity (VA). Standard multiple regression was performed to identify predictors of macular thickness SD. Main outcome measures: Standard deviations across 12 months for CST, CV, and CAT and VA at 12 months. Results: One hundred thirty-four eyes, including 71 with branch RVO (BRVO) and 63 with central RVO (CRVO), were evaluated. Mean baseline and 12-month CST were 488.6 +/- 165.0 mu m and 334.3 +/- 131.9 mu m (change, -154.3 +/- 210.2 mu m; P < 0.001), with CST SD of 114.1 +/- 77.0 mu m. Baseline and 12-month VA were 52.8 +/- 20.9 letters and 65.9 +/- 17.3 letters (change, +13.1 +/- 20.3 letters; P < 0.001). Central subfield thickness SD was a significant negative predictor of 12-month VA (-5.21 letters/100 mu m; 95% confidence interval [CI], -10.21 to -0.22 letters/100 mu m; P = 0.041) when adjusting for baseline factors and injections. Baseline CST and number of injections were not predictive (P = 0.101). Stratification by CST SD demonstrated a 10-letter difference in 12-month VA between the first and fourth quartiles. Baseline CST and RVO diagnosis were the only significant predictors of CST SD (CRVO vs. BRVO: +34.64 mu m/100 mu m [95% CI, 29.33-39.94 mu m/100 mu m; P < 0.001] and +22.13 mu m/100 mu m [95% CI, 4.81-39.44 mu m/100 mu m; P = 0.013]). Associations using CV and CAT were similar. Conclusions: Larger macular thickness fluctuations are associated with poorer visual outcomes in patients with RVO treated with anti-VEGF agents. Macular thickness fluctuations, in addition to absolute macular thickness, may be an important prognostic biomarker in these patients. (C) 2020 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology