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Invited Commentary
January 6, 2022

Central Retinal Vein Occlusion—What Is the Potential Importance of Persistent and Recurrent Macular Edema?

Author Affiliations
  • 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  • 2John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
JAMA Ophthalmol. 2022;140(2):151-152. doi:10.1001/jamaophthalmol.2021.5620

Macular edema is a common sequela of central retinal vein occlusion (CRVO) that can be associated with vision loss if untreated. Anti–vascular endothelial growth factor (VEGF) therapies are efficacious in this setting; however, the clinical relevance of persistent or recurrent macular edema in CRVO has been unclear. This question may have important implications for treatment decision-making and injection burden in patients with CRVO.

To explore this question, Gurudas et al1 conducted a post hoc analysis of the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) randomized clinical trial to elucidate the association between patterns of macular edema and visual outcomes in patients with CRVO undergoing anti-VEGF therapy. More than 450 eyes were randomized to aflibercept, bevacizumab, or ranibizumab therapy, which was administered at baseline and weeks 4, 8, and 12, followed by pro re nata (PRN) treatment according to prespecified criteria. Their findings are presented in this issue of JAMA Ophthalmology, in which persistent macular edema (adjusted difference: −10.98 Early Treatment Diabetic Retinopathy Study letters; 95% CI, −16.19 to −5.76) or recurrent macular edema (adjusted difference: −5.39 letters; 95% CI, −10.15 to −0.64) at 100 weeks were associated with worse visual acuity to a clinically relevant degree relative to patients without macular edema (termed a dry macula). Their analysis supports the hypothesis that patients with persistent or recurrent macular edema in CRVO are associated with worse visual outcomes relative to patients with persistently dry maculas.

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