Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab

Raafay Sophie, Pin wen Wang, Roomasa Channa, Carlos Quezada-Ruiz, Ann Clark, Peter A Campochiaro

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. Design: Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. Participants: 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. Methods: With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. Main Outcome Measures: Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. Results: In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30–1.79), male sex (OR, 2.48; 95% CI, 1.20–5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12–0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01–1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15–0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00–1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35–1.89), never smoking (OR, 2.80; 95% CI, 1.27–6.17), and young age (OR, 0.58; 95% CI, 0.41–0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03–4.39), young age (OR, 0.41; 95% CI, 0.28–0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73–0.93), hypertension (OR, 4.47; 95% CI, 1.70–11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21–0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47–0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06–7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14–2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04–2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06–4.40) predicted CST ≤250 μm. Conclusions: There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.

Original languageEnglish (US)
JournalOphthalmology
DOIs
StateAccepted/In press - Jan 1 2019

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Retinal Vein
Retinal Vein Occlusion
Odds Ratio
Confidence Intervals
Visual Acuity
Perfusion
Hematocrit
Ranibizumab
Subretinal Fluid
Smoking
Hypertension
Pressure

ASJC Scopus subject areas

  • Ophthalmology

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Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab. / Sophie, Raafay; Wang, Pin wen; Channa, Roomasa; Quezada-Ruiz, Carlos; Clark, Ann; Campochiaro, Peter A.

In: Ophthalmology, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab",
abstract = "Purpose: To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. Design: Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. Participants: 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. Methods: With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. Main Outcome Measures: Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. Results: In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95{\%} confidence interval [CI], 1.30–1.79), male sex (OR, 2.48; 95{\%} CI, 1.20–5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95{\%} CI, 0.12–0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95{\%} CI, 1.01–1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95{\%} CI, 0.15–0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95{\%} CI, 1.00–1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95{\%} CI, 1.35–1.89), never smoking (OR, 2.80; 95{\%} CI, 1.27–6.17), and young age (OR, 0.58; 95{\%} CI, 0.41–0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95{\%} CI, 1.03–4.39), young age (OR, 0.41; 95{\%} CI, 0.28–0.59), poor baseline BCVA (OR, 0.82; 95{\%} CI, 0.73–0.93), hypertension (OR, 4.47; 95{\%} CI, 1.70–11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95{\%} CI, 0.21–0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95{\%} CI, 0.47–0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95{\%} CI, 1.06–7.49), high systolic OPP throughout the study (OR, 1.61; 95{\%} CI, 1.14–2.27), large areas of central hemorrhage (OR, 1.44; 95{\%} CI, 1.04–2.00), and no subretinal fluid (OR, 2.15; 95{\%} CI, 1.06–4.40) predicted CST ≤250 μm. Conclusions: There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.",
author = "Raafay Sophie and Wang, {Pin wen} and Roomasa Channa and Carlos Quezada-Ruiz and Ann Clark and Campochiaro, {Peter A}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ophtha.2019.07.018",
language = "English (US)",
journal = "Ophthalmology",
issn = "0161-6420",
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TY - JOUR

T1 - Different Factors Associated with 2-Year Outcomes in Patients with Branch versus Central Retinal Vein Occlusion Treated with Ranibizumab

AU - Sophie, Raafay

AU - Wang, Pin wen

AU - Channa, Roomasa

AU - Quezada-Ruiz, Carlos

AU - Clark, Ann

AU - Campochiaro, Peter A

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. Design: Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. Participants: 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. Methods: With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. Main Outcome Measures: Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. Results: In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30–1.79), male sex (OR, 2.48; 95% CI, 1.20–5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12–0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01–1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15–0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00–1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35–1.89), never smoking (OR, 2.80; 95% CI, 1.27–6.17), and young age (OR, 0.58; 95% CI, 0.41–0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03–4.39), young age (OR, 0.41; 95% CI, 0.28–0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73–0.93), hypertension (OR, 4.47; 95% CI, 1.70–11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21–0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47–0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06–7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14–2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04–2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06–4.40) predicted CST ≤250 μm. Conclusions: There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.

AB - Purpose: To investigate characteristics associated with visual and anatomic outcomes in branch and central retinal vein occlusion (BRVO and CRVO) patients treated with ranibizumab. Design: Post hoc analysis of patients with BRVO and CRVO from 2 multicenter clinical trials who completed month 12 of the HORIZON extension trial. Participants: 205 patients with BRVO and 181 patients with CRVO who completed month 12 of the extension trial. Methods: With the use of logistic regression, covariates with a P value < 0.20 from univariate analysis were included in multivariate models to identify independent factors associated with a given outcome (at P < 0.05), with preset variables of disease duration and original treatment assignment. Main Outcome Measures: Best-corrected visual acuity (BCVA) ≥20/40 (≥70 letters), gain ≥15 letters, and central subfield thickness (CST) ≤250 μm at HORIZON month 12. Results: In patients with BRVO, good baseline BCVA (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.30–1.79), male sex (OR, 2.48; 95% CI, 1.20–5.13), and normal hematocrit (low vs. normal, OR, 0.26; 95% CI, 0.12–0.59) predicted BCVA ≥20/40; high central foveal thickness (OR, 1.03; 95% CI, 1.01–1.04) and normal hematocrit (low vs. normal, OR, 0.31; 95% CI, 0.15–0.66) predicted BCVA improvement ≥15 letters; and extensive baseline subretinal fluid modestly predicted CST ≤250 μm (OR, 1.08; 95% CI, 1.00–1.16). In patients with CRVO, good baseline BCVA (OR, 1.59; 95% CI, 1.35–1.89), never smoking (OR, 2.80; 95% CI, 1.27–6.17), and young age (OR, 0.58; 95% CI, 0.41–0.82) predicted BCVA ≥20/40; never smoking (OR, 2.13; 95% CI, 1.03–4.39), young age (OR, 0.41; 95% CI, 0.28–0.59), poor baseline BCVA (OR, 0.82; 95% CI, 0.73–0.93), hypertension (OR, 4.47; 95% CI, 1.70–11.75), and low diastolic ocular perfusion pressure (OPP) throughout the study (OR, 0.39; 95% CI, 0.21–0.72) predicted BCVA improvement ≥15 letters; and young age (OR, 0.65; 95% CI, 0.47–0.90), lower mean hematocrit (low vs. normal, OR, 2.81; 95% CI, 1.06–7.49), high systolic OPP throughout the study (OR, 1.61; 95% CI, 1.14–2.27), large areas of central hemorrhage (OR, 1.44; 95% CI, 1.04–2.00), and no subretinal fluid (OR, 2.15; 95% CI, 1.06–4.40) predicted CST ≤250 μm. Conclusions: There are substantial differences in good outcome factors in CRVO versus BRVO, suggesting differences in pathophysiology. Young age, never smoking, hemodilution, and hypertension/high systolic perfusion pressure are more beneficial in CRVO, suggesting that avoidance of sluggish blood flow and maintenance of perfusion may be particularly important in CRVO.

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