SCORE (not!): Air-ball for IVTA in BRVO

7 11 2009

The one-year results of the SCORE study were published in September.  The studies (two really, one comparing standard of care vs. intravitreal triamcinolone (IVTA) injections in central retinal vein occlusion (CRVO), and the other in branch retinal vein occlusion (BRVO).  Here I’ll discuss the results in the BRVO study.  Standard of care for BRVO with macular edema is laser.  The study compared visual results for patients with BRVO who received either laser, IVTA 1 mg or IVTA 4 mg.  The results showed no significant difference if visual outcome among the three groups.  Vision improved by 3 lines or more in 29%, 26% and 27% respectively.  Because IVTA carries the risk of increased IOP and cataract, the study recommends that laser treatment remain standard of care for treating macular edema in BRVO.  It’s interesting that in the SCORE CRVO study, IVTA proved to be more effective than standard care (observation), whereas in the BRVO study, standard care (laser) proved to be more effective than IVTA.  Here’s the abstract.

Arch Ophthalmol. 2009 Sep;127(9):1115-28.
A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6.
Scott IU, Ip MS, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Chan CK, Gonzalez VH, Singerman LJ, Tolentino M; SCORE Study Research Group.

OBJECTIVE: To compare the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone with standard care (grid photocoagulation in eyes without dense macular hemorrhage and deferral of photocoagulation until hemorrhage clears in eyes with dense macular hemorrhage) for eyes with vision loss associated with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Multicenter, randomized clinical trial of 411 participants. Main Outcome Measure Gain in visual acuity letter score of 15 or more from baseline to month 12.

RESULTS: Twenty-nine percent, 26%, and 27% of participants achieved the primary outcome in the standard care, 1-mg, and 4-mg groups, respectively. None of the pairwise comparisons between the 3 groups was statistically significant at month 12. The rates of elevated intraocular pressure and cataract were similar for the standard care and 1-mg groups, but higher in the 4-mg group.

CONCLUSIONS: There was no difference identified in visual acuity at 12 months for the standard care group compared with the triamcinolone groups; however, rates of adverse events (particularly elevated intraocular pressure and cataract) were highest in the 4-mg group. Application to Clinical Practice Grid photocoagulation as applied in the SCORE Study remains the standard care for patients with vision loss associated with macular edema secondary to BRVO who have characteristics similar to participants in the SCORE-BRVO trial. Grid photocoagulation should remain the benchmark against which other treatments are compared in clinical trials for eyes with vision loss associated with macular edema secondary to BRVO.

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