Outcomes after a Physician-directed Pause of Anti-Vascular Endothelial Growth Factor Therapy in Eyes with Branch Retinal Vein Occlusion

Abstract

Purpose: To determine the outcomes of physician-directed pausing of anti–vascular endothelial growth factor (anti-VEGF) injections in eyes with branch retinal vein occlusion (BRVO). Methods: This retrospective review investigated eyes of patients with BRVO-associated macular edema that received ≥3 anti-VEGF injections within the first 6 months of diagnosis, followed by a ≥6-month physician-directed treatment pause, with ≥1 year of follow-up, between January 1, 2015, and December 1, 2022. The rate and timing of treatment reinitiation, as well as associated changes in visual acuity (VA) and optical coherence tomography (OCT) characteristics, were evaluated. Results: Of 402 eyes that received a mean of 9 injections over a mean of 14.3 months before treatment suspension, 253 (62.9%) did not need further treatment for a mean of 35.5 months. Mean VA at time of pause (0.35 logMAR [Snellen 20/45]) stayed stable at 1 year (0.38 logMAR [Snellen 20/48]; P = .113) but worsened slightly by the final visit (0.4 logMAR [Snellen 20/50]; P = .011). Mean central foveal thickness at time of pause (215 µm) remained stable at 1 year (209 µm; P = .961) and at final visit (217 µm; P = .466). For the remaining 37.1% of eyes, treatment was resumed after a mean of 17.7 months. Longer last-injection intervals (P = .010), residual fluid at time of pause (P < .001), and shorter time from edema diagnosis to first injection (P = .049) were associated with resumption. Conclusion: In most patients with BRVO who had a physician-directed pause of anti-VEGF therapy due to disease inactivity, the VA and OCT metrics remained stable for almost 3 years. However, more than one-third of eyes required additional injections, highlighting the importance of continued follow-up after treatment cessation.