COMMENTARY

Keeping SCORE: Corticosteroids for Retinal Vein Occlusions

Kapil G. Kapoor, MD; Sophie J. Bakri, MD

Disclosures

November 02, 2011

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, et al; SCORE Study Research Group
Arch Ophthalmol. 2009;127:1115-1128

Abstract

A Randomized Trial Comparing the Efficacy and Safety of Intravitreal Triamcinolone With Observation to Treat Vision Loss Associated With Macular Edema Secondary to Central Retinal Vein Occlusion: The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study Report 5

Ip MS, Scott IU, VanVeldhuisen PC, et al; SCORE Study Research Group
Arch Ophthalmol. 2009;127:1101-1114

Abstract

Study Summary and Viewpoint

The Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE) study is the first multicenter randomized clinical trial to demonstrate the benefit of corticosteroids in managing macular edema associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).

The SCORE-CRVO trial has significant clinical impact because it provides the first level 1 evidence to support intervention for visual acuity gain in macular edema with CRVO. The caveat of these findings is that the treatment group had a more significant adverse event profile compared with the observation group, particularly cataract progression and elevated intraocular pressure. This did necessitate further treatment in the form of intraocular pressure-lowering drops at 12 months (35% in the 4-mg triamcinolone group and 20% in the 1-mg triamcinolone group compared with 8% in the observation group) or increased cataract surgery at 12-24 months. Despite these adverse events, the likelihood of visual acuity gain of 15 or more letters at 12 months was 5 times greater with intravitreal triamcinolone compared with observation. The trial data support the 1-mg triamcinolone dose as preferred given its superior safety profile over the 4-mg dose.

The SCORE-BRVO trial demonstrated similar efficacy with intravitreal triamcinolone and grid laser photocoagulation for visual acuity gain in managing macular edema associated with BRVO. Similarly to the SCORE-CRVO trial, the triamcinolone group had significantly more cataract progression and elevated intraocular pressure. This resulted in additional treatment in the triamcinolone group, necessitating the increased use of intraocular pressure-lowering drops at 12 months (41% of patients in the 4-mg treatment group and 7% of patients in the 1-mg treatment group compared with only 2% in the standard care group) and increased cataract and glaucoma surgery at 12-24 months. Notably, after cataract surgeries performed between 12 and 24 months, data confirmed that cataract progression was not masking any therapeutic benefit in visual acuity gain in the triamcinolone group. These are important considerations when evaluating the risks and benefits of triamcinolone in managing macular edema secondary to BRVO. Results of the SCORE-BRVO trial demonstrated the treatment benefit of triamcinolone but upheld grid laser photocoagulation as the standard of care given its similar efficacy in visual acuity gain but its superior safety profile.

In conclusion, macular edema associated with CRVO and BRVO is a significant source of visual loss, and the SCORE trial makes important contributions to our understanding of the role of corticosteroids in the management of macular edema associated with BRVO and CRVO.

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