Corticosteroids reduce macular edema in patients with retinal vein occlusion? SCORE! The Standard Care vs Corticosteroid for Central Retinal Vein Occlusion (SCORE-CRVO) sought to determine the optimal treatment for vision loss associated with macular edema secondary to perfused central retinal vein occlusion (CRVO). 271 patients from 66 clinical sites were randomized to three groups: observation (n=88), 1mg intravitreal triamcinolone (n=92), 4mg intravitreal triamcinolone (n=91). Participants were retreated at 4-month intervals for 36 months.
Overall, the SCORE-CRVO is a landmark study because it led to a major shift in the treatment of vision loss associated with macular edema secondary to CRVO. Prior to this study, there was no proven, effective treatment for this condition and the standard of care was observation. The results demonstrate both 1-mg and 4-mg intravitreal triamcinolone had better visual acuity outcomes over 12 months compared to the untreated natural course of disease. Given the safety profile of the low dose, particularly with respect to glaucoma and cataract, 1-mg intravitreal triamcinolone became the preferred treatment of macular edema in patients with CRVO. Shortly after this study, however, another set of Landmark studies (BRAVO & CRUISE) enlightened us to even more effective treatment options.
- The likelihood of a 15 letter gain in visual acuity at 1 year was five times greater with 1mg intravitreal triamcinolone (95% CI, 1.8-14.1; P=.001) and 4mg intravitreal triamcinolone (95% CI, 1.8-14.4; P=.001) compared to the observation group.
- Unlike visual acuity, no significant difference was found in retinal thickness between groups at 12 months.
- There was a dose-dependent relationship to the need of initiating IOP-lowering medications with triamcinolone (41% in the 4-mg group and 7% in the 1-mg group) compared with the standard-care group (2%).