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Kim TH, Yoon CK, Lee JE, Lee JE, Chung IY, Sagong M, Kim KH, Kim HW. One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.12.1918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Hoon Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Joo Eun Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Kun Hyung Kim
- Institute of Environmental and Occupational Medicine, Department of Occupational and Environmental Medicine, Inje University College of Medicine, Busan, Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Pielen A, Junker B, Feltgen N. Retinal Vein Occlusion. ANTI-ANGIOGENIC THERAPY IN OPHTHALMOLOGY 2016. [DOI: 10.1007/978-3-319-24097-8_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Farinha C, Marques JP, Almeida E, Baltar A, Santos AR, Melo P, Costa M, Figueira J, Cachulo ML, Pires I, Silva R. Treatment of Retinal Vein Occlusion with Ranibizumab in Clinical Practice: Longer-Term Results and Predictive Factors of Functional Outcome. Ophthalmic Res 2015; 55:10-8. [PMID: 26540281 DOI: 10.1159/000440848] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate long-term results and predictors of efficacy in patients with macular edema due to retinal vein occlusion (RVO) treated with intravitreal ranibizumab in a clinical practice setting. METHODS The clinical records of patients with a minimum follow-up of 3 years were retrospectively analyzed. Sixteen eyes with branch RVO (BRVO) and 16 with central RVO (CRVO) were included. All patients performed cross-sectional evaluation with best-corrected visual acuity (BCVA), spectral domain optical coherence tomography and fluorescein angiography. The foveal avascular zone (FAZ) was assessed and microstructural morphology of the retina was characterized. RESULTS Follow- up was 42.9 ± 9.0 and 44.8 ± 8.0 months in the CRVO and BRVO groups, respectively. Patients with CRVO received on average 6.9 injections, with a final VA gain of 8.3 ± 15.0 letters (p = 0.05). BRVO eyes had on average 5.9 injections, with a final VA gain of 1.6 ± 21.0 letters (p > 0.05). The FAZ area remained stable in both groups (p > 0.05). Baseline BCVA and disruption of the retinal pigment epithelium (RPE) were predictors of final BCVA (p = 0.001 and 0.011, respectively). CONCLUSION Although functional outcomes were inferior to those reported in clinical trials, ranibizumab was satisfactory in the long-term treatment of macular edema secondary to RVO and was not associated with increased macular ischemia. Final BCVA depends on baseline BCVA and RPE integrity.
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Affiliation(s)
- Cláudia Farinha
- Medical Retina Unit, Department of Ophthalmology, Centro Hospitalar e Universitx00E1;rio de Coimbra (CHUC), Coimbra, Portugal
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Budzinskaya MV, Mazurina NK, Egorov AE, Kuroedov AV, Loskutov IA, Plyukhova AA, Razik S, Ryabtseva AA, Simonova SV. [Retinal vein occlusion management algorithm. Part 3. Neovascular complications]. Vestn Oftalmol 2015; 131:67-75. [PMID: 26977729 DOI: 10.17116/oftalma2015131667-75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neovascular complications severity in central/branch retinal vein occlusion (RVO) correlates with the level of occlusion and the degree of retinal perfusion disturbance. Large areas of retinal non-perfusion (more than half of the total retinal area) are associated with the risk for posterior segment neovascularization as high as 33% and for neovascular glaucoma - 45%. Over the past 30 years there has been an evident declining tendency of neovascular complications rates in the natural course of RVO. In ischemic RVO, anterior segment neovascularization is more aggressive than posterior. Neovascular glaucoma usually develops within the first 6 months of disease and correlates with uncontrolled arterial hypertension. Panretinal photocoagulation (PRP) is a standard treatment for anterior and posterior segment neovascularization in RVO patients. Anti-VEGF agents, if used as monotherapy, lead to rapid, however, short-term remission. Combination therapy, that is anti-VEGF injections and PRP, is the most effective. Intravitreal steroids have demonstrated no effect on ocular neovascularization. If PRP cannot be performed and intraocular pressure levels remain high, one should consider glaucoma drainage implant surgery. Preventive measures for neovascular complications that have proved effective so far include regular follow-ups, individually scheduled intravitreal injections, and PRP for large zones of ischemia.
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Affiliation(s)
- M V Budzinskaya
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N K Mazurina
- Posterior segment eye surgery and diagnostics center LLC, 2-aya Vladimirskaya St., Moscow, Russian Federation, 111123
| | - A E Egorov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997
| | - A V Kuroedov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997; Mandryka Clinical Research and Training Medical Center, 8A Bol'shaya Olen'ya St., Moscow, Russian Federation, 107014
| | - I A Loskutov
- Scientific Clinical Center of JSC Russian Railways, 20 Chasovaya St., Russian Federation, 125315
| | - A A Plyukhova
- 'SovMedTeh' LLC, Eximer clinic, 3-1 Marksistskaya St., Moscow, Russian Federation, 109147
| | - S Razik
- Medical diagnostic center 'Olimp' LLC, 77 Udal'tsova St., Moscow, Russian Federation, 119454
| | - A A Ryabtseva
- Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, 61/2 Shchepkina St., Moscow, Russian Federation, 129110
| | - S V Simonova
- S.P. Botkin State Clinical Hospital, Branch #1, Moscow Department of Public Health, 7 Mamonovskiy pereulok, Moscow, Russian Federation, 123001
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Dugel PU, Capone A, Singer MA, Dreyer RF, Dodwell DG, Roth DB, Shi R, Walt JG, Scott LC, Hollander DA. Two or more dexamethasone intravitreal implants in treatment-naïve patients with macular edema due to retinal vein occlusion: subgroup analysis of a retrospective chart review study. BMC Ophthalmol 2015; 15:118. [PMID: 26337664 PMCID: PMC4558971 DOI: 10.1186/s12886-015-0106-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 08/19/2015] [Indexed: 12/23/2022] Open
Abstract
Background Dexamethasone intravitreal implant (DEX implant) is a biodegradable, sustained-release implant that releases dexamethasone for up to 6 months. We evaluated the efficacy and safety of DEX implant in the treatment of macular edema secondary to retinal vein occlusion (RVO) in treatment-naïve patients. Methods A multicenter, retrospective, open-label chart review study investigated the efficacy and safety of DEX implant treatment in 289 patients with macular edema secondary to branch or central RVO (BRVO, CRVO) who received ≥2 treatments with DEX implant in the study eye. Concomitant adjunctive RVO treatments were permitted. Data collected from the time of the first implant (baseline) to 3–6 months after the last implant included best-corrected visual acuity (BCVA) and central retinal thickness measured with optical coherence tomography. In this subgroup analysis, we evaluated outcomes in patients who had received no previous treatment for RVO complications. Results Thirty-nine patients were treatment-naïve at the time of their first DEX implant (18 BRVO, 21 CRVO). Before the initial DEX implant, the mean duration of macular edema in treatment-naïve patients was 4.9 months, mean central retinal thickness was 550 μm, and mean Early Treatment Diabetic Retinopathy Study BCVA was 8.5 lines (20/125 Snellen). Treatment-naïve patients received a mean of 2.9 implants, either as monotherapy (n = 12) or with adjunctive RVO treatments (n = 27). The mean interval between implants was 177 days. After the first through sixth implants, mean changes from baseline BCVA ranged from +3.0 − +8.0 lines, and mean decreases from baseline central retinal thickness ranged from 241–459 μm. BCVA improved in both BRVO and CRVO and in both phakic and pseudophakic eyes. Overall, 83.8 % of treatment-naïve patients gained ≥2 lines in BCVA, 70.3 % gained ≥3 lines in BCVA, and 56.4 % achieved central retinal thickness ≤250 μm. The most common adverse event was increased intraocular pressure. Fifteen treatment-naïve patients had intraocular pressure ≥25 mm Hg; none required laser or incisional glaucoma surgery. Conclusion Treatment with 2 or more DEX implants had a favorable safety profile and improved visual acuity and anatomic outcomes when used, either alone or with adjunctive RVO therapy, as initial treatment for RVO-associated macular edema. Trial registration ClinicalTrials.gov NCT01411696, registered on August 5, 2011.
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Affiliation(s)
- Pravin U Dugel
- Retinal Consultants of Arizona, 1101 E. Missouri Avenue, P.O. Box 32530, Phoenix, AZ, 85014-2709, USA.
| | | | | | | | | | - Daniel B Roth
- Retina-Vitreous Center, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Rui Shi
- Allergan, Inc., Irvine, CA, USA.
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Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, Ramskold L, Pasu S. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol 2015; 2015:627674. [PMID: 26417453 PMCID: PMC4568374 DOI: 10.1155/2015/627674] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/31/2023] Open
Abstract
Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.
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Affiliation(s)
- Vikas Tah
- The Royal Berkshire NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK
| | - Harry O. Orlans
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Jonathan Hyer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Edward Casswell
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | | | - Louise Ramskold
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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Abstract
PURPOSE To analyze the presence of hyperreflective foci in Type 1 and Type 2 diabetic patients, separately, without clinically significant diabetic macular edema and visual impairment. METHODS Noninvasive, observational prospective study. Seventeen and 19 consecutive Type 1 and Type 2 diabetic patients (33 and 38 eyes), respectively, were recruited. All patients had no clinically significant diabetic macular edema or visual impairment. Two age- and sex-matched control groups were also included. Patients underwent an ophthalmologic examination including spectral domain optical coherence tomography. Hyperreflective foci were counted considering horizontal B-scan passing through the fovea. RESULTS On spectral domain optical coherence tomography, patients affected by Type 1 and Type 2 diabetes had a mean of 7.5 ± 4.6 and 9.9 ± 4.5 hyperreflective foci, respectively. Subjects of control groups had a mean of 0.9 ± 0.8 and 1.7 ± 1.5 hyperreflective foci, respectively. Hyperreflective foci amount was statistically different between Type 1 and Type 2 diabetic groups (P = 0.032) and significantly higher in diabetic patients than in controls (P < 0.001). Hyperreflective foci amount was significantly higher in diabetic patients with a poor quality glycometabolic control (P < 0.001 and P = 0.016) or affected by hypertension (P = 0.008). CONCLUSION We reported the presence of hyperreflective foci in diabetic patients without diabetic macular edema and visual impairment. This spectral domain optical coherence tomography finding might be a useful marker for the diagnosis and the follow-up in the early stage of diabetic retinopathy.
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Abstract
Aims Branch retinal vein occlusion (BRVO) leads to extensive vascular remodeling and is important cause of visual impairment. Although the vascular morphological changes following experimental vein occlusion have been described in a variety of models using angiography, the underlying cellular events are ill defined. Methods and Results We here show that laser-induced experimental BRVO in mice leads to a wave of TUNEL-positive endothelial cell (EC) apoptosis in the upstream vascular network associated with a transient edema and hemorrhages. Subsequently, we observe an induction of EC proliferation within the dilated vein and capillaries, detected by EdU incorporation, and the edema resolves. However, the pericytes of the upstream capillaries are severely reduced, which was associated with continuing EC apoptosis and proliferation. The vascular remodeling was associated with increased expression of TGFβ, TSP-1, but also FGF2 expression. Exposure of the experimental animals to hypoxia, when pericyte (PC) dropout had occurred, led to a dramatic increase in endothelial cell proliferation, confirming the vascular instability induced by the experimental BRVO. Conclusion Experimental BRVO leads to acute endothelial cells apoptosis and increased permeability. Subsequently the upstream vascular network remains destabilized, characterized by pericyte dropout, un-physiologically high endothelial cells turnover and sensitivity to hypoxia. These early changes might pave the way for capillary loss and subsequent chronic ischemia and edema that characterize the late stage disease.
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Lindsell LB, Lai MM, Fine HF. Current concepts in managing retinal vein occlusion in young patients. Ophthalmic Surg Lasers Imaging Retina 2015; 46:695-701. [DOI: 10.3928/23258160-20150730-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sheu SJ, Wu TT, Horng YH. Efficacy and Safety of Dexamethasone Intravitreal Implant for Treatment of Refractory Macular Edema Secondary to Retinal Vein Occlusion in Taiwan. J Ocul Pharmacol Ther 2015; 31:461-7. [PMID: 26067779 DOI: 10.1089/jop.2014.0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the long-term efficacy and safety of slow-release dexamethasone intravitreal implant (DEX implant) in patients with refractory macular edema (ME) secondary to retinal vein occlusion (RVO) in Taiwan. METHODS We conducted a retrospective chart review of patients with a diagnosis of ME secondary to RVO who received the DEX implant at Kaohsiung Veterans General Hospital from October 2010 to February 2014. RESULTS A total of 28 patients with an average age of 60.7 ± 11.1 years were examined. Of these patients, 17 were diagnosed with branch RVO (BRVO) and 11 were diagnosed with central RVO (CRVO). The mean maximal change in vision from the baseline after the final injection was an improvement of 1.7 ± 2.8 lines (equivalent to 8.5 ETDRS letters; p<0.0001). The response to the first injection was similar across both BRVO and CRVO groups, but patients with BRVO showed a more favorable response than those with CRVO after the second injection. The response in patients who had refractory ME after at least 3 previous interventions was similar to the whole group. Three patients (10.7%) had elevated intraocular pressure (IOP) that was well controlled by IOP-lowering medications. None of these patients required laser or glaucoma surgery. Five patients (17.9%) exhibited cataract progression during the observation period. CONCLUSION The DEX implant is an effective and safe treatment for ME, secondary to RVO, including refractory ME.
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Affiliation(s)
- Shwu-Jiuan Sheu
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan .,2 School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Tsung-Tien Wu
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan .,2 School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Yu-Harn Horng
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan
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Singer MA, Capone A, Dugel PU, Dreyer RF, Dodwell DG, Roth DB, Shi R, Walt JG, Scott LC, Hollander DA. Two or more dexamethasone intravitreal implants as monotherapy or in combination therapy for macular edema in retinal vein occlusion: subgroup analysis of a retrospective chart review study. BMC Ophthalmol 2015; 15:33. [PMID: 25885285 PMCID: PMC4391088 DOI: 10.1186/s12886-015-0018-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 03/19/2015] [Indexed: 12/03/2022] Open
Abstract
Background Dexamethasone intravitreal implant (DEX implant) is a sustained-release biodegradable implant approved for treatment of macular edema associated with retinal vein occlusion (RVO). The safety and efficacy of treatment of RVO-associated macular edema with sequential DEX implants in clinical practice was evaluated in patients who received DEX implant as monotherapy compared with patients who received DEX implant in combination with other RVO treatments. Methods A multicenter, retrospective, open-label chart review study (one study eye/patient) evaluated use of DEX implant and outcomes in 289 patients with branch or central RVO who received at least 2 DEX implant treatments in the study eye. Data were collected from the time of the first implant (baseline) to 3–6 months after the last implant. Subgroup analysis evaluated outcomes in patients receiving only DEX implant during the study versus patients receiving DEX implant plus adjunctive RVO treatments. Endpoints included best-corrected visual acuity (BCVA) and central retinal thickness (CRT) change from baseline. Results DEX implant was used as monotherapy in 84 (29.1%) patients and in combination with other therapy in 205 (70.9%) patients. Mean number of DEX implant treatments received was 3.1 in the monotherapy group and 3.3 in the combination therapy group (P = 0.344). Mean time between implants was longer in the combination therapy group (177 vs. 151 days, P < 0.001). Mean change from baseline BCVA after the first through sixth DEX implants ranged from +0.6 to +3.4 lines in the monotherapy group and +1.3 to +2.8 lines in the combination therapy group. Mean decrease from baseline CRT ranged from 165 to 230 μm in the monotherapy group and 136 to 175 μm in the combination therapy group. Increased intraocular pressure was more common in the combination therapy group. Conclusions Treatment of RVO-associated macular edema with at least 2 sequential DEX implants was safe and effective both when used alone and when combined with other RVO treatments. Improvements in BCVA and CRT were generally similar in the monotherapy and combined therapy groups. Trial registration ClinicalTrials.gov NCT01411696.
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Affiliation(s)
- Michael A Singer
- Medical Center Ophthalmology Associates, 9157 Huebner Road, San Antonio, TX, 78240, USA.
| | | | | | | | | | - Daniel B Roth
- Retina-Vitreous Center, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Rui Shi
- Allergan, Inc., Irvine, CA, USA.
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Turgut B, Yildirim H. The causes of hyperreflective dots in optical coherence tomography excluding diabetic macular edema and retinal venous occlusion§. Open Ophthalmol J 2015; 9:36-40. [PMID: 25926902 PMCID: PMC4407005 DOI: 10.2174/1874364101509010036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 02/18/2015] [Accepted: 03/05/2015] [Indexed: 12/29/2022] Open
Abstract
Purpose : To investigate the causes of hyperreflective dots (HRDs) in spectral domain optical coherence tomography (OCT) excluding diabetic macular edema (DME) and RVO (retinal vein occlusion). Patients and Methods : The medical records of 56 patients with HRDs documented by OCT were reviewed retrospectively. The patients with DME and RVO were excluded from the study in order to prevent misdiagnosing hard exudates or HRDs. The causes, unilaterality or bilaterality of HRD and demographic properties of the patients with HRD were evaluated. Results : Sixty four eyes of 56 patients having HRDs were included in this study. Of the patients with HRD, 17 (30.36%) were women and 39 (69.64%) were men. The ages of patients were between 13 to 84 years (median 60.18 years). The causes of HRD were as follows: papilledema in 4 eyes (6.25%), active neovascular age related macular degeneration (AMD) in 33 eyes (51.56%), familial dominant drusen in 2 eyes (3.13%), central serous chorioretinopathy in 19 eyes (29.69%) and commotio retina in 2 eyes (3.13%), choroidal folds in one eye (1.56%), branch retinal artery occlusion in one eye (1.56%), central retinal artery occlusion in one patient (1.56%) and Best vitelliform macular dystrophy in one eye (1.56%). The most common cause of HRD was AMD. The causes of HRDs in both eyes were AMD and papilledema. Conclusion : The most common causes of HRDs excluding DME and RVO seem as active exudative AMD. The presence of HRDs in retinal diseases might affect the decisions and the results of the treatment and the prognosis of diseases.
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Affiliation(s)
- Burak Turgut
- Fırat University, School of Medicine, Department of Ophthalmology, Elazığ, Turkey
| | - Hakan Yildirim
- Fırat University, School of Medicine, Department of Ophthalmology, Elazığ, Turkey
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Chiquet C, Dupuy C, Bron AM, Aptel F, Straub M, Isaico R, Romanet JP, Creuzot-Garcher C. Intravitreal dexamethasone implant versus anti-VEGF injection for treatment-naïve patients with retinal vein occlusion and macular edema: a 12-month follow-up study. Graefes Arch Clin Exp Ophthalmol 2015; 253:2095-102. [DOI: 10.1007/s00417-015-2947-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/17/2014] [Accepted: 01/21/2015] [Indexed: 01/06/2023] Open
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65
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Budzinskaya MV, Mazurina NK, Egorov AE, Kuroedov AV, Loskutov IA, Plyukhova AA, Razik S, Ryabtseva AA, Simonova SV. [Retinal vein occlusion management algorithm. Part 1. Classification, diagnosis, and acute-stage treatment]. Vestn Oftalmol 2015; 131:51-56. [PMID: 26977727 DOI: 10.17116/oftalma2015131651-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Considering an upward global trend in cardiovascular disease rates, retinal vein occlusion (RVO) in particular, development of therapeutic guidelines is a pressing issue in ophthalmology. Risk factors for RVO include hypertension, atherosclerosis, diabetes mellitus, blood disorders, inflammatory disorders, and prescription drug use. Three stages of RVO have been identified. By location, the entity can be divided into three big groups: central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemicentral retinal vein occlusion (HCRVO), each being either ischemic or nonischemic. Functional prognosis is better in nonischemic occlusions. Patient management comprises acute-stage treatment (anticoagulants, fibrinolytic agents, and hemodilution) and struggling with ocular complications (intravitreal injections and laser coagulation). It is essential that primary assessment and follow-up of patients at any stage of RVO include optical coherence tomography and fluorescent angiography.
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Affiliation(s)
- M V Budzinskaya
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - N K Mazurina
- Posterior segment eye surgery and diagnostics center LLC, 2-aya Vladimirskaya St., Moscow, Russian Federation, 111123
| | - A E Egorov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997
| | - A V Kuroedov
- Pirogov Russian National Research Medical University, 1 Ostrovityanova St., Moscow, Russian Federation 117997; Mandryka Clinical Research and Training Medical Center, 8A Bol'shaya Olen'ya St., Moscow, Russian Federation, 107014
| | - I A Loskutov
- Scientific Clinical Center of JSC Russian Railways, 20 Chasovaya St., Russian Federation, 125315
| | - A A Plyukhova
- 'SovMedTeh' LLC, Eximer clinic, 3-1 Marksistskaya St., Moscow, Russian Federation, 109147
| | - S Razik
- Medical diagnostic center 'Olimp' LLC, 77 Udal'tsova St., Moscow, Russian Federation, 119454
| | - A A Ryabtseva
- Moscow Regional Research and Clinical Institute named after M.F. Vladimirskiy, 61/2 Shchepkina St., Moscow, Russian Federation, 129110
| | - S V Simonova
- S.P. Botkin State Clinical Hospital, Branch #1, Moscow Department of Public Health, 7 Mamonovskiy pereulok, Moscow, Russian Federation, 123001
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Keren S, Loewenstein A, Coscas G. Pathogenesis, prevention, diagnosis and management of retinal vein occlusion. World J Ophthalmol 2014; 4:92-112. [DOI: 10.5318/wjo.v4.i4.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/26/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Retinal vein occlusion (RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone (Ozurdex), bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.
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Ramezani A, Esfandiari H, Entezari M, Moradian S, Soheilian M, Dehsarvi B, Yaseri M. Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent onset central retinal vein occlusion. Acta Ophthalmol 2014; 92:e530-9. [PMID: 24373344 DOI: 10.1111/aos.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/26/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute central retinal vein occlusion (CRVO). METHODS In this randomized clinical trial, 86 eyes with recent onset (<12 weeks) CRVO were assigned to two groups: IVB group (43 eyes) that received three monthly injections of 1.25 mg of IVB, and IVT group (43 eyes) that received two injections of 2 mg IVT 2 months apart. Outcomes were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) changes. RESULTS Mean BCVA improved significantly at 6 months in both groups; from 0.87 ± 0.49 to 0.41 ± 0.35 logMAR in IVB group, and from 0.81 ± 0.45 to 0.62 ± 0.48 logMAR in IVT group (p < 0.001). However, between-group differences reach a significant level at months 4 (p = 0.003) and 6 (p < 0.001) in favour of the IVB group. In terms of CMT reduction, the difference between the groups was statistically significant (p = 0.002) at month 6. Significant differences were noted more in the ischaemic cases in favour of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits. CONCLUSIONS Both 3-times monthly IVB injections and 2-times IVT injections could be effective in cases with recent onset CRVO up to 6 months. However, considering the better outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The observed favourable responses were more pronounced in the ischaemic types; nevertheless, this should be confirmed in larger studies.
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Affiliation(s)
- Alireza Ramezani
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
- School of Medicine; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Hamed Esfandiari
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Morteza Entezari
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Siamak Moradian
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Masoud Soheilian
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Babak Dehsarvi
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Mehdi Yaseri
- Department of Ophthalmology; Ophthalmic Research Center; School of Medicine; Labbafinejad and Imam Hossein Medical Centers; Shahid Beheshti University of Medical Sciences; Tehran Iran
- Department of Biostatistics and Epidemiology; Tehran University of Medical Sciences; Tehran Iran
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68
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Abraldes MJ, Zapata MA, Gómez-Ulla F, García-Arumí J. [From scientific evidence to clinical practice: treatment regimens for macular edema secondary to retinal vein occlusion]. ACTA ACUST UNITED AC 2014; 87 Suppl 1:54-62. [PMID: 24278990 DOI: 10.1016/s0365-6691(12)70052-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab.
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Sarao V, Bertoli F, Veritti D, Lanzetta P. Pharmacotherapy for treatment of retinal vein occlusion. Expert Opin Pharmacother 2014; 15:2373-84. [DOI: 10.1517/14656566.2014.956083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Valentina Sarao
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Federica Bertoli
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Daniele Veritti
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
| | - Paolo Lanzetta
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
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Gerding H, Monés J, Tadayoni R, Boscia F, Pearce I, Priglinger S. Ranibizumab in retinal vein occlusion: treatment recommendations by an expert panel. Br J Ophthalmol 2014; 99:297-304. [PMID: 25075121 PMCID: PMC4345884 DOI: 10.1136/bjophthalmol-2014-305041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Retinal vein occlusion (RVO) is a common cause of retinal vascular disease, resulting in potentially irreversible loss of vision despite the existence of several therapeutic options. The humanised monoclonal antibody fragment ranibizumab binds to and inhibits vascular endothelial growth factor, a key driver of macular oedema in RVO. In 2010, ranibizumab was approved in the USA for the treatment of macular oedema in RVO and, in 2011, ranibizumab was approved in the European Union for the treatment of visual impairment caused by macular oedema secondary to RVO in branch and central RVO. Ranibizumab provides an additional therapeutic option for this complex disease: an option that was not fully considered during the preparation of current international guidelines. An expert panel was convened to critically evaluate the evidence for treatment with ranibizumab in patients with visual impairment caused by macular oedema secondary to RVO and to develop treatment recommendations, with the aim of assisting physicians to optimise patient treatment.
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Affiliation(s)
- Heinrich Gerding
- Augenzentrum Klinik Pallas, Olten, Switzerland Department of Ophthalmology, University of Muenster, Muenster, Germany
| | - Jordi Monés
- Institut de la Màcula i de la Retina, Centro Médico Teknon and Barcelona Macula Foundation, Barcelona, Spain
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Lariboisière, Université Paris Diderot-Sorbonne Paris Cité, AP-HP, Paris, France
| | - Francesco Boscia
- Department of Ophthalmology, University of Sassari, Sassari, Italy
| | - Ian Pearce
- St Paul's Eye Unit, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion (Shasta study). Retina 2014; 34:342-51. [PMID: 23846381 DOI: 10.1097/iae.0b013e318297f842] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the efficacy, safety, and reinjection interval of dexamethasone intravitreal implant (DEX implant) in branch retinal vein occlusion and central retinal vein occlusion patients receiving ≥ 2 DEX implant treatments. METHODS Multicenter (26-site), retrospective chart review study. Data were collected from baseline (at first DEX implant) through 3 months to 6 months after last DEX implant. RESULTS Patients (n = 289) received 2 to 9 (mean, 3.2) DEX implants as monotherapy (29.1% of patients) or with adjunctive treatments/procedures. Mean duration of macular edema before first DEX implant was 18.4 months. Mean reinjection interval was 5.6 months. Mean peak change in best-corrected visual acuity from baseline through 4 weeks to 20 weeks after final DEX implant was +1.0 line (P < 0.001). Best-corrected visual acuity and central retinal thickness improved significantly from baseline after each of the first 6 DEX implant injections (P ≤ 0.037); 59.7% of branch retinal vein occlusion and 66.7% of central retinal vein occlusion patients achieved ≥ 2-line best-corrected visual acuity improvement. Intraocular pressure increase (≥ 10 mmHg) occurred in 32.6% of patients; 29.1% used intraocular pressure-lowering medication to treat increases associated with DEX implant. Only 1.7% of patients required incisional glaucoma surgery. CONCLUSION Retinal vein occlusion patients treated with multiple DEX implant injections, either alone or combined with other therapies, had improved central retinal thickness and visual acuity with each subsequent injection. No new safety concerns developed with multiple implants.
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Gardašević Topčić I, Šuštar M, Brecelj J, Hawlina M, Jaki Mekjavić P. Morphological and electrophysiological outcome in prospective intravitreal bevacizumab treatment of macular edema secondary to central retinal vein occlusion. Doc Ophthalmol 2014; 129:27-38. [PMID: 24906869 DOI: 10.1007/s10633-014-9445-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate intravitreal bevacizumab (IVB) treatment in patients with central retinal vein occlusion (CRVO) by spectral domain optical coherence tomography (OCT) and electroretinography (ERG). METHODS Twenty-two CRVO patients were treated with IVB injections and followed for 1 year. Morphological effect of treatment was observed with fluorescent angiography and OCT. Functional effect was followed with best corrected visual acuity (BCVA) and ERG: combined rod-cone response of the standard full-field ERG (dark adapted 3.0 ERG), photopic negative response (PhNR), and pattern ERG (PERG). RESULTS Best corrected visual acuity (BCVA) improved by 18.2 letters after 6 months (p ≤ 0.001) and additional 4.7 letters by the 12th month (p ≤ 0.001). The central retinal thickness of 829.8 ± 256.7 μm decreased to 398.8 ± 230 μm (p ≤ 0.001) after 6 months and to 303.7 ± 128.9 μm during the following 6 months (p ≤ 0.001). The total macular volume (14.4 ± 4.2 mm(3)) decreased to 9.6 ± 3.2 mm(3) and 8.5 ± 2.0 mm(3) after 6 months and 1 year of treatment, respectively (p ≤ 0.001). Electrophysiological measures improved significantly after 6 months and 1 year of treatment: the a-wave implicit time of dark adapted 3.0 ERG from 25.6 ± 2.3 to 24.1 ± 2.1 and 24.1 ± 2.0 ms (p ≤ 0.01); the PhNR from -5.9 ± 6.6 to -9.4 ± 6.1 and -10.4 ± 4.6 µV (p ≤ 0.05); the PERG P50 amplitude from 0.2 ± 0.3 to 0.9 ± 0.6 and 1.1 ± 0.6 µV (p ≤ 0.001); and N95 amplitude from 0.4 ± 0.6 to 1.2 ± 0.9 and 1.6 ± 0.9 µV (p ≤ 0.001). CONCLUSIONS Intravitreal bevacizumab (IVB) treatment of macular edema due to CRVO improved standard morphological measures and the electrophysiological function of outer and inner retinal layers, which was most evident in central retina.
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Chapin J, Carlson K, Christos PJ, DeSancho MT. Risk Factors and Treatment Strategies in Patients With Retinal Vascular Occlusions. Clin Appl Thromb Hemost 2013; 21:672-7. [PMID: 24335246 DOI: 10.1177/1076029613513320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Retinal vein occlusion (RVO) and retinal artery occlusion (RAO) cause significant visual impairment. The role of thrombophilia and cardiovascular testing is uncertain, and optimal treatment strategies have not been determined. We reviewed medical records of 39 patients with RVO and RAO (23 women and 16 men). Thrombophilia and cardiovascular evaluations were performed and outcomes were reviewed. In all, 24 (61.5%) patients had at least 1 thrombophilia. Elevated factor VIII levels were found in RVO (n = 5) but not in RAO. There are no other significant differences in thrombophilias in RVO compared to those in RAO. Most patients had hypertension(41.2% RAO and 55% RVO) and hyperlipidemia (35.5% RAO and 81.8% RVO). In all, 4 women were using oral contraceptives, 2 were pregnant or postpartum. Follow-up data was available for 28 patients (13 RAO, 15 RVO). Nineteen were treated with aspirin, four with warfarin, and one with low molecular weight heparin. Eight patients reported improvement in vision at time of follow-up (5 RAO, 3 RVO). Multiple risk factors are associated with RVO and RAO, and a complete assessment should include thrombophilia and cardiovascular studies.
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Affiliation(s)
- John Chapin
- Division of Hematology-Medical Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Karen Carlson
- Division of Hematology-Medical Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA
| | - Maria Teresa DeSancho
- Division of Hematology-Medical Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Chatziralli IP, Jaulim A, Peponis VG, Mitropoulos PG, Moschos MM. Branch retinal vein occlusion: treatment modalities: an update of the literature. Semin Ophthalmol 2013; 29:85-107. [PMID: 24171809 DOI: 10.3109/08820538.2013.833271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. METHODS Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search. RESULTS Treatment modalities were analyzed. CONCLUSIONS There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).
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Retreatment with Ozurdex for macular edema secondary to retinal vein occlusion. Eur J Ophthalmol 2013; 24:1-9. [PMID: 24249150 DOI: 10.5301/ejo.5000376] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the current practice of retreatment with Ozurdex injections in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), and to recommend simple guidelines for Ozurdex reinjection in management of RVO. METHODS This was a multicenter retrospective study of patients who received more than 2 Ozurdex injections for the treatment of ME in RVO. Recorded parameters included percent of patients with a 15-letter gain, visual acuity (VA) improvement from baseline, change in central macular thickness (CMT), time to reinjection, and occurrence of any complications. RESULTS A total of 128 patients were included, 58 (45.3%) with central RVO (CRVO) and 70 (54.7%) with branch RVO (BRVO). Mean interval for Ozurdex reinjection was 5.9 months following the first injection and 8.7 months following the second. A >15-letter gain in VA was observed in 34 (48.8%) patients with CRVO and 16 (28%) patients with BRVO. Mean overall VA improvement at month 6 did not show significance (p>0.05); however, a significantly better mean VA improvement was seen in treatment-naïve eyes (p<0.03). The CMT was significantly reduced compared to baseline. The mean CMT decreased by 214.6 µm in eyes with BRVO (n = 53) and by 355.1 µm in eyes with CRVO (n = 63) (p = 0.002). Complication rates were very low. CONCLUSIONS Repeated injections of Ozurdex are effective and have a favorable safety profile. In current practice, the retreatment interval with Ozurdex injections might be too long, precluding the full therapeutic potential of this treatment modality. A strategy for managing RVO patients treated with Ozurdex on an as-needed basis is provided.
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Bandello F, Spina CL, Battaglia Parodi M. Management of macular edema from branch retinal vein occlusions. EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/17469899.2013.843454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Treatment of Macular Edema Associated with Retinal vein Occlusion Using Sustained-release Dexamethasone Implants in a Clinical Setting. Eur J Ophthalmol 2013; 23:558-63. [DOI: 10.5301/ejo.5000261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate the clinical effect, safety, and administration procedure of slow-release dexamethasone implants (Ozurdex®) for macular edema secondary to retinal vein occlusion in clinical praxis. Methods Data from 11 patients (4 eyes with central vein occlusion and 7 eyes with branch vein occlusion) were reviewed. Data were compiled and analyzed with respect to best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events. Follow-up was 10 months. Changes in BCVA ≥ logMAR 0.2, IOP ≥5 mm Hg, and CMT ≥100 μm were considered clinically relevant. Results Two months after the first dexamethasone implant, BCVA improved from logMAR 0.65 ± 0.2 to logMAR 0.34 ± 0.1. All patients demonstrated a decrease in CMT from an initial average value of 632 ± 178 μm to 229 ± 34 μm. However, in 10 out of 11 eyes, macular edema recurred by month 4 through 5 and a second dexamethasone implant was administered. Two and 4 months after the second implant, BCVA was logMAR 0.36 ± 0.2 and logMAR 0.40 ± 0.2 and the CMT was 254 ± 61 μm and 357 ± 81 μm, respectively. The IOP increased 5.1 ± 1.5 mm Hg 1 month after the first implant compared to baseline. In eyes with an IOP above 25 mm Hg (4 out of 11), pressure-lowering eyedrops were administered. Conclusions Administration of dexamethasone implants induced a clinically relevant increase in visual acuity and a decrease in central macular thickness. In 91% of patients, macular edema recurred within 5 months and a second implant was administered. Adverse events, primarily increased IOP, were manageable. The injection procedure was relatively simple and uncomplicated.
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Macular pseudohole development after sustained-release dexamethasone intravitreal implant for macular edema due to central retinal vein occlusion. Eur J Ophthalmol 2013; 24:134-7. [PMID: 23709332 DOI: 10.5301/ejo.5000317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To report a case of macular pseudohole (MPH) development after sustained-release dexamethasone intravitreal implant for chronic macular edema due to central retinal vein occlusion (CRVO). METHODS A 70-year-old man with cystoid macular edema (CME) due to CRVO underwent sustained-release dexamethasone intravitreal implant. En face optical coherence tomography (OCT) was performed before and after treatment. RESULTS One month after dexamethasone intravitreal implant, best-corrected visual acuity (BCVA) improved from 1.0 to 0.5 logMAR. At 2 months, BCVA decreased from 0.5 to 1.3 logMAR. En face OCT detected the development of MPH due to exacerbation of centripetal vitreomacular transverse tractional forces on the overlying retina. CONCLUSIONS Macular pseudohole seems to be a complication of intravitreal therapy in patients with coexisting vitreomacular traction. En face OCT gives useful information to understand the mechanism of MPH development after sustained-release dexamethasone intravitreal implant.
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Li ZQ, Zhou XX, Lin S, Li JL, Wu JG. Angiography reveals early hiding iris neovascularization after ischemic CRVO. Int J Ophthalmol 2013; 6:253-4. [PMID: 23638433 PMCID: PMC3633771 DOI: 10.3980/j.issn.2222-3959.2013.02.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 03/20/2013] [Indexed: 11/02/2022] Open
Affiliation(s)
- Zhi-Qing Li
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Xu Zhou
- Department of Electron Microscope, Tianjin Medical University Basic Medical College, Tianjin 300070, China
| | - Song Lin
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Jun-Ling Li
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Jian-Guo Wu
- Tianjin Medical University Eye Hospital, Tianjin 300384, China
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Abstract
PURPOSE OF REVIEW Retinal vein occlusion (RVO) is a sight-threatening retinal vascular disorder associated with macular edema and neovascularization. Until recently, the standard of care for branch RVO-associated macular edema was grid laser photocoagulation and observation for central RVO-associated macular edema. Neovascularization was treated with scatter laser photocoagulation. The purpose of this article is to review recent findings that have changed our treatments of RVO. RECENT FINDINGS The recent development of intravitreal pharmacotherapy has demonstrated benefit with anti-vascular endothelial growth factor (VEGF) agents and corticosteroids for the treatment of RVO-associated macular edema. The intravitreal use of FDA-approved ranibizumab (Lucentis) and a sustained release dexamethasone implant (Ozurdex), along with off-label bevacizumab (Avastin) and preservative-free triamcinolone, has significantly expanded our treatment options and replaced standard of care for treatment of RVO-associated macular edema. Whereas anti-VEGF agents can also induce rapid regression of neovascularization, scatter laser photocoagulation remains the standard of care to prevent neovascular complications. SUMMARY Intravitreal pharmacotherapy has revolutionized our treatment of retinal vascular diseases, including RVO. Although these intravitreal agents are effective, our understanding of their specific indications and long-term roles is still evolving. Furthermore, until the underlying occlusive pathophysiology of RVO can be addressed, our treatments will be limited to temporizing therapies against a chronic disease.
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Coscas G, De Benedetto U, Coscas F, Li Calzi CI, Vismara S, Roudot-Thoraval F, Bandello F, Souied E. Hyperreflective Dots: A New Spectral-Domain Optical Coherence Tomography Entity for Follow-Up and Prognosis in Exudative Age-Related Macular Degeneration. Ophthalmologica 2013; 229:32-7. [DOI: 10.1159/000342159] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 07/20/2012] [Indexed: 01/09/2023]
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Rehak M, Spies E, Scholz M, Wiedemann P. Behandlung der Patienten mit einem Venenastverschluss in Abhängigkeit von der Verschlussdauer. Ophthalmologe 2012; 110:966-74. [DOI: 10.1007/s00347-012-2723-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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La Spina C, De Benedetto U, Parodi MB, Coscas G, Bandello F. Practical management of retinal vein occlusions. Ophthalmol Ther 2012; 1:3. [PMID: 25135583 PMCID: PMC4108135 DOI: 10.1007/s40123-012-0003-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Indexed: 11/26/2022] Open
Abstract
Retinal vein occlusion (RVO) is the second most common cause of visual impairment due to retinal disease after diabetic retinopathy. Nowadays, the introduction of new, powerful diagnostic tools, such as spectral domain optical coherence tomography, and the widespread diffusion of intravitreal drugs, such as vascular endothelial grow factor inhibitors or implantable steroids, have dramatically changed the management and prognosis of RVO. The authors aim to summarize and review the main clinical, diagnostic, and therapeutic aspects of this condition. The authors conducted a review of the most relevant clinical trials and observational studies published within the last 30 years using a keyword search of MEDLINE, EMBASE, Current Contents, and Cochrane Library. Furthermore, for all treatments discussed, the level of evidence supporting its use, as per the US Preventive Task Force Ranking System, is provided.
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Affiliation(s)
- Carlo La Spina
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Umberto De Benedetto
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
| | - Gabriel Coscas
- Hôpital Intercommunal de Créteil, Service Universitaire d’ophtalmologie, Créteil, France
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Via Olgettina, 60, 20132 Milan, Italy
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Querques L, Querques G, Lattanzio R, Gigante SR, Del Turco C, Corradetti G, Cascavilla ML, Bandello F. Repeated intravitreal dexamethasone implant (Ozurdex®) for retinal vein occlusion. ACTA ACUST UNITED AC 2012; 229:21-5. [PMID: 23006995 DOI: 10.1159/000342160] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/11/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the effects of repeated intravitreal dexamethasone implant (IDI) (Ozurdex®) in eyes with macular edema (ME) due to retinal vein occlusion (RVO). METHODS We reviewed the charts of patients with RVO-related ME, who received repeated Ozurdex IDI (0.7 mg) on an 'as-needed' basis. Main outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), retreatment interval, and incidence of side effects. RESULTS A total of 33 eyes were included for analysis. Retreatment with Ozurdex was judged necessary after 4.7 ± 1.1 months from the first IDI (1st IDI) and 5.1 ± 1.5 months from the second IDI (2nd IDI). Baseline BCVA was 0.65 ± 0.43 logMAR; it significantly improved to 0.50 ± 0.42 logMAR after 1.4 ± 0.7 months from the 1st IDI (peaking efficacy) (p < 0.001) and to 0.48 ± 0.44 logMAR after 1.8 ± 0.8 months from the 2nd IDI (peaking efficacy) (p < 0.001). CMT decreased from 636 ± 217 µm (baseline) to 300 ± 114 µm, 1.4 ± 0.7 months after the 1st IDI (p < 0.001), and to 298 ± 91 µm, 1.8 ± 0.8 months after the 2nd IDI (p < 0.001). A rebound effect was recorded in 7 eyes after the 1st IDI (mean 168 ± 158 µm) and in 4 eyes after the 2nd IDI (mean 215 ± 199 µm). All eyes with a rebound effect improved again after a 2nd intravitreal Ozurdex injection. No serious adverse events were observed; 12 eyes developed a transient IOP increase, and cataracts were extracted in 2 eyes. CONCLUSION Repeated intravitreal Ozurdex on an 'as-needed' basis, with a retreatment interval <6 months, may produce long-term clinically meaningful benefits in the treatment of ME due to RVO, without other significant side effects than expected after intraocular corticosteroid treatment.
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Affiliation(s)
- Lea Querques
- Department of Ophthalmology, University Scientific Institute San Raffaele, Milan, Italy
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Martinelli I, De Stefano V. Extra-abdominal venous thromboses at unusual sites. Best Pract Res Clin Haematol 2012; 25:265-74. [PMID: 22959543 DOI: 10.1016/j.beha.2012.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venous thrombosis typically involves the lower extremities. Rarely, it can occur in cerebral, splanchnic, or renal veins, with a frightening clinical impact. Other rare manifestations are upper-extremity deep vein thrombosis, that can complicate with pulmonary embolism and post-thrombotic syndrome, and retinal vein occlusion, significantly affecting the quality of life. This review is focused on venous thromboses at unusual extra-abdominal sites. Local infections or cancer are frequent in cerebral sinus-venous thrombosis. Upper-extremity deep vein thrombosis is mostly due to catheters or effort-related factors. Common risk factors are inherited thrombophilia and oral contraceptive use. Acute treatment is based on heparin; in cerebral sinus-venous thrombosis, local or systemic fibrinolysis should be considered in case of clinical deterioration. Vitamin-K antagonists are recommended for 3-6 months; indefinite anticoagulation is suggested for recurrent thrombosis or unprovoked thrombosis and permanent risk factors. However, such recommendations mainly derive from observational studies; there are no data about long-term treatment of retinal vein occlusion.
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Affiliation(s)
- Ida Martinelli
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
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