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Hayreh SS. Photocoagulation for retinal vein occlusion. Prog Retin Eye Res 2021; 85:100964. [PMID: 33713810 DOI: 10.1016/j.preteyeres.2021.100964] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself. Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed. In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed. The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed. Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.
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Affiliation(s)
- Sohan Singh Hayreh
- Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA, USA.
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Intravitreal Bevacizumab Associated with Grid Laser Photocoagulation in Macular Edema Secondary to Branch Retinal Vein Occlusion. Eur J Ophthalmol 2018; 21:434-9. [DOI: 10.5301/ejo.2010.6101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2010] [Indexed: 01/17/2023]
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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Pielen A, Mirshahi A, Feltgen N, Lorenz K, Korb C, Junker B, Schaefer C, Zwiener I, Hattenbach LO. Ranibizumab for Branch Retinal Vein Occlusion Associated Macular Edema Study (RABAMES): six-month results of a prospective randomized clinical trial. Acta Ophthalmol 2015; 93:e29-37. [PMID: 25042729 DOI: 10.1111/aos.12488] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 05/25/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE To compare standard-of-care grid laser photocoagulation versus intravitreal ranibizumab (IVR) versus a combination of both in the treatment of chronic (>3 months) macular oedema secondary to branch retinal vein occlusion. METHODS Prospective, randomized, multicentre clinical trial. Thirty patients with a best-corrected visual acuity (BCVA) between 20/320 and 20/40 were randomized 1:1:1 to receive grid laser or three monthly injections of 0.5 mg IVR or both followed by 3 months of observation. RESULTS Mean change from baseline BCVA at month 6 was +2 letters [laser; 0.04 logMAR, 95% confidence interval (-0.17; 0.25)], +17 letters [IVR; 0.34 (0.19; 0.5)] and +6 letters [combination; 0.12 (0.01; 0.24)] (IVR versus laser p = 0.02 and IVR versus combination p = 0.02). At month 3, mean improvement in central retinal thickness (CRT) was 90.6 μm (laser) (-18.65; 199.8), 379.5 μm (IVR) (204.2; -554.8), and 248 μm (167.2; -328.8) (combination) (IVR versus laser p = 0.005, laser versus combination p = 0.02). During the observation period, CRT improved in laser [37.6 μm (-66.82; 142.0)], but deteriorated in IVR [-142.4 μm (-247.6; -37.16)] and combination [-171.7 μm (-250.4; -92.96)] (laser versus IVR p = 0.01, laser versus combination p = 0.002) indicating recurrent oedema. Less laser retreatments (at 8 weeks) were required in combination group (2/10) than grid group (7/10). CONCLUSION Six-month results suggest that ranibizumab may be superior to grid laser in improving visual acuity. Grid combined with IVR neither enhanced functional and morphological improvement of IVR nor did it prevent or prolong recurrence of oedema. In IVR groups, CRT increased slowly after stopping injections, whereas improvement in visual acuity was sustained, indicating that morphological changes occur prior to functional impairment.
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Affiliation(s)
- Amelie Pielen
- Eye Center; Albert-Ludwigs-University of Freiburg; Freiburg Germany
- Eye Hospital; Hannover Medical School; Hannover Germany
| | - Alireza Mirshahi
- Department of Ophthalmology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Nicolas Feltgen
- Department of Ophthalmology; Georg August University; Goettingen Germany
| | - Katrin Lorenz
- Department of Ophthalmology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Christina Korb
- Department of Ophthalmology; University Medical Center; Johannes Gutenberg-University; Mainz Germany
| | - Bernd Junker
- Eye Center; Albert-Ludwigs-University of Freiburg; Freiburg Germany
- Eye Hospital; Hannover Medical School; Hannover Germany
| | - Caroline Schaefer
- Department of Ophthalmology; Georg August University; Goettingen Germany
| | - Isabella Zwiener
- Institute for Medical Biostatistics, Epidemiology and Informatics; J. Gutenberg University Medical Center; Mainz Germany
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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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Comparison between Intravitreal Triamcinolone with Grid Laser Photocoagulation versus Bevacizumab with Grid Laser Photocoagulation Combinations for Branch Retinal Vein Occlusion. ISRN OPHTHALMOLOGY 2013; 2013:141279. [PMID: 24555129 PMCID: PMC3910673 DOI: 10.1155/2013/141279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/10/2013] [Indexed: 11/20/2022]
Abstract
Purpose. To compare the efficacy of intravitreal triamcinolone (IVT) and intravitreal bevacizumab (IVB), both combined with grid laser photocoagulation (GLP) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. Retrospective, comparative study. The newly diagnosed patients with ME secondary to BRVO who were treated with IVT and GLP or IVB and GLP were included. The main outcome measures were changed in the best corrected visual acuity (BCVA) and central retinal thickness (CRT) from the baseline to month 24. Results. Ninety-nine eyes of 99 patients were included. The change in BCVA was not statistically different in any time points between the two groups (P > 0.05, for all). The change in CRT was not statistically different in any time points between the two groups (P > 0.05, for all). The mean number of injections at month 24 was 2.38 ± 1.06 in the IVT+GLP group and 4.17 ± 1.30 in the IVB+GLP group (P = 0.0001). The need for cataract surgery (P = 0.01) and secondary glaucoma (P = 0.03) occurrence were more common in IVT group. Conclusion. Both treatment modalities were effective in the treatment of ME secondary to BRVO. The number of injections was significantly lower in the IVT group than in the IVB group; however cataract and secondary glaucoma were more frequent in the IVT+GLP group than in the IVB+GLP group.
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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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Schneider EW, Mruthyunjaya P, Hariprasad SM. Combination therapy for macular edema secondary to retinal vein occlusion. Ophthalmic Surg Lasers Imaging Retina 2013; 44:434-8. [DOI: 10.3928/23258160-20130909-02] [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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Jonas JB, Lam DSC. Retinal Vein Occlusions. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:355-63. [PMID: 26107729 DOI: 10.1097/apo.0b013e31827674a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Retinal vein occlusions (RVOs) are second to diabetic retinopathy in the prevalence as retinal vascular disorder and are characterized by dilatation of the retinal veins with retinal and subretinal hemorrhages, macular edema, hard retinal exudates, retinal ischemia, and consequent atrophy of the retina and optic nerve. They are differentiated into central RVOs and branch RVOs (BRVO), into ischemic versus nonischemic RVOs, and in the case of BRVOs, into intrapapillary BRVOs and extrapapillary BRVOs. Diagnosis is based on ophthalmoscopy, fluorescein angiography, and spectral-domain optical coherence tomography. The latter can display the presence and integrity of the retinal outer limiting membrane and of the inner and outer segments of the photoreceptors as useful information for prognosis and a guide for treatment. Risk factors for RVOs are glaucoma and arterial hypertension. Ischemic RVOs can develop iris neovascularization and secondary angle-closure glaucoma. Formerly, therapy consisted of laser photocoagulation in a "grid" pattern over the leaking area, leading to a reduction of macular edema and, as adverse effect, to focal retinal destruction. Intravitreal medical therapy including steroids and vascular endothelial growth factor inhibitors shows a marked antiedematous effect leading to an at least temporary reduction in foveal edema and correspondingly improves visual function. Intravitreal medical therapy is associated with the disadvantage of a limited duration of its effect and the advantage of not damaging the retina. A preventive therapy to avoid a recurrence of RVO or the development of an RVO in the contralateral eye has not been proven yet.
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Affiliation(s)
- Jost B Jonas
- From the *Department of Ophthalmology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; and †State Key Laboratory (Ophthalmology) and Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Combined intravitreal bevacizumab and grid laser photocoagulation for macular edema secondary to branch retinal vein occlusion. Eur J Ophthalmol 2012; 22:607-14. [PMID: 22101497 DOI: 10.5301/ejo.5000085] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate long-term efficacy of intravitreal bevacizumab (IVB) versus combined IVB and macular grid laser photocoagulation for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). METHODS In this prospective study, 18 eyes were randomized into 2 groups according to treatment: Group 1 (9 eyes) underwent IVB at baseline, at month 1, and at month 2; Group 2 (9 eyes) underwent same IVB protocol combined with macular grid laser photocoagulation. Macular edema and visual acuity represented the endpoints of the study. IVB reinjections were performed in both groups if recurrent macular edema was diagnosed. Spectral domain optical coherence tomography examination as well as visual acuity examination were performed during follow-up. Statistical evaluation was performed for a matched-pair analysis. RESULTS In Group 1, median baseline central retinal thickness (CRT) decreased from 420 µm (95% confidence interval 355.6-484.4) to 323 µm (261.44-384.56) at month 12 (p=0.06); median baseline BCVA improved from 0.7 logMAR (0.54-0.86) to 0.4 logMAR (0.29-0.51) at month 12 (p<0.01). In Group 2, baseline CRT decreased from 386 µm (353.91-418.09) to 238 µm (200.58-275.42) at month 12 (p<0.01); median BCVA improved from 0.6 logMAR (0.45-0.75) to 0.2 logMAR (0.12-0.28) at month 12 (p<0.01). A statistically significant difference (p=0.03) was found regarding the median number of injections (Group 1: 4±1.1; Group 2: 3±0.4). CONCLUSIONS Both treatment modalities appeared effective to control BRVO-induced macular edema. In the combined-treatment Group, we observed a lower number of reinjections during follow-up, suggesting the efficacy of grid laser photocoagulation to reduce the number of intravitreal injections and maintain short- and long-term results of the therapy.
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Pitcher JD, Liu T, Prasad PS, Schwartz SD, Hubschman JP. Short-duration focal pattern grid photocoagulation for macular edema secondary to branch retinal vein occlusion. Semin Ophthalmol 2012; 27:69-72. [PMID: 22784269 DOI: 10.3109/08820538.2011.643272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the safety, functional, and anatomical outcomes of short-duration pattern scanning laser (PASCAL) macular photocoagulation in the treatment of macular edema related to branch retinal vein occlusion (BRVO). METHODS Consecutive retrospective analysis of visual acuity (VA), optical coherence tomography (OCT), and adverse events from eyes treated with PASCAL macular photocoagulation for BRVO-related macular edema. Two-tailed paired t-tests were used to compare pre- and post-treatment VA and central retinal thickness (CRT). RESULTS A total of 35 eyes from 35 patients and 18 eyes from 18 patients met study criteria for VA and OCT analysis, respectively. All treatments were delivered with the same PASCAL photocoagulation unit. Mean laser settings were 133-µm spot size, 15-millisecond pulse duration, 250-mW power, and fluence of 29 J/cm(2) with an average of 1.4 treatments and 335 shots per patient. Adjunct treatment with intravitreal anti-VEGF injections and pan-retinal photocoagulation was administered in 27 and 16 eyes, respectively. At an average follow-up of 12 months (range 3-43 months) post-treatment, no laser-related ocular complications were observed. Visual acuity was not significantly changed (p = 0.07), although the number of patients with vision better than 20/40 doubled following treatment. CRT was reduced by an average of 110 µm (p = 0.0009). CONCLUSION Short-duration PASCAL macular photocoagulation appears to be a safe treatment option that results in significant anatomical improvement in macular edema related to BRVO.
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Affiliation(s)
- John D Pitcher
- Jules Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles, CA 90095-7000, USA
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Arima M, Miyazaki M, Arakawa S, Mochizuki Y, Ishibashi T. Post-treatment change in the localization of recurrent or persistent macular edema secondary to branch retinal vein occlusion. Ophthalmologica 2012; 228:1-6. [PMID: 22653313 DOI: 10.1159/000334620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 10/11/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the change in localization of recurrent or persistent macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after a therapeutic intervention. METHODS Twenty-six eyes of 23 patients with recurrent or persistent ME secondary to BRVO were included in this retrospective case series. We analyzed the distance between the fovea and the top of the ME (fovea-ME top distance) and the ME area using optical coherence tomography before treatment and when ME recurred or persisted. RESULTS The fovea-ME top distance decreased from 1.8 ± 1.6 to 1.2 ± 1.3 mm (p = 0.008). The ME area also decreased from 11.9 ± 4.9 to 7.6 ± 5.0 mm(2) (p = 0.0003). The retinal vascular leakage area correlated with the ME area in all eyes. CONCLUSION The site of recurrent or persistent ME tends to shift toward the fovea. These results suggest that residual perifoveal vascular leakage might be the predominant cause of recurrent or persistent ME.
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Affiliation(s)
- Mitsuru Arima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lee SM, Byon IS, Lee JE, Oum BS. Combined Therapy of Bevacizumab and Grid Photocoagulation for Macular Edema in Branch Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.10.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seung Min Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Boo Sub Oum
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Oliver A, Kertes PJ. The intravitreal use of corticosteroids. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.3] [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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