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Vinković M, Bosnar D, Tedeschi Reiner E, De Salvo G, Matić S. COMBINED TREATMENT WITH BEVACIZUMAB AND TRIAMCINOLONE ACETONIDE FOR MACULAR EDEMA DUE TO RETINAL VEIN OCCLUSION. Acta Clin Croat 2020; 59:569-575. [PMID: 34285426 PMCID: PMC8253081 DOI: 10.20471/acc.2020.59.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to determine the efficacy of combined intravitreal bevacizumab and triamcinolone in the treatment of macular edema due to retinal vein occlusion. A prospective randomized trial was conducted in the Department of Ophthalmology, Osijek University Hospital Centre in Osijek including 51 patients divided into three groups depending on the drug received. The first group received 1.25 mg intravitreal bevacizumab, the second group received 1 mg intravitreal triamcinolone, and the third group received a combination of 1.25 mg bevacizumab and 1 mg intravitreal triamcinolone on the same day. Changes in the central macular thickness, intraocular pressure and visual acuity were monitored during the follow up period. The retinal perfusion status was evaluated by fluorescein angiography. The group that received combined treatment had better outcome in terms of reduction of macular thickness. There was no statistically significant intraocular pressure elevation among the three treatment groups or within each group of patients. A positive trend regarding visual improvement was observed in the group receiving combined treatment in spite of the lowest initial visual acuity, highest value of macular thickness and longest mean duration of symptoms. In conclusion, combined treatment with bevacizumab and triamcinolone for the treatment of retinal vein occlusion is more potent, safe, efficient and cost-effective. It can also be recommended because fewer injections are needed in patients undergoing treatment for macular edema.
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Affiliation(s)
- Maja Vinković
- 1Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 2Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Ophthalmology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Ophthalmology, Southampton University Hospital, Southampton, United Kingdom
| | - Damir Bosnar
- 1Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 2Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Ophthalmology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Ophthalmology, Southampton University Hospital, Southampton, United Kingdom
| | - Eugenia Tedeschi Reiner
- 1Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 2Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Ophthalmology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Ophthalmology, Southampton University Hospital, Southampton, United Kingdom
| | - Gabriella De Salvo
- 1Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 2Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Ophthalmology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Ophthalmology, Southampton University Hospital, Southampton, United Kingdom
| | - Suzana Matić
- 1Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 2Department of Ophthalmology, Osijek University Hospital Centre, Osijek, Croatia; 3Department of Ophthalmology, Sveti Duh University Hospital, Zagreb; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 4Department of Ophthalmology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 5Department of Ophthalmology, Southampton University Hospital, Southampton, United Kingdom
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Pielen A, Feltgen N, Hattenbach LO, Hoerauf H, Bertelmann T, Quiering C, Vögeler J, Priglinger S, Lang GE, Schmitz-Valckenberg S, Wolf A, Rehak M. Ranibizumab Pro Re nata versus Dexamethasone in the Management of Ischemic Retinal Vein Occlusion: Post-hoc Analysis from the COMRADE Trials. Curr Eye Res 2019; 45:604-614. [PMID: 31665935 DOI: 10.1080/02713683.2019.1679839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To compare ischemia-related clinical outcomes in patients treated with either ranibizumab pro re nata (PRN) or single dexamethasone implant in the Branch Retinal Vein Occlusion (COMRADE-B) or Central Retinal Vein Occlusion (COMRADE-C) trials.Methods: A post-hoc analysis of the Phase IIIb, 6-month, multicenter, double-masked, randomized, COMRADE-B and COMRADE-C trials. Change over 6 months in retinal ischemia status (central avascular [CA] zone and peripheral nonperfusion [PNP]), mean best-corrected visual acuity (BCVA), the development of shunt vessels and neovascularization, and frequency of laser therapy were assessed in retinal vein occlusion (RVO) patients treated with either ranibizumab 0.5 mg PRN or single dexamethasone 0.7 mg implant, as per European labels, in the COMRADE-B (N = 244; ranibizumab, 126, dexamethasone, 118) or COMRADE-C (N = 243; ranibizumab, 124, dexamethasone, 119) trials. BCVA progression in ischemic vs. non-ischemic patients based on the ischemia assessment at month 6 was carried out.Results: Visual acuity (VA) gains from baseline to month 6 were higher with ranibizumab than with dexamethasone in both patients with central ischemia and those with peripheral retinal nonperfusion, independent of the type of RVO (branch or central). The presence of CA and PNP had a significant impact on VA gain over 6 months in CRVO patients (p < .0001), while there was no significant impact in BRVO. Ranibizumab was associated with less new ischemia than dexamethasone. Central RVO patients treated with dexamethasone received more laser treatments over the 6 months than those treated with ranibizumab, while there was no difference in the frequency of laser therapy between the branch RVO treatment groups.Conclusions: VA gain over six months in ranibizumab-treated RVO patients is not affected by ischemia, and is associated with less development of new ischemia during the first 6 months of treatment and equal or fewer laser treatments than dexamethasone implant.
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Affiliation(s)
- Amelie Pielen
- Hannover Medical School, University Eye Hospital, Hannover, Germany.,Eye Center, University Medical Center Freiburg, Freiburg, Germany
| | - Nicolas Feltgen
- Eye Hospital, University Medical Center, Goettingen, Germany
| | | | - Hans Hoerauf
- Eye Hospital, University Medical Center, Goettingen, Germany
| | | | - Claudia Quiering
- Department of Ophthalmology, Novartis Pharma GmbH, Nuremberg, Germany
| | - Jessica Vögeler
- Department of Ophthalmology, Novartis Pharma GmbH, Nuremberg, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, University Eye Hospital, Ludwig Maximilian Universität, München, Germany
| | - Gabriele E Lang
- Department of Ophthalmology, University Eye Hospital Ulm, Ulm, Germany
| | | | - Armin Wolf
- Department of Ophthalmology, University Eye Hospital, Ludwig Maximilian Universität, München, Germany
| | - Matus Rehak
- Eye Hospital, Universitätsklinikum Leipzig, Leipzig, Germany
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Abri Aghdam K, Reznicek L, Soltan Sanjari M, Framme C, Bajor A, Klingenstein A, Kernt M, Seidensticker F. Peripheral retinal non-perfusion and treatment response in branch retinal vein occlusion. Int J Ophthalmol 2016; 9:858-62. [PMID: 27366688 DOI: 10.18240/ijo.2016.06.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the association between the size of peripheral retinal non-perfusion and the number of intravitreal ranibizumab injections in patients with treatment-naive branch retinal vein occlusion (BRVO) and macular edema. METHODS A total of 53 patients with treatment-naive BRVO and macular edema were included. Each patient underwent a full ophthalmologic examination including optical coherence tomography (OCT) imaging and ultra wide-field fluorescein angiography (UWFA). Monthly intravitreal ranibizumab injections were applied according to the recommendations of the German Ophthalmological Society. Two independent, masked graders quantified the areas of peripheral retinal non-perfusion. RESULTS Intravitreal injections improved best-corrected visual acuity (BCVA) significantly from 22.23±16.33 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters to 36.23±15.19 letters (P<0.001), and mean central subfield thickness significantly reduced from 387±115 µm to 321±115 µm (P=0.01). Mean number of intravitreal ranibizumab injections was 3.61±1.56. The size of retinal non-perfusion correlated significantly with the number of intravitreal ranibizumab injections (R=0.724, P<0.001). CONCLUSION Peripheral retinal non-perfusion in patients with BRVO associates significantly with intravitreal ranibizumab injections in patients with BRVO and macular edema.
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Affiliation(s)
- Kaveh Abri Aghdam
- Department of Ophthalmology, University Eye Hospital, Medical School of Hannover, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Lukas Reznicek
- Department of Ophthalmology, Ludwig Maximilians University, Mathildenstr. 8, Munich 80336, Germany
| | - Mostafa Soltan Sanjari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran 14456-13131, Iran
| | - Carsten Framme
- Department of Ophthalmology, University Eye Hospital, Medical School of Hannover, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Anna Bajor
- Department of Ophthalmology, University Eye Hospital, Medical School of Hannover, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Annemarie Klingenstein
- Department of Ophthalmology, Ludwig Maximilians University, Mathildenstr. 8, Munich 80336, Germany
| | - Marcus Kernt
- Department of Ophthalmology, Ludwig Maximilians University, Mathildenstr. 8, Munich 80336, Germany
| | - Florian Seidensticker
- Department of Ophthalmology, University Eye Hospital, Medical School of Hannover, Carl-Neuberg-Straße 1, Hannover 30625, Germany; Department of Ophthalmology, Ludwig Maximilians University, Mathildenstr. 8, Munich 80336, Germany
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Gokce G, Metin S, Erdem U, Sobaci G, Durukan AH, Cagatay HH, Ekinci M. Late hyperbaric oxygen treatment of cilioretinal artery occlusion with nonischemic central retinal vein occlusion secondary to high altitude. High Alt Med Biol 2014; 15:84-8. [PMID: 24673536 DOI: 10.1089/ham.2013.1086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To report a case of cilioretinal artery occlusion (CRAO) with central retinal vein occlusion (CRVO) after a journey to high altitude region and the use of late period hyperbaric oxygen (HBO) therapy successfully. CASE REPORT A previously healthy 48-year-old lowlander woman was admitted to our department for sudden blurred vision in her right eye started at 2 weeks prior to examination. The patient had a history of 1-month exposure to high altitude that finished a day before the onset of her complaints. The best corrected visual acuity (BCVA) was 10/20 in the right eye (RE) and 10/10 in the left eye. Fundus examination of the RE revealed whitening of the retina along the distribution of cilioretinal artery, sparing fovea, flame-shaped hemorrhages, and roth spots with minimally dilated and tortuous retinal veins. Visual field analysis revealed centrocecal scotoma. The patient was treated by a daily session of 2 h of HBO at 2.5 atmosphere absolute for 11 days. BCVA rised to a level of 20/20 for the RE and the scotomas were disappeared immediately after using of the HBO treatment. CONCLUSION CRVO related CRAO should be regarded as a rare complication of exposure to high altitude and HBO seems to be the treatment of choice of high altitude related co-occurence of CRVO and CRAO in the late period.
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Affiliation(s)
- Gokcen Gokce
- 1 Department of Ophthalmology, Sarikamis Military Hospital , Kars, Turkey
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Pinna A, Simula P, Zinellu A. Subcutaneous Nadroparin Calcium in the Treatment of Recent Onset Retinal Vein Occlusion: A Pilot Study. J Ocul Pharmacol Ther 2012; 28:448-54. [DOI: 10.1089/jop.2012.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Antonio Pinna
- Section of Ophthalmology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Piera Simula
- Section of Ophthalmology, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Angelo Zinellu
- Section of Clinical Biochemistry, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Retinal vein occlusion: beyond the acute event. Surv Ophthalmol 2011; 56:281-99. [PMID: 21601903 DOI: 10.1016/j.survophthal.2010.11.006] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 11/30/2010] [Accepted: 11/30/2010] [Indexed: 11/21/2022]
Abstract
Retinal vein occlusion is a major cause of vision loss. We provide an overview of the clinical features, pathogenesis, natural history, and management of both branch retinal vein occlusion and central retinal vein occlusion. Several recent multicenter randomized clinical trials have been completed which have changed the approach to this disorder. Management of retinal vein occlusions can be directed at the underlying etiology or the resulting sequelae. Options include surgical intervention, laser photocoagulation, intravitreal pharmacotherapy, and sustained drug delivery devices.
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Wang HY, Li X, Wang YS, Zhang ZF, Li MH, Su XN, Zhu JT. Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion. Int J Ophthalmol 2011; 4:89-94. [PMID: 22553618 DOI: 10.3980/j.issn.2222-3959.2011.01.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 12/28/2010] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS In group 1, the mean BCVA improved from 37.78±6.14 (baseline) to 48.06±3.86, 46.48±4.77 and 44.18±5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92±6.20 (baseline) to 50.69±4.22, 48.76±5.59 and 45.70±6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.
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Affiliation(s)
- Hai-Yan Wang
- Department of Ophthalmology, The Eye Institute of PLA, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
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Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion: 6 months of follow-up. Graefes Arch Clin Exp Ophthalmol 2009; 248:375-80. [DOI: 10.1007/s00417-009-1211-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 09/24/2009] [Indexed: 11/26/2022] Open
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Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion. Retina 2009; 29:511-5. [PMID: 19174717 DOI: 10.1097/iae.0b013e318195ca65] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To evaluate the outcome of cystoid macular edema treated with intravitreal injections of bevacizumab and macular grid laser photocoagulation (GLP), in patients with perfused branch retinal vein occlusion. METHODS Thirty eyes of 30 consecutive patients with cystoid macular edema secondary to nonischemic branch retinal vein occlusion were assigned to either GLP group or to intravitreal bevacizumab (IB) group. Complete ophthalmologic examinations were performed just before GLP and IB injection at 1, 3, 6, and 12 months after treatment. Changes in logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), central macular thickness (CMT) shown by optical coherence tomography-3 were evaluated. RESULTS Baseline BCVA (logMAR) and CMT were, respectively, 0.89 +/- 0.13 and 650 +/- 140 microm for the GLP group, 0.87 +/- 0.16 and 690 +/- 120 microm for the IB group. After the treatment, at 1, 3, 6, and 12 months in the GLP group, BCVA had improved by 0.19, 0.22, 0.21, and 0.20 logMAR, CMT had decreased by 40%, 41.3%, 40.5%, and 42%. In the IB group, BCVA had improved by 0.31, 0.32, 0.30, and 0.31 logMAR and CMT had decreased by 59.5%, 59%, 60%, and 60.3%. The group receiving bevacizumab had better BCVA and lower CMT values at all time points (P < 0.05). CONCLUSION Intravitreal bevacizumab injection improves BCVA and reduces CMT more than GLP. Intravitreal bevacizumab injection was well tolerated and could be used as primary treatment in patients with cystoid macular edema secondary to perfused branch retinal vein occlusion.
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Ramchandran RS, Fekrat S, Stinnett SS, Jaffe GJ. Fluocinolone acetonide sustained drug delivery device for chronic central retinal vein occlusion: 12-month results. Am J Ophthalmol 2008; 146:285-291. [PMID: 18533125 DOI: 10.1016/j.ajo.2008.03.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 03/28/2008] [Accepted: 03/31/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine treatment outcomes of a long-acting intravitreal fluocinolone acetonide sustained drug delivery implant in eyes with central retinal vein occlusion (CRVO) and chronic refractory macular edema. DESIGN Prospective, noncomparative, interventional case series. METHODS Fourteen eyes of 14 patients with chronically persistent macular edema associated with CRVO underwent intraocular implantation of a three-year fluocinolone acetonide sustained drug delivery system. Best-corrected Early Treatment of Diabetic Retinopathy visual acuity (VA), central foveal thickness determined by optical coherence tomography, and intraocular pressure (IOP) were recorded after the first 12 months after implant insertion. RESULTS The median (range) vein occlusion and macular edema duration were 12.5 months (range, seven to 49). No eye experienced intraoperative complications. At baseline, median VA was 20/126, improved to 20/60 by two months, and was 20/80 by 12 months. A significant proportion of eyes had gained lines of VA at 12 months compared with baseline (P = .002). At 12 months, the mean and median central retinal thickness decreased from 622 and 600 microm before surgery, respectively, to 307 and 199 microm after surgery, respectively (P = .008). By month 12, cataract had developed in all five phakic patients, and 13 of 14 eyes required medical or surgical IOP-lowering interventions. CONCLUSIONS VA improved and macular edema decreased in a significant proportion of implanted eyes with chronic, CRVO-associated macular edema. Cataract formation and elevated IOP, the main side effects, were managed, respectively, with cataract extraction and medical or surgical IOP control, or both. This system is a promising novel alternative to currently available treatments for this challenging patient population.
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Affiliation(s)
- Rajeev S Ramchandran
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
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Koizumi H, Ferrara DC, Bruè C, Spaide RF. Central retinal vein occlusion case-control study. Am J Ophthalmol 2007; 144:858-863. [PMID: 17916319 DOI: 10.1016/j.ajo.2007.07.036] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 07/27/2007] [Accepted: 07/29/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate risk factors for central retinal vein occlusion (CRVO). DESIGN Retrospective case-control study. METHODS Consecutive patients with CRVO examined from July 1, 2005 through July 31, 2006 were compared with an historical gender- and age-matched control group of patients with ocular problems other than vascular occlusive disease from the same referral practice. Risk factors for CRVO were evaluated. RESULTS The 144 patients in the CRVO group, 87 males and 57 females, had a mean age of 69.6 years (+/-13.6 years). CRVO was associated with hypertension (P < .001), diabetes mellitus (P = .047), glaucoma (P < .001), atrial fibrillation (P = .036), angiotensin-converting enzyme inhibitor use (P = .022), aspirin use (P < .001), and warfarin use (P = .011) by univariate analyses. Postmenopausal estrogen use was more common among women in the control group (P = .029). Multivariate logistic regression found the independent predictors for CRVO to be: glaucoma (adjusted odds ratio [OR], 4.75; P < .001), aspirin use (adjusted OR, 2.66; P = .001), and warfarin use (adjusted OR, 3.34; P = .005). CONCLUSIONS We found many of the same risk factors previously identified for CRVO by other studies, but we identified both aspirin and warfarin use to be independent risk factors for CRVO. Although these findings suggest the vasculopathic and prothrombotic risks in some patients may not be addressed adequately by antithrombotic therapy, they also suggest that the pathogenesis of CRVO may be more complicated than just the development of a primary thrombus within the vein.
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Affiliation(s)
- Hideki Koizumi
- Vitreous-Retina-Macula Consultants of New York, New York, NY 10022, USA
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McIntosh RL, Mohamed Q, Saw SM, Wong TY. Interventions for branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 2007; 114:835-54. [PMID: 17397923 DOI: 10.1016/j.ophtha.2007.01.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 01/08/2007] [Accepted: 01/08/2007] [Indexed: 12/21/2022] Open
Abstract
TOPIC To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema and/or neovascularization secondary to branch retinal vein occlusion (BRVO). CLINICAL RELEVANCE Branch retinal vein occlusion is the second most common retinal vascular disease. METHODS/LITERATURE REVIEWED English and non-English articles were retrieved using a keyword search of Medline (1966 onwards), Embase, the Cochrane Collaboration, the National Institute of Health Clinical Trials Database, and the Association for Research in Vision and Ophthalmology Annual Meeting Abstract Database (2003-2005). This was supplemented by hand searching references of review articles. Two investigators independently identified all randomized clinical trials (RCTs) with more than 3 months' follow-up. RESULTS From 4332 citations retrieved, 12 RCTs were identified. There were 5 RCTs on laser photocoagulation. Grid macular laser photocoagulation was effective in improving VA in 1 large multicenter RCT, the Branch Vein Occlusion Study (BVOS), but 2 smaller RCTs found no significant difference. The BVOS showed that scatter retinal laser photocoagulation was effective in preventing neovascularization and vitreous hemorrhage in patients with neovascularization, but a subsequent RCT found no significant effect. Randomized clinical trials evaluating intravitreal steroids (n = 2), hemodilution (n = 3), ticlopidine (n = 1), and troxerutin (n = 1) showed limited or no benefit. CONCLUSIONS There is limited level I evidence for any interventions for BRVO. The BVOS showed that macular grid laser photocoagulation is an effective treatment for macular edema and improves vision in eyes with VA of 20/40 to 20/200, and that scatter laser photocoagulation can effectively treat neovascularization. The effectiveness of many new treatments is unsupported by current evidence.
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Affiliation(s)
- Rachel L McIntosh
- Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC, Australia
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