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Hunt AR, Nguyen V, Creuzot-Garcher CP, Alforja S, Gabrielle PH, Zarranz-Ventura J, Guillemin M, Fraser-Bell S, Casaroli Marano RP, Arnold J, McAllister IL, O'Toole L, Gillies MC, Barthelmes D, Mehta H. Twelve-month outcomes of ranibizumab versus aflibercept for macular oedema in branch retinal vein occlusion: data from the FRB! registry. Br J Ophthalmol 2021; 106:1178-1184. [PMID: 33712484 DOI: 10.1136/bjophthalmol-2020-318491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/12/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND/AIMS To compare the efficacy of ranibizumab (0.5 mg) with aflibercept (2 mg) in the treatment of cystoid macular oedema due to branch retinal vein occlusion (BRVO) over 12 months. METHODS A multicentre, international, database observational study recruited 322 eyes initiating therapy in real-world practice over 5 years. The main outcome measure was mean change in EDTRS letter scores of visual acuity (VA). Secondary outcomes included anatomic outcomes, percentage of eyes with VA >6/12 (70 letters), number of injections and visits, time to first inactivity, switching or non-completion. RESULTS Generalised mixed effect models demonstrated that mean (95% CI) adjusted 12-month VA changes for ranibizumab and aflibercept were similar (+10.8 (8.2 to 13.4) vs +10.9 (8.3 to 13.5) letters, respectively, p=0.59). The mean adjusted change in central subfield thickness (CST) was greater for aflibercept than ranibizumab (-170 (-153 to -187) µm vs -147 (-130 to -164) µm, respectively, p=0.001). The overall median (Q1, Q3) of 7 (4, 8) injections and 9 (7, 11) visits was similar between treatment groups. First grading of inactivity occurred sooner with aflibercept (p=0.01). Switching was more common from ranibizumab (37 eyes, 23%) than from aflibercept (17 eyes, 11%; p=0.002). CONCLUSION Visual outcomes at 12 months in this direct comparison of ranibizumab and aflibercept for BRVO in real-world practice were generally good and similar for the 2 drugs, despite a greater effect of aflibercept on CST and time to first grading of inactivity.
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Affiliation(s)
- Adrian R Hunt
- Medical Retina, Westmead Hospital, Westmead, New South Wales, Australia .,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Socorro Alforja
- Institut Clínic de Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pierre-Henry Gabrielle
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, Bourgogne, France
| | | | - Martin Guillemin
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
| | - Samantha Fraser-Bell
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jennifer Arnold
- Marsden Eys Specialists, Parramatta, Greater Western Sydney, Australia
| | - Ian L McAllister
- Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | | | - Mark C Gillies
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Barthelmes
- UniversitatsSpital Zurich Augenklinik und Poliklinik, Zurich, ZH, Switzerland
| | - Hemal Mehta
- Medical Retina, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Medical Retina, Moorfields Eye Hospital, London, UK
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Treatment outcomes of retinal vein occlusion in clinical practice in Nepal. BMC Ophthalmol 2021; 21:92. [PMID: 33602158 PMCID: PMC7890616 DOI: 10.1186/s12886-021-01857-y] [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: 07/24/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the treatment outcomes of retinal vein occlusion (RVO) in a routine clinical practice in Nepal. METHODS This was a retrospective analysis of observational data of patients with RVO who attended the retina clinic of the Tilganga Institute of Ophthalmology from 1 November 2017 to 31 October 2018. The main outcome was the mean change in visual acuity (VA) at 12 months from the start of treatment. Other outcomes of interest were the mean change in central subfield thickness (CST) and the number of treatments over 12 months. RESULTS A total of 99 eyes (of 99 patients) with RVO (60 - branch RVO [BRVO] and 39 - central RVO [CRVO] were available for the analysis. Eyes with CRVO had worse VA and CST at baseline. Eyes in both groups were similar for age, associated factors for RVO, duration of vision loss and the presence of ischemia at baseline. The mean (95% Confidence Interval [CI]) VA change at 12 months for BRVO was - 0.35 (- 0.46, - 0.23) logMAR (p < 0.001) from a mean (SD) of 0.75 (0.42) logMAR at baseline with 63% achieving VA < 0.3 logMAR while for CRVO it was - 0.35 (- 0.46, - 0.23) logMAR (p = 0.19) from 1.13 (0.61) logMAR at baseline and VA < 0.3 logMAR in 36%. The mean (95% CI) change in CST over 12 months was - 114 (- 189, - 40) μm (p = 0.003) from a mean (SD) of 423 (151) μm at baseline for BRVO and - 184(- 276, - 91) μm (p < 0.001) from 519 (213) μm for CRVO. Patients in both groups received a median of 2 bevacizumab injections over 12 months. Around 37% eyes were lost before 12 months' observation. The mean VA and CST trajectory in these eyes at their last visit was similar to those that completed 12 months. CONCLUSION The outcomes of RVO over the 12 months were inferior and the number of treatments fewer than those of the clinical trials and other reports from routine clinical practice. Future studies to identify the treatment barriers are warranted to improve the treatment outcomes in our patients.
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Narayanan R, Kelkar A, Abbas Z, Goel N, Soman M, Naik N, Sudhalkar A, Walinjkar J, Shah U, Maksane N. Sub-optimal gain in vision in retinal vein occlusion due to under-treatment in the real world: results from an open-label prospective study of Intravitreal Ranibizumab. BMC Ophthalmol 2021; 21:33. [PMID: 33435908 PMCID: PMC7805171 DOI: 10.1186/s12886-020-01757-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022] Open
Abstract
Background Macular edema secondary to retinal vein occlusion (RVO) is an important cause of loss of vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) are the standard of care in this disease, as shown in numerous randomized controlled trials. The purpose of this study was to study the efficacy and safety of ranibizumab, an anti-VEGF agent, in the real-world setting. Methods This was 48 weeks, open-label, prospective, multicentre, observational study. Patients diagnosed with ME secondary to RVO were treated with IVI of Ranibizumab 0.5 mg in real-world conditions. Efficacy was measured by improvement seen in best-corrected visual acuity (BCVA) in terms of Early Treatment of Diabetic Retinopathy Study (ETDRS) Letter Scores and change in central retinal thickness (CRT) measured by optical coherence tomography. Results One hundred eyes of 100 patients (79 with branch retinal vein occlusion and 21 with central retinal vein occlusion) were recruited in the study. The mean (standard deviation, SD) BCVA was 52.8 (21.99) letters at baseline and 62.3 (24.40) letters at week 48. From baseline, there was a significant improvement in BCVA by 7.7 letters (p = 0.001) at 48 weeks. The mean (SD) of CRT was 479.9 (216.25) μm at baseline and it decreased significantly to 284.9 (171.35) μm at week 48 (p < 0.001). During the study period, the average number of intravitreal injections was 3.5 per patient. There was no report of endophthalmitis in any eye. Conclusions Ranibizumab is well tolerated and effective in treating macular edema secondary to RVO in real-world clinical settings. However, there is under-treatment compared to controlled clinical trials, and the gain in vision is sub-optimal with under-treatment. Trial registration Clinical Trials Registry - India: CTRI/2015/07/005985.
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Affiliation(s)
- Raja Narayanan
- L V Prasad Eye Institute, Hyderabad Eye Research Foundation, Hyderabad, Telangana, India.
| | - Aditya Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Zahir Abbas
- Apollo Gleneagles Heart Centre, Kolkata, West Bengal, India
| | - Neha Goel
- ICARE Research Center, Noida, Uttar Pradesh, India
| | - Manoj Soman
- Chaithanya Eye Hospital, Trivendrum, Kerala, India
| | - Naveen Naik
- Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aditya Sudhalkar
- Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat, India
| | | | - Utkarsh Shah
- Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
| | - Nitin Maksane
- Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
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Sakanishi Y, Tamaki K, Mashimo K, Sakuma T, Ebihara N. Relationship between Recurrence of Macular Edema Due to Branch Retinal Vein Occlusion and Changes in Choroidal Thickness. Ophthalmic Res 2020; 64:363-368. [PMID: 33070137 DOI: 10.1159/000512357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The role of vascular endothelial growth factor in macular edema (ME) due to branch retinal vein occlusion (BRVO) by enhancing vascular permeability has been well studied. ME due to BRVO often recurs; however, there has been no report on the relationship between this recurrence and choroidal thickness (CT), considering the high vascularity of the choroid. This study was designed to investigate this relationship. METHODS In this retrospective consecutive case series, patients with recurrence of ME within 6 months of receiving intravitreal aflibercept injection treatment for naive ME due to BRVO at Juntendo University Urayasu Hospital were included. Retinal thickness (RT) and CT were measured in the fovea and on the occlusion, non-occlusion, nasal, and temporal sides at baseline, after the first intravitreal aflibercept administration, and before and after recurrence. We also examined the change for each side before and after reinjection. RESULTS This study included 11 patients and 11 eyes. The subfoveal CT and RT at baseline were 261.9 ± 93.4 μm and 691.5 ± 254.4 μm, respectively, which significantly decreased to 208.5 ± 70.3 μm and 188.6 ± 33.8 μm, respectively, at 1 month after the first injection (p = 0.001 and p < 0.01, respectively). These values also significantly decreased at all the other sites after treatment. There were 14 recurrences within the 6 months following intravitreal aflibercept injection; RT significantly changed at all sites before and after recurrence and reinjection. CT significantly changed at the subfovea and on the occlusion and non-occlusion sides; however, there was no significant change on the nasal and temporal sides. CONCLUSION In patients with BRVO, the CT around the macula after initial treatment was significantly reduced; however, at the time of ME recurrence and reinjection, there were site-dependent differences in the changes observed in the CT. These findings suggest that the pathologies of ME at initial occurrence and at the time of recurrence are different.
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Affiliation(s)
- Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan,
| | - Kazunori Tamaki
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
| | - Keitaro Mashimo
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
| | - Toshiro Sakuma
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Japan
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Ang JL, Ah-Moye S, Kim LN, Nguyen V, Hunt A, Barthelmes D, Gillies MC, Mehta H. A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion. Eye (Lond) 2020; 34:1770-1796. [PMID: 32313172 PMCID: PMC7608462 DOI: 10.1038/s41433-020-0861-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/19/2020] [Accepted: 03/24/2020] [Indexed: 01/10/2023] Open
Abstract
This review assessed the real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion (BRVO). A meta-analysis of 2530 eyes from 48 real-world studies of therapies for macular oedema secondary to BRVO was conducted. Baseline characteristics, visual, anatomical and safety outcomes were recorded. The weighted mean and weighted estimates from random-effects models were calculated for visual acuity (VA) and central subfield thickness (CST) changes at 6, 12 and 24 months. Primary outcome was change in VA (logMAR letters) at 12 months. Study quality was assessed using the quality appraisal checklist for case series developed by Institute of Health Economics. The mean baseline VA for the pooled data was 54.0 (51.5, 56.5) letters and the mean baseline CST was 501.3 (483.5, 519.1) µm. The random-effects estimate for mean (95% CI) change in VA was 14.6 (12.5, 16.7) letters at 12 months (n = 1727). The random-effects estimate for mean (95% CI) change in CST was -181.7 (-230.7, -132.7) µm at 12 months (n = 1325). The quality of studies varied considerably. Ocular and systemic adverse events were discussed in 79% and 42% of treatment arms respectively, with possible under-reporting. Visual and anatomical gains achieved in the real-world for anti-VEGF therapy were not as impressive as seminal RCTs, possibly due to reduced injection frequency in the real world and differences in baseline characteristics. There is an urgent need for consensus on the minimum efficacy, treatment burden and safety data to collect to strengthen the real-world evidence base.
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Affiliation(s)
- Juan Lyn Ang
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Sarah Ah-Moye
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Leah N Kim
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Vuong Nguyen
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Adrian Hunt
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Daniel Barthelmes
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, University Hospital Zurich & University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Hemal Mehta
- Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK. .,Macular Research Group, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.
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Spooner K, Hong T, Fraser-Bell S, Chang AA. Current Outcomes of Anti-VEGF Therapy in the Treatment of Macular Oedema Secondary to Branch Retinal Vein Occlusions: A Meta-Analysis. Ophthalmologica 2019; 242:163-177. [PMID: 31158837 DOI: 10.1159/000497492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The current body of evidence on the efficacy and safety of anti-VEGFs for macular oedema secondary to branch retinal vein occlusion (BRVO) is steadily growing as large clinical trials and observational studies are continually completed. The aim of this meta-analysis is to analyse anatomical and functional outcomes in response to anti-VEGF therapy using evidence generated from a pooled analysis of current clinical trials and observational studies. METHODS The current meta-analysis includes treatment of BRVO with aflibercept, bevacizumab and ranibizumab from randomised controlled trials and observational studies. Inclusion criteria included peer-reviewed publications with at least a 12-month follow-up period. On literature review using multiple electronic databases (PubMed, Embase and Cochrane), 22 studies met the inclusion criteria. Baseline patient characteristics, study design, sample size and 12- and 24-month change in best corrected visual acuity (BCVA) and central foveal thickness (CFT) as measured on optical coherence tomography imaging were pooled in a meta-analysis. Data were then stratified by study design and anti-VEGF therapy in subgroup analyses. RESULTS A total of 1,236 eyes from 22 studies were included in this meta-analysis. Mean baseline BCVA ranged from 66 ETDRS letters (20/50 Snellen equivalent) to 35 letters (20/200 Snellen). Mean baseline CFT ranged from 406.0 to 681.0 µm. Anti-VEGF treatment demonstrated an overall mean improvement in BCVA at 12 months of 14 letters (95% CI 12.0 to 16.2, p < 0.001) and CFT reduction of 228 µm (95% CI -278.9 to -176.1, p < 0.001). The BCVA gains at 12 months were maintained to month 24 with a mean gain of 12.5 letters (95% CI 6.3 to 18.8, p < 0.001), as well as reduction of CFT of 238 µm (95% CI -336.0 to -140.2, p < 0.001). No cases of endophthalmitis or glaucoma were reported in any study. CONCLUSION This meta-analysis confirms the comparable safety and efficacy of anti-VEGF therapies for patients with cystoid macular oedema secondary to BRVO. There is a need for randomised prospective comparative trials of anti-VEGF agents for BRVO.
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Affiliation(s)
- Kimberly Spooner
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia
| | - Samantha Fraser-Bell
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia.,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew A Chang
- Sydney Institute of Vision Science, Sydney Retina, Sydney, New South Wales, Australia, .,Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia,
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Gao X, Obeid A, Aderman CM, Ali FS, Vander JF, Hsu J, Ho AC. Intravitreal Anti-Vascular Endothelial Growth Factor Injections for Macular Edema Associated With Central Retinal Vein Occlusion in Patients Age 40 Years or Younger. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e96-e104. [DOI: 10.3928/23258160-20190401-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/28/2018] [Indexed: 11/20/2022]
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8
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Spooner K, Fraser-Bell S, Hong T, Chang AA. Five-year outcomes of retinal vein occlusion treated with vascular endothelial growth factor inhibitors. BMJ Open Ophthalmol 2019; 4:e000249. [PMID: 30997407 PMCID: PMC6440600 DOI: 10.1136/bmjophth-2018-000249] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Report 5-year outcomes of patients receiving anti-vascular endothelial growth factor (VEGF) for the treatment of macular oedema secondary to retinal vein occlusion (RVO. Methods Retrospective review of eyes with RVO which initiated anti-VEGF treatment. Data including age, gender, visual acuity (VA) and injection numbers were obtained from medical records. Optical coherence tomography scans were graded for presence or absence of macular oedema and central foveal thickness (CFT). Macular perfusion was assessed on fundus fluorescein angiography by masked graders. Results 68 eyes (31 branch RVO, BRVO; 35 central RVO, CRVO and 2 hemi-RVO) with 5 years of follow-up after initiation of anti-VEGF treatment. Mean change in VA at 5 years was + 9.6 ± 21.6 letters among CRVO eyes and + 14.2 ± 15.6 letters among eyes with BRVO (p=0.001). Vision of 20/40 or better was achieved in 65 % of treated eyes. The proportion of eyes with a three-line improvement of vision (15 letters) at 5 years was 22 %. Mean CFT decreased by 257.6 ± 249.8 µm in eyes with CRVO and 145.6 ± 143.3 µm in eyes with BRVO. Conclusion The results confirm good long-term outcomes can be achieved with anti-VEGF therapy for RVO.
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Affiliation(s)
- Kimberly Spooner
- Research, Sydney Institute of Vision Science, Sydney, New South Wales, Australia.,Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Samantha Fraser-Bell
- Department of Opthalmology and Eye Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, New South Wales, Australia
| | - Andrew A Chang
- Sydney Institute of Vision Science, Sydney, New South Wales, Australia
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Abstract
PURPOSE Retinal vein occlusion (RVO) is an important cause of visual disability in the modern world. We aim to evaluate the real-world outcomes of patients with RVO treated with anti-vascular endothelial growth factor (VEGF) in Portugal. METHODS We performed a retrospective, observational, multicenter study including 8 centers across Portugal and 200 patients treated with either ranibizumab or bevacizumab. Data were collected at 3 time points: time of diagnosis (0 time point) and 6 and 12 months after initiating treatment. Demographic and clinical data were collected. RESULTS Median visual acuity (VA) and central macular thickness (CMT) improved in the branch RVO (BRVO), central RVO (CRVO), bevacizumab, and ranibizumab groups at 6 and 12 months compared to baseline, with CMT improving further only in the CRVO and ranibizumab groups between 6 and 12 months (p = 0.002 and p = 0.001, respectively). The CMT was lower in the ranibizumab group compared to the bevacizumab group both at 6 and 12 months (p<0.02). Median CMT improved in both the good and poor baseline VA groups at 6 and 12 months compared to baseline (p<0.001). Median VA only improved for the group with poor baseline VA at 6 and 12 months of follow-up (p<0.001). Regression analysis identified several baseline variables as predictors of visual outcomes at 6 and 12 months, with different results depending on the analyzed group. CONCLUSIONS Both treatments were effective, although less effective than results reported in clinical trials. The morphologic response was better with ranibizumab compared to bevacizumab, although functionally there were no differences.
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Bulut MN, Çallı Ü, Akçay G, Kıvrak U, Bulut K, Özertürk Y. Effects of Dexamethasone Implant on Multifocal Electroretinography in Central Retinal Vein Occlusion. J Ophthalmic Vis Res 2018; 13:23-28. [PMID: 29403585 PMCID: PMC5782451 DOI: 10.4103/jovr.jovr_118_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: To investigate the effect of Ozurdex (dexamethasone intravitreal implant) on multifocal electroretinography (mfERG) findings during the treatment of macular edema secondary to the central retinal vein occlusion (CRVO). Methods: Fifteen eyes of 15 patients who were treated with Ozurdex implant due to CRVO-related macular edema were included in this study. Best corrected visual acuity (BCVA), central macular thickness (CMT), and mfERG evaluations were performed for all patients before injection of Ozurdex. After the injection, BCVA and CMT were measured at months 3 and 6 and mfERG test was performed at month 6 for all patients. Results: Pre-implantation mfERG P wave amplitude values of r1, r2, r3, r4 and r5 were 57.8 ± 14.8, 25.1 ± 10.6, 17.2 ± 7.3, 12.0 ± 5.0 and 7.1 ± 3.6 nV/deg2, respectively. They increased to 72.9 ± 33.2, 31.2 ± 9.3, 22.6 ± 7.6, 15.6 ± 7.1 and 10.9 ± 5.7 nV/deg2, respectively, at month 6. However, these increases were not statistically significant (all P > 0.05). Pre-implantation mfERG r1, r2, r3, r4 and r5 P wave implicit times were 40.1 ± 10.9, 39.4 ± 3, 38.4 ± 3.4, 38.2 ± 3.1 and 39.3 ± 2.2 ms, respectively and these values were measured as 38.9 ± 8.2, 38.4 ± 4.7, 37 ± 3.8, 37.5 ± 4.6 and 37.7 ± 4.7 ms at 6 months. Although there were reductions in P wave implicit times in all rings, they were not statistically significant (all P > 0.05). Conclusion: In this prospective study, we found that the Ozurdex implant had no effect on mfERG findings 6 months after insertion for treatment of CRVO-related macular edema.
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Affiliation(s)
- Muhammed Nurullah Bulut
- Sağlık Bilimleri University Dr. Lütfi Kırdar Kartal Education and Research Hospital Eye Department, Istanbul, Turkey
| | - Ümit Çallı
- Sağlık Bilimleri University Dr. Lütfi Kırdar Kartal Education and Research Hospital Eye Department, Istanbul, Turkey
| | - Güzide Akçay
- Sağlık Bilimleri University Dr. Lütfi Kırdar Kartal Education and Research Hospital Eye Department, Istanbul, Turkey
| | - Ulviye Kıvrak
- Sağlık Bilimleri University Dr. Lütfi Kırdar Kartal Education and Research Hospital Eye Department, Istanbul, Turkey
| | - Kezban Bulut
- Sağlık Bilimleri University Dr. Lütfi Kırdar Kartal Education and Research Hospital Eye Department, Istanbul, Turkey
| | - Yusuf Özertürk
- Sağlık Bilimleri University Dr. Lütfi Kırdar Kartal Education and Research Hospital Eye Department, Istanbul, Turkey
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Winterhalter S, Eckert A, Vom Brocke GA, Schneider A, Pohlmann D, Pilger D, Joussen AM, Rehak M, Grittner U. Real-life clinical data for dexamethasone and ranibizumab in the treatment of branch or central retinal vein occlusion over a period of six months. Graefes Arch Clin Exp Ophthalmol 2017; 256:267-279. [PMID: 29185099 DOI: 10.1007/s00417-017-3852-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the therapeutic outcome for dexamethasone implant (DEX) or intravitreal ranibizumab (IVR) injections over 6 months in patients with macular edema due to branch or central retinal vein occlusion (BRVO, CRVO), in a real-life setting. METHODS A total of 107 patients with BRVO or CRVO were included into this retrospective single-center observational study. Patients were treated with monotherapy consisting of DEX or three monthly IVR injections following a pro re nata regimen (PRN). Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP) were compared between the two therapy groups after 1, 3 and 6 months. RESULTS BRVO patients treated with DEX achieved a statistically significant gain in BCVA measured in logMAR after 1 month (mean gain, 95% CI: 0.21, 0.08-0.34, p = 0.001), 3 months (0.16, 0.03-0.28, p = 0.012) and 6 months (0.19, 0.07-0.32, p = 0.002), whereas patients treated with IVR showed a statistically significant BCVA gain in month 3 (mean improvement, 95% CI: 0.13, 0.01-0.26, p = 0.039) and month 6 (0.16, 0.03-0.29, p = 0.018). BCVA in CRVO patients with DEX worsened slightly at month 6 (mean worsening, 95% CI: -0.08, -0.24 to 0.08, p = 0.305), while IVR treated-patients achieved a statistically significant BCVA gain at 3 months (mean improvement, 95% CI: 0.14, 0.02-0.25, p = 0.021). Both therapies were accompanied by statistically significant CRT reductions of 150 to 200 μm (median). Adverse events reported were predictable and limited. CONCLUSIONS In a clinical setting, comparable improvement in BCVA and CRT were observed after DEX and IVR injections for treatment of BRVO. CRVO patients showed greater benefit with IVR.
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Affiliation(s)
- Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Annabelle Eckert
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Ophthalmicus Augentagesklinik, Villingen-Schwenningen, Germany
| | - Gerrit-Alexander Vom Brocke
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alice Schneider
- Department of Biostatistics and Clinical Epidemiology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Dominika Pohlmann
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matus Rehak
- Department of Ophthalmology, Campus Virchow-Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Ophthalmology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical Epidemiology, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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12
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Lin TC, Hwang DK, Hsu CC, Peng CH, Wang ML, Chiou SH, Chen SJ. Protective effect of metformin against retinal vein occlusions in diabetes mellitus - A nationwide population-based study. PLoS One 2017; 12:e0188136. [PMID: 29136662 PMCID: PMC5685597 DOI: 10.1371/journal.pone.0188136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022] Open
Abstract
Previous studies have found that metformin can reduce cardiovascular risk, but its association with retinal vein occlusion (RVO) is unknown. In this population-based cohort study using the Taiwan National Health Insurance Research Database (NHIRD), we demonstrated the protective effect of metformin against RVO in diabetes mellitus (DM) and explored the incidence rate and factors associated with RVO development in general and diabetic populations. One million patients were randomly selected from the registry files of the NHIRD, and all their claims data were collected for the 1996–2011 period. Patients with a new diagnosis of central or branch RVO were identified using International Classification of Disease codes. DM was defined for patients with diagnoses and treatments. Factors associated with RVO development in the non-DM and DM cohorts were explored using Cox proportional regression models. In total, 1,018 RVO patients were identified from the database. The average incidence of RVO was 9.93 and 53.5 cases per 100,000 person-years in the non-DM and DM cohorts, respectively. Older age, DM, hypertension, and glaucoma were significant risk factors for RVO, whereas the prescription of anticoagulants was a significant protective factor. In the DM cohort, older age, hypertension, and diabetic retinopathy were significant risk factors for RVO, whereas metformin treatment was a significant protective factor. These results confirmed the risk factors for RVO and demonstrated the protective effect of metformin against RVO in DM patients. Prescribing metformin for DM patients may be beneficial for reducing the incidence of RVO, along with its hypoglycemic action.
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Affiliation(s)
- Tai-Chi Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Public Health and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chih-Chien Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hsien Peng
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital & Fu-Jen Catholic University, Taipei Taiwan
| | - Mong-Lien Wang
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hwa Chiou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail:
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13
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Short-term results of endovascular surgery with tissue plasminogen activator injection for central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2017; 255:2135-2140. [PMID: 28803326 DOI: 10.1007/s00417-017-3763-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/01/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To examine the effects of retinal endovascular surgery (REVS) with tissue plasminogen activator injection into the retinal vein in central retinal vein occlusion (CRVO) eyes. METHODS Sixteen consecutive CRVO patients with macular edema and decreased visual acuity who were referred to Toyama University Hospital between March 2014 and February 2016 were included in this study. Changes in visual acuity (VA) and central retinal thickness (CRT) were evaluated up to 6 months after REVS. Staining and leakage of the retinal veins in fluorescein angiography (FA) was graded in nine patients. RESULTS Ten of 16 eyes were determined to be non-ischemic while the remaining six were ischemic. The mean logarithm of the minimum angle of resolution (logMAR) of VA was significantly improved from 0.98 ± 0.58 (mean ± standard deviation) at baseline to 0.78 ± 0.61 at 3 months (p = 0.002), and 0.64 ± 0.60 at 6 months (p = 0.003) after REVS. At 6 months, VA was improved in eight eyes (50%), while the other eight (50%) showed no change; none showed worsening. In the 10 eyes with non-ischemic CRVO, the mean VA was significantly improved at 6 months (p = 0.002), whereas no improvement was found in the six eyes with ischemic CRVO, . In all eyes, the mean CRT was significantly improved from 804 ± 343 μm at baseline to 506 ± 304 μm at 2 months (p = 0.014), 332 ± 229 μm at 3 months (p = 0.0001), and 305 ± 235 μm at 6 months (p = 0.00001). The postoperative complications observed were prolonged vitreous hemorrhage in one eye and neovascular glaucoma in two eyes. For postoperative recurrence of macular edema, sub-tenon injection of triamcinolone acetonide was given to five eyes, and intravitreal injection of an anti-VEGF agent was given to five eyes. Pan-retinal photocoagulation was performed on six eyes with ischemic type CRVO. The FA score was significantly improved after REVS (p = 0.018). CONCLUSIONS REVS using a specially made micro-needle may be a surgical treatment option for non-ischemic CRVO, but it did not seem effective for ischemic CRVO.
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14
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Zhang T, Zhang J, Sun X, Tian J, Shi W, Yuan G. Early vitrectomy for dense vitreous hemorrhage in adults with non-traumatic and non-diabetic retinopathy. J Int Med Res 2017. [PMID: 28627981 PMCID: PMC5805203 DOI: 10.1177/0300060517708942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the etiologies for dense vitreous hemorrhage in adults with
non-traumatic and reveal management of early vitrectomy for the disease. Methods Study included 105 eyes from 105 patients. Outcome measures were etiologies
of vitreous hemorrhage, formation of retinal and/or disk neovascular
membrane (NVM), incidence of retinal tear and detachment, visual acuity (VA)
and postoperative complications. Results Mean time between presentation and surgery was 7.1 days. The most common
etiologies were retinal vein occlusion (RVO) (58.1%), retinal tear (22.9%)
and retinal vasculitis (10.4%). Most RVO (77.0%) and retinal vasculitis
(72.7%) eyes were associated with retinal and/or disk NVM. Retinal tear and
retinal detachment was found in 24 and 48 eyes, respectively. VA improved
significantly from 1/70 to 0.6 following vitrectomy. The most common
postoperative complication was cataract (28.6%). Conclusion RVO, retinal tear and retinal vasculitis were the most common causes of dense
vitreous hemorrhage. Early vitrectomy has a good outcome with acceptable
complication rates in this setting.
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Affiliation(s)
- Ting Zhang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
| | - Jingjing Zhang
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaolei Sun
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
| | - Jingyi Tian
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
| | - Weiyun Shi
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
| | - Gongqiang Yuan
- Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Jinan, China
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15
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Minami Y, Nagaoka T, Ishibazawa A, Yoshida A. Correlation between short- and long-term effects of intravitreal ranibizumab therapy on macular edema after branch retinal vein occlusion: a prospective observational study. BMC Ophthalmol 2017; 17:90. [PMID: 28610573 PMCID: PMC5470248 DOI: 10.1186/s12886-017-0485-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 06/08/2017] [Indexed: 11/25/2022] Open
Abstract
Background The correlation between the short- and long-term effects of intravitreal ranibizumab (IVR) on macular edema after branch retinal vein occlusion (BRVO) remains unclear. We assessed the correlation between the short- and long-term effects of IVR on macular edema after BRVO. Methods Twenty-one eyes with macular edema after BRVO were enrolled in this prospective observational study. We measured the foveal thickness (FT) and the best-corrected visual acuity (BCVA) before, 1 day after, and 1 month after IVR (0.5 mg) and then at least every 2 months thereafter until 6 months after the injection. If the macular edema recurred, another injection was administered. The primary endpoint was the change from baseline in the BCVA (ΔVA). Results The mean logarithm of the minimum angle of resolution VA improved significantly (p = 0.01, p < 0.0001, respectively) after 1 day from 0.65 ± 0.28 to 0.51 ± 0.21 (20/89 to 20/63, Snellen equivalent) and after 6 months to 0.29 ± 0.24 (20/39, Snellen equivalent). The mean FT decreased significantly (p < 0.0001) after 1 day from 482 ± 85 μm to 349 ± 75 μm and after 6 months to 305 ± 84 μm. The 1-day VA was significantly (r = 0.68, p = 0.0007) positively correlated with the 6-month VA. The 1-day ΔVA was significantly (r = 0.79, p < 0.0001) positively correlated with the 6-month ΔVA. Conclusions The short-term effects of IVR may predict the long-term effects of IVR in macular edema secondary to BRVO. Trial registration Trial registration number: UMIN000027003. Retrospectively registered. (April/15/2017)
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Affiliation(s)
- Yoshiro Minami
- Department of Ophthalmology, Nayoro City General Hospital, Nishi 7 Minami 8-1, Nayoro, 096-8511, Japan.
| | - Taiji Nagaoka
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Akihiro Ishibazawa
- Department of Ophthalmology, Nayoro City General Hospital, Nishi 7 Minami 8-1, Nayoro, 096-8511, Japan.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
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16
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Sakanishi Y, Usui-Ouchi A, Tamaki K, Mashimo K, Ito R, Ebihara N. Short-term outcomes in patients with branch retinal vein occlusion who received intravitreal aflibercept with or without intravitreal ranibizumab. Clin Ophthalmol 2017; 11:829-834. [PMID: 28496301 PMCID: PMC5422553 DOI: 10.2147/opth.s133594] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine the short-term outcomes for patients who received intravitreal aflibercept (IVA) with or without intravitreal ranibizumab (IVR) for macular edema (ME) due to branch retinal vein occlusion (BRVO). Patients and methods Patients received IVA for ME due to BRVO. Patients who initially received IVA were defined as the treatment-naïve group and those who were switched from IVR to IVA after ME recurrence were defined as the switching group. Patient outcomes were examined at 1 week and 1 month postinjection. Results Both groups comprised 27 eyes from 27 patients. There was a significant decrease in central macular thickness (CMT) at 1 week and 1 month postinjection in both groups. There was also a significant improvement in best-corrected visual acuity (BCVA) at 1 week and 1 month postinjection in the treatment-naïve group and 1 month in the switching group. Younger age was associated with a good BCVA at 1 month postinjection in the switching group, and the absence of epiretinal membrane was associated with a reduction in CMT at 1 month postinjection in the switching group. Conclusion IVA is temporarily effective for treating ME due to BRVO regardless of a history of IVR use.
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Affiliation(s)
- Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Ayumi Usui-Ouchi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Kazunori Tamaki
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Keitaro Mashimo
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Rei Ito
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
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17
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SHORT-TERM EFFECT OF INTRAVITREAL RANIBIZUMAB THERAPY ON MACULAR EDEMA AFTER BRANCH RETINAL VEIN OCCLUSION. Retina 2017; 36:1726-32. [PMID: 26866527 DOI: 10.1097/iae.0000000000000991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the short-term effect of intravitreal ranibizumab (IVR) on macular edema after branch retinal vein occlusion. METHODS Twenty-three eyes with macular edema after branch retinal vein occlusion were enrolled in a prospective observational study. After administering one IVR injection (0.5 mg) for the first time, the authors measured the foveal thickness (FT) before and 2 hours, 1 and 3 days, 1 week, and 1 month later and the best-corrected visual acuity at all times except 2 hours, and determined the changes from baseline (ΔFT and ΔVA). RESULTS The mean FT decreased significantly (P < 0.0001) from 522 ± 131 μm to 458 ± 96 μm after 2 hours. The mean logarithm of the minimum angle of resolution (logMAR) visual acuity improved significantly (P < 0.05) after 1 day from 0.69 ± 0.40 to 0.55 ± 0.34 (20/98-20/70, Snellen equivalent). The ΔFT after 2 hours was significantly positively correlated with the ΔFT after 1 week (r = 0.76, P < 0.001) and 1 month (r = 0.67, P < 0.001). The ΔVA after 1 day was correlated positively with the ΔVA after 1 week (r = 0.80, P < 0.001) and 1 month (r = 0.59, P < 0.01). CONCLUSION Structural and functional effects of IVR for branch retinal vein occlusion occurred within 1 day. The short-term effects of IVR may predict the outcome of the therapy at 1 week and 1 month after IVR in macular edema secondary to branch retinal vein occlusion.
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18
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Çakmak HB, Arikan Yorgun M, Toklu Y, Mutlu M. Intravitreal PRN ranibizumab treatment for macular edemadue to branch retinal vein occlusion. Turk J Med Sci 2017; 47:40-46. [PMID: 28263518 DOI: 10.3906/sag-1509-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 04/21/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To evaluate the effect of intravitreal pro re nata (PRN) ranibizumab treatment from the start on the best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) in macular edema (ME) due to branch retinal vein occlusion (BRVO). MATERIALS AND METHODS Patients with ME secondary to BRVO, who were treated on a PRN basis after a single intravitreal ranibizumab injection, were retrospectively evaluated. The main outcome measures were changes in BCVA and CRT as measured by optical coherence tomography. RESULTS The number of injections over 6 months was 2.43 ± 1.16. The mean BCVA of the patients was 0.84 ± 0.10 logMAR at baseline and 0.41 ± 0.06 at the 6th month (P < 0.001). Mean BCVA of the ischemic BRVO group was 1.06 ± 0.68 logMAR at baseline and 0.44 ± 0.30 logMAR at the 6th month (P < 0.05). Similarly, the mean BCVA of the nonischemic BRVO group was 0.77 ± 0.53 logMAR at baseline and 0.41 ± 0.36 logMAR at the 6th month (P < 0.05). Between groups, there was no significant difference in mean BCVA at any examination. CONCLUSION Intravitreal ranibizumab is a safe and effective treatment option for ME due to ischemic and nonischemic BRVO using PRN from the start.
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Affiliation(s)
- Hasan Basri Çakmak
- Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mücella Arikan Yorgun
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Yasin Toklu
- Department of Ophthalmology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Melek Mutlu
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
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19
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Sakanishi Y, Lee A, Usui-Ouchi A, Ito R, Ebihara N. Twelve-month outcomes in patients with retinal vein occlusion treated with low-frequency intravitreal ranibizumab. Clin Ophthalmol 2016; 10:1161-5. [PMID: 27382250 PMCID: PMC4922787 DOI: 10.2147/opth.s107594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the clinical efficacy of low-frequency intravitreal ranibizumab to treat macular edema due to retinal vein occlusion (RVO). PATIENTS AND METHODS This was a retrospective examination of cases that received intravitreal ranibizumab for untreated RVO over a period of 12 months. Instead of the conventional three monthly injections, injections were given once during the introductory period. If the recurrence of macular edema was diagnosed during the monthly visit, additional injections were given as needed. There were 21 eyes of 21 patients with branch RVO (BRVO) and ten eyes of ten patients with central RVO (CRVO). The parameters examined included the number of injections over the 12-month period, improvements in best-corrected visual acuity (BCVA), and the central macular thickness (CMT). For BRVO, preinjection parameters that had an effect on the prognosis of BCVA after the 12-month period were also examined. RESULTS The total mean number of injections over the 12-month period was 3.4 for CRVO and 2.1 for BRVO. For CRVO, the BCVA in log minimum angular resolution changed from a preinjection value of 0.80 to 0.55 at 12 months. For BRVO, the change was from 0.51 to 0.30. For all diseases, BCVA improved after 12 months compared with the preinjection values (P<0.05). There was improvement in the CMT, and the CRVO changed from 765.0 μm at preinjection to 253.5 μm 12 months later. BRVO changed from 524.1 to 250.1 μm, and pre-injection BCVA was associated with a prognosis of visual acuity after 12 months of the initial injection (P=0.0485). CONCLUSION Even with a low number of injections during the introductory period, there were still improvements in both visual acuity and CMT in RVO patients after 12 months, indicating that it was an effective treatment.
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Affiliation(s)
- Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Ami Lee
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Ayumi Usui-Ouchi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Rei Ito
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan
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20
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Abstract
End stage renal disease (ESRD) has been reported to be an important risk factor for systemic vascular disease. Retinal vein occlusion (RVO) is closely related with cardiovascular diseases; however, its association with ESRD had not been reported. The aim of the study was to investigate whether ESRD is a risk factor for RVO, including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). This population-based study is based on the longitudinal data from Taiwan National Health Insurance Research Database. The study cohort comprised 5344 patients with diagnosis of ESRD on hemodialysis or peritoneal dialysis during the period from January 1996 to December 2011. For each ESRD patient, we selected 20 non-ESRD patients matched on age and sex. Each ESRD patient and his/her controls were followed from the initiation of renal dialysis until either the diagnosis of RVO or censorship. Kaplan-Meier method was used to compare the hazard of RVO between cohorts. Stratified Cox proportional hazard models were applied to estimate the hazard ratio (HR) adjusted by the comorbidities of RVO including diabetes mellitus (DM), hypertension, hypercholesteremia, and hypertriglyceridemia. After stratifying by DM status, the statistics were applied again to examine the associations among the DM cohort and non-DM cohort.The 16-year RVO cumulative incidence for ESRD cohort was 2-fold to the non-ESRD (1.01% vs 0.46%). After matching with age, sex, hypertension, and hypercholesteremia, the adjusted HR was 1.46 (95% confidence interval = 1.07-2.01, P value = 0.018). By further excluding patients with DM, the adjusted HR escalated to 2.43 (95% confidence interval = 1.54-3.83, P < 0.001). In contrast, there was no significant risk of ESRD on RVO in the DM patients (HR = 1.03). We conclude that among the non-DM patients, ESRD cases had significantly higher RVO rate than the non-ESRD, which indicates that ESRD maybe a potential risk factor for the development of RVO in nondiabetic patients.
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Affiliation(s)
- San-Ni Chen
- From the Department of Ophthalmology, Changhua Christian Hospital, Changhua (S-NC); Taiwan School of Medicine, Kaohsiung Medical University, Kaohsiung (S-NC); School of Medicine, Chung-Shan Medical University (S-NC); Department of Nephrology, Kuang-Tien Hospital, Taichung (T-CY); and Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan (J-TL, L-BL)
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21
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Lip PL, Malick H, Damer K, Elsherbiny S, Darrad KM, Mushtaq B, Mitra A, Stavrou P, Yang Y. One-year outcome of bevacizumab therapy for chronic macular edema in central and branch retinal vein occlusions in real-world clinical practice in the UK. Clin Ophthalmol 2015; 9:1779-84. [PMID: 26445525 PMCID: PMC4590638 DOI: 10.2147/opth.s89147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The purpose of this study was to investigate the 12-month outcome of macular edema secondary to both chronic and new central and branch retinal vein occlusions treated with intravitreal bevacizumab in the real-life clinical setting in the UK. Methods Retrospective case notes analysis of consecutive patients with retinal vein occlusions treated with bevacizumab in 2010 to 2012. Outcome measures were visual acuity (measured with Snellen, converted into logMAR [logarithm of the minimum angle of resolution] for statistical calculation) and central retinal thickness at baseline, 4 weeks post-loading phase, and at 1 year. Results There were 56 and 100 patients with central and branch retinal vein occlusions, respectively, of whom 62% had chronic edema and received prior therapies and another 32% required additional laser treatments post-baseline bevacizumab. Baseline median visual acuity was 0.78 (interquartile range [IQR] 0.48–1.22) in the central group and 0.6 (IQR 0.3–0.78) in the branch group. In both groups, visual improvement was statistically significant from baseline compared to post-loading (P<0.001 and P=0.03, respectively), but was not significant by month 12 (P=0.058 and P=0.166, respectively); 30% improved by at least three lines and 44% improved by at least one line by month 12. Baseline median central retinal thickness was 449 μm (IQR 388–553) in the central group and 441 μm (IQR 357–501) in the branch group. However, the mean reduction in thickness was statistically significant at post-loading (P<0.001) and at the 12-month time point (P<0.001) for both groups. The average number of injections in 1 year was 4.2 in the central group and 3.3 in the branch group. Conclusion Our large real-world cohort results indicate that bevacizumab introduced to patients with either new or chronic edema due to retinal vein occlusion can result in resolution of edema and stabilization of vision in the first year.
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Affiliation(s)
- Peck Lin Lip
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Huzaifa Malick
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Kenan Damer
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Samer Elsherbiny
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Kanupriya M Darrad
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Bushra Mushtaq
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Panagiota Stavrou
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK
| | - Yit Yang
- Birmingham and Midland Eye Centre, City Hospital, Aston University, Birmingham, UK ; School of Health and Life Sciences, Aston University, Birmingham, UK
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22
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Kokolaki AE, Georgalas I, Koutsandrea C, Kotsolis A, Niskopoulou M, Ladas I. Comparative analysis of the development of collateral vessels in macular edema due to branch retinal vein occlusion following grid laser or ranibizumab treatment. Clin Ophthalmol 2015; 9:1519-22. [PMID: 26366053 PMCID: PMC4562744 DOI: 10.2147/opth.s81576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the differences in the development of collateral vessels in patients with macular edema due to branch retinal vein occlusion (BRVO) after treatment with either grid laser or ranibizumab (RNB). Methods Comparative study including patients with macular edema due to acute BRVO and best-corrected visual acuity (BCVA) between 20/40 and 20/200. The sample was divided into two groups according to the treatment applied: laser group, including eyes treated with Argon laser when retinal hemorrhages were sufficiently absorbed to perform the treatment, and RNB group, including patients treated initially with one monthly intravitreal injection for a period of 3 months of RNB and more injections according to need thereafter. Before treatment patients in both groups, received a complete ophthalmic examination, including BCVA, fundus examination, optical coherence tomography, fundus color photography, and fundus fluorescein angiography (FA). This same protocol of examination was repeated in every visit after treatment, except FA that was only repeated every 3 months. The detection of the collateral vessels was done by two experienced examiners based on the analysis of the early phase of the FA. If there was a discrepancy in their judgment, the criterion of a third examiner evaluating the FA was considered. Results Mean baseline BCVA was 0.86±0.26 and 0.82±0.25 (logMAR [logarithm of the minimum angle of resolution]) in the RNB and laser groups, respectively (P=0.83). At the end of the follow-up, mean BCVA was 0.38±0.18 and 0.64±0.33 (logMAR) in the RNB and laser groups, respectively. The difference in the final BCVA between both groups was statistically significant (P=0.002). Collaterals developed in both groups; 66.67% of patients (14 out of 21 patients) developed collaterals at a mean time of 6.14±2.60 months after diagnosis in the RNB group, and 68.18% (16 out of 22 patients) developed collaterals in the laser group at a mean time of 6.2±1.97 months after diagnosis. No statistically significant differences between groups were found in the number of cases developing collateral vessels (P=1.00) as well as in the time required for such development (P=0.947). Conclusion The use of RNB for the treatment of macular edema due to BRVO does not seem to alter the development of collateral vessels. Future studies with larger samples are required to confirm these outcomes.
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Affiliation(s)
| | - Ilias Georgalas
- Department of Ophthalmology, University of Athens, Athens, Greece
| | | | | | | | - Ioannis Ladas
- Department of Ophthalmology, University of Athens, Athens, Greece
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Full-thickness retinochoroidal incision in the management of central retinal vein occlusion. J Ophthalmol 2015; 2015:853539. [PMID: 25734009 PMCID: PMC4334934 DOI: 10.1155/2015/853539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/29/2014] [Accepted: 01/17/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate the clinical outcomes in patients with central retinal vein occlusion (CRVO) treated with full-thickness retinochoroidal incisions and to compare whether there is difference in treatment response in ischemic and nonischemic CRVO. Methods. Retrospective study of patients of CRVO receiving full-thickness retinochoroidal incisions in Changhua Christian Hospital. Fluorescein angiography (FA), slit-lamp biomicroscopy, indirect funduscopy, best corrected visual acuity, and central macular thickness (CMT) measured by optical coherence tomography were performed pre- and postoperatively. Patients were divided into an ischemic and nonischemic group according to the findings of FA. Patients were followed up for at least 1 year. Results. Twenty-eight eyes (14 ischemic and 14 nonischemic CRVO) were included. Functional retinochoroidal venous anastomosis (RCVA) was achieved in 48 of the 65 retinochoroidal incisions (73.8%). Central macular thickness (CMT) and retinal hemorrhage decreased significantly after the surgery. Significant visual gain was observed postoperatively in the nonischemic group, but not in the ischemic group. Postoperative complications included vitreous hemorrhage (17.8%), neovascular glaucoma (7.1%), and preretinal fibrovasular membrane (10.7%), all of which were in the ischemic group. Conclusions. RCVA formation induced by retinochoroidal incisions could improve venous flow, and decrease CMT and retinal hemorrhage. However, only eyes with nonischemic CRVO showed visual improvement.
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Călugăru D, Călugăru M. Intravitreal bevacizumab in acute central/hemicentral retinal vein occlusions: three-year results of a prospective clinical study. J Ocul Pharmacol Ther 2014; 31:78-86. [PMID: 25313921 DOI: 10.1089/jop.2014.0037] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To prospectively evaluate the effects of intravitreal bevacizumab (IVB, Avastin; Genentech, Inc., San Francisco, CA) injections in patients with acute central/hemicentral retinal vein occlusions (C/HCRVOs) (≤1 month after the occlusion was diagnosed) over the course of 3 years. METHODS The study included 57 patients with unilateral acute C/HCRVOs. Initially, the treatment for acute C/HCRVO patients consisted of 4 consecutive IVB injections administered off-label at a dose of 2.5 mg per injection, with each injection spaced ∼45 days apart. Thereafter, IVB therapy was flexible, and subsequent injections were administered during scheduled visits whenever a best corrected visual acuity (BCVA) loss of ≥5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters occurred and/or iris/angle neovascularization appeared (regardless of the intraocular pressure level). Changes in the BCVA and foveal thickness (FT), number of IVB injections administered, and incidence of neovascular glaucoma (NVG) were estimated. RESULTS The increase in the BCVA score at month 36 was 17.15 (ETDRS letters) (P<0.0001) in cases of nonischemic and 26.81 (ETDRS letters) (P<0.01) in cases of ischemic occlusions. At the end of the follow-up, the proportion of BCVA score improvements greater than 15 ETDRS letters was similar in patients with both forms of occlusions (measured in 45.5% of nonischemic and 45.8% of ischemic patients) (P=0.977). There were significant reductions in FT from baseline values to 230±40.50 μm (P=0.0001) in patients with nonischemic occlusions and 270±40.50 μm (P=0.0001) in patients with ischemic forms. There was a significant difference (P<0.03) in the number of IVB injections administered in patients with nonischemic C/HCRVOs (8.7±1.58) compared to patients with ischemic occlusions (9.7±1.78). NVG occurred in 2 cases of ischemic occlusions. CONCLUSIONS The 3-year IVB therapy provided sustained vision and FT gains in most phakic patients with acute C/HCRVOs, making this treatment option a rational and viable therapeutic strategy. Bevacizumab was more effective in patients with ischemic occlusions who required a significantly higher number of injections.
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Affiliation(s)
- Dan Călugăru
- 1 Department of Ophthalmology, University "Grigore T. Popa" Iaşi , Romania
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