Treatment of branch retinal vein occlusion

Intravitreal bevacizumab for symptomatic retinal arterial macroaneurysm

PURPOSE

To evaluate the therapeutic effect of intravitreal bevacizumab injection for symptomatic retinal arterial macroaneurysm.

DESIGN

Retrospective interventional case series.

METHODS

The study included 23 patients (23 eyes) with symptomatic retinal arterial macroaneurysm. They were categorized according to treatment method into 2 groups: an intravitreal bevacizumab-treated group (11 eyes) and an untreated group (12 eyes). Bevacizumab was injected at the initial visit, followed by as-needed monthly reinjection. Best-corrected visual acuity (BCVA) and central macular thickness were documented and analyzed between groups.

RESULTS

The mean follow-up period for all subjects was 10.83 ± 4.6 months. The mean number of injections for the treated group was 1.42 ± 0.69. The mean logarithm of the minimal angle of resolution (logMAR) of BCVA improved from baseline at the last follow-up by 0.26 in the bevacizumab-treated group (P = .02) and by 0.34 in the untreated group (P = .005). Average central macular thickness decreased from 384.4 ± 150.1 μm to 265 ± 112.5 μm in the bevacizumab-treated group (P = .0002) and from 413.2 ± 155.2 μm to 236.3 ± 103.5 μm in the untreated group (P = .008). The BCVA was significantly improved from baseline after 1 month in the bevacizumab-treated group (P = .02) and after 3 months in the untreated group (P = .01). However, there was no statistically significant difference in BCVA improvement or central macular thickness improvement achieved at the final visit.

CONCLUSIONS

Intravitreal bevacizumab injection likely hastens resolution of macular edema and hemorrhage secondary to retinal arterial macroaneurysm. Intravitreal bevacizumab injection could be an effective treatment option for symptomatic retinal arterial macroaneurysm.

Comparison of natural course, intravitreal triamcinolone, and intravitreal bevacizumab for treatment of macular edema secondary to branch retinal vein occlusion

PURPOSE

To evaluate the natural course of the eyes with macular edema secondary to branch retinal vein occlusion (BRVO) and to compare the visual outcome and macular thickness with eyes treated with intravitreal injection of triamcinolone acetonide (IVTA) and intravitreal injection of bevacizumab (IVB).

METHODS

We reviewed the medical records of the patients with macular edema secondary to BRVO who were followed over 12 months. We evaluated the best corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients who have had no treatment for macular edema (natural course group) and compared the BCVA and CMT of the patients who had been treated with IVTA or IVB.

RESULTS

BCVA and CMT of the natural course group improved in a slow, but steady manner. The IVTA and the IVB group showed temporary improvement after injection, but macular edema recurred and there was no significant difference in the visual outcome and macular thickness after 6 months.

CONCLUSIONS

Although IVTA and IVB were effective to decrease the macular edema at 1 month after the injection in BRVO. BCVA and CMT of the natural course group were not inferior to both the IVTA and the IVB groups at 12 months.

Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion

PURPOSE

To compare cytokines in undiluted vitreous of treatment-naïve patients with macular oedema without vitreomacular traction secondary to branch (BRVO), central (CRVO) and hemi-central (H-CRVO) retinal vein occlusion.

METHODS

Ninety-four patients (median age 72 years, 42 men) underwent an intravitreal combination therapy, including a single-site 23-gauge core vitrectomy and the application of bevacizumab and dexamethasone due to vision-decreasing macular oedema. Among these were 43 patients with BRVO, 35 with CRVO and 16 patients with hemi-CRVO, which were distributed in a fresh or old retinal vein occlusion type (seven or more months after onset). Undiluted vitreous samples were analysed for interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF-A) with cytometric BEAD assay. Vitreous samples from patients with idiopathic epiretinal membrane served as controls (n = 14).

RESULTS

The mean cytokine values were highest in the CRVO group with IL-6 = 64.7 pg/ml (SD ± 115.8), MCP-1 = 1015.8 pg/ml (±970.1) and VEGF-A = 278.4 pg/ml (±512.8), followed by the H-CRVO group with IL-6 = 59.9 pg/ml (SD ± 97.5), MCP-1 = 938.8 pg/ml (±561.1) and VEGF-A = 211.5 pg/ml (±232.4). The BRVO group had IL-6 = 23.2 pg/ml (SD ± 48.8), MCP-1 = 602.6 g/ml (±490.3) and VEGF-A = 161.8 pg/ml (±314.4). The values of MCP-1 and VEGF-A were significantly different for CRVO or H-CRVO versus BRVO. All values were significantly higher than in the control samples, which had 6.2 ± 3.4 pg/ml (IL-6), 253 ± 74 pg/ml (MCP-1) and 7 ± 4.9 pg/ml (VEGF-A). Within the old RVO type, only MCP-1 was significantly different for CRVO or H-CRVO versus BRVO.

CONCLUSIONS

Both inflammatory markers and VEGF-A were higher in CRVO and H-CRVO than in BRVO undiluted vitreous samples. It seems that monocyte recruitment to the vessel wall, which might underlie the importance of eosinophils in tissue remodelling after RVO, is of special interest owing to the significant difference in MCP-1 in the older RVO types.

Reactivity of white blood cell flux to hyperoxia in patients infected with human immunodeficiency virus

PURPOSE

The aetiology of the apparently vasoocclusive phenomena in human immunodeficiency virus (HIV)-related retinopathy is not well understood. Several hypotheses, including infectious damage of the retinal vasculature and altered retinal haemodynamics, have been postulated. Direct measurement of oxygen tension in the retina is not possible in vivo and indirect methods have to be employed. The objective of this study was to investigate the retinal vascular response to 100% oxygen breathing in patients with HIV.

METHODS

Twelve patients infected with HIV and 12 healthy individuals, matched for age, sex and smoking habits, were studied in an open study using the blue-field entoptic technique for the measurement of retinal white blood cell (WBC) flux. Reactivity in retinal blood flow during 100% O(2) breathing over 15 min was measured and expressed as percentage change over baseline.

RESULTS

WBC velocity during oxygen inhalation decreased over baseline by 9.0 ± 5.8% in HIV-infected patients and by 18.6 ± 5.4% in healthy participants (p < 0.04 between groups, ANOVA). The decrease in WBC velocity was paralleled by a decrease in WBC density. This decrease tended to be more pronounced in healthy participants (13.6 ± 7.9%) than in HIV-infected patients (8.0 ± 10.8%), but the difference was not statistically significant (p = 0.1 between groups, ANOVA). WBC flux decrease was 16.2 ± 11.4% in HIV-infected patients and 29.5 ± 9.5% in the control group and was significant between groups (p = 0.007 between groups, ANOVA).

CONCLUSION

Our results indicate a reduced reactivity of WBC flux to systemic hyperoxia in patients with HIV. Whether abnormal retinal haemodynamics in HIV-infected persons contributes to the pathogenesis of HIV-related microvascular diseases or is a consequence of the structural changes associated with the disease is unknown.

A comparison of three different intravitreal treatment modalities of macular edema due to branch retinal vein occlusion

PURPOSE

To compare the efficacy of intravitreal injection of triamcinolone, bevacizumab, and a combination of triamcinolone-bevacizumab for the management of macular edema due to branch retinal vein occlusion.

METHODS

Fifty-two eyes of 52 patients (29 male, 23 female) with branch retinal vein occlusion and macular edema were included. Patients received one of the following intravitreal treatments: 4 mg triamcinolone acetonide monotherapy (n=17), 1.25 mg bevacizumab monotherapy (n=14) or a combination of 2 mg triamcinolone acetonide and 1.25 mg bevacizumab (n=21). Measurements of Snellen visual acuity and central macular thickness with optical coherence tomography were done at baseline, and at months one, three, and six.

RESULTS

At baseline, the three groups did not differ in age (P=0.12), duration of macular edema (P=0.24), visual acuity (P=0.62), central macular thickness (P=0.16), and intraocular pressure (P=0.15). All study groups showed significant reduction of central macular thickness (P=0.02, P=0.02, and P=0.001, respectively) and improvement in visual acuity (P=0.02, P= 0.02 and P=0.02, respectively) one month after injection. At six months, there was a significant reduction in central macular thickness (P=0.02, P=0.02, and P=0.04, respectively) while only bevacizumab monotherapy group demonstrated significant improvement in visual acuity (P=0.01).

CONCLUSION

Intravitreal injection of triamcinolone, bevacizumab or combination of triamcinolone-bevacizumab appears to have similar therapeutic effects on macular edema due to branch retinal vein occlusion at one month. Intravitreal injection of bevacizumab yielded better results of visual acuity than the others at six months.