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Frederiksen KH, Vestergaard JP, Pedersen FN, Vergmann AS, Sørensen TL, Laugesen CS, Kawasaki R, Peto T, Grauslund J. Navigated laser and aflibercept versus aflibercept monotherapy in treatment-naïve branch retinal vein occlusion: A 12-month randomized trial. Acta Ophthalmol 2022; 100:e1503-e1509. [PMID: 35611568 PMCID: PMC9790367 DOI: 10.1111/aos.15182] [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: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Angiostatic agents have proven effective in the treatment of macular oedema in patients with branch retinal vein occlusion (BRVO). However, treatment is inconvenient and expensive, and novel treatment regimens are warranted. We aimed to evaluate if combination treatment of navigated central retinal laser and aflibercept lowered the treatment burden in these patients. METHODS Treatment-naïve patients with BRVO and macular oedema were included at two centres and randomized 1:1 to three monthly injections of 2.0 mg aflibercept with (Group A) or without (Group B) navigated central laser, followed by aflibercept as needed from month 4 through 12. Re-treatment need was evaluated, and secondary endpoints included functional and anatomical outcomes and safety evaluated by retinal microperimetry. RESULTS We evaluated 41 eyes of 41 patients with a mean age of 69.6 years. Baseline median best-corrected visual acuity (BCVA) was 70.0 letters, and median central retinal thickness (CRT) was 502 μm with no difference between Groups A (n = 21) and B (n = 20). Percentage of patients needing re-treatment after month three was 71% and 80% (p = 0.72). At month 12, groups did not differ in number of injections after loading (1 versus 2, p = 0.43), change in BCVA (+12.8 versus +15.1 letters, p = 0.48), CRT (-195 versus -181 μm, p = 0.82), or retinal sensitivity (+3.3 versus +4.1 dB, p = 0.67). CONCLUSION In treatment-naïve BRVO patients, addition of navigated central laser to aflibercept did not lower treatment burden or affect functional or anatomical outcomes. A low number of intravitreal injections were needed for successful outcome in both treatment arms.
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Affiliation(s)
- Katrine Hartmund Frederiksen
- Department of OphthalmologyOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | | | - Frederik Nørregaard Pedersen
- Department of OphthalmologyOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | | | - Torben Lykke Sørensen
- Department of OphthalmologyZealand University HospitalRoskildeDenmark,Faculty of Health and Medical ScienceUniversity of CopenhagenCopenhagenDenmark
| | | | - Ryo Kawasaki
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,Department of Vision InformaticsOsaka University School of MedicineOsakaJapan
| | - Tunde Peto
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark,School of Medicine, Dentistry and Biomedical SciencesQueen's UniversityBelfastUK
| | - Jakob Grauslund
- Department of OphthalmologyOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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2
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Hunter A, Williams M. Long-term outcomes for patients treated for macular oedema secondary to retinal vein occlusion: a systematic review. BMJ Open Ophthalmol 2022; 7:bmjophth-2022-001010. [PMID: 36063388 PMCID: PMC9198693 DOI: 10.1136/bmjophth-2022-001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
This systematic review assessed the long-term outcomes for patients treated with intravitreal antivascular endothelial growth factor or dexamethasone for macular oedema (MO) secondary to retinal vein occlusion (RVO). Studies investigating patients of all ages with MO due to RVO only were included. The review was deliberately broad in scope, including comparative and non-comparative studies to ensure inclusion of real-world type evidence. Risk of bias was assessed. In total, 76 data sets were included (10 775 participants). Overall, mean best-corrected visual acuity (BCVA) improved from baseline to 5 years by 16.1 letters (p<0.01). BCVA improved from baseline in both central RVO (CRVO) and branch RVO (BRVOs) at 2 years, by 9.1 (p<0.01) (difference from baseline in CRVOs) and 9.1 (p<0.01) letters, respectively. At 5 years, BCVA improved from baseline in CRVOs by 15.6 letters and in BRVOs by 16.2; the difference between RVO types was not significant (p=0.18). Two studies had 5-year data for ranibizumab, and improvement was evident. There was no significant difference between outcomes in randomised controlled trials (RCTs) compared with non RCTs. These results suggest a benefit to receiving long-term intravitreal treatments for MO due to RVO.
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Affiliation(s)
- Alexandra Hunter
- Centre for Medical Education, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Michael Williams
- Centre for Medical Education, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
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3
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Wei P, Liu C, Zhang Y, Yang L. Evaluation of retinal sensitivity and microstructure in areas of capillary nonperfusion of eyes with branch retinal vein occlusion. BMC Ophthalmol 2021; 21:331. [PMID: 34507529 PMCID: PMC8434714 DOI: 10.1186/s12886-021-02089-w] [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: 03/08/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate macular microstructure alterations in the parafoveal nonperfusion areas of eyes with branch retinal vein occlusions (BRVO), and to investigate their impact on retinal sensitivity. Methods This was a cross-sectional study including thirteen BRVO patients with parafoveal capillary nonperfusion areas (NPA). Multiple modalities including microperimetry, optical coherence tomography angiography, and optical coherence tomography were performed to measure retinal sensitivity and thickness, and to identify the microstructure changes and perfusion status. Results The retinal sensitivity and thickness in the NPA were significantly lower than those in the perfusion areas (PA) (P = 0.001, P = 0.003). Microstructure changes, including disorganization of the retinal inner layers (DRIL), disruption of the outer retinal layers, and cysts were more frequently observed in NPA (P = 0.002, P = 0.018, P = 0.068). Within NPA, the retinal sensitivity of areas with DRIL, and outer retinal layers disruption was significantly lower than that of the areas without DRIL (P = 0.016), and with intact outer retinal layers (P < 0.001), respectively. 1dB increase in retinal sensitivity was correlated with 2.2 μm (95 % confidence interval, 1.71–2.7) increase of the thickness (P < 0.001). The retinal sensitivity was significantly lower at points with both DRIL and outer retinal layers disruption than at the points with DRIL or outer retina layers disruption alone (P = 0.001, P = 0.001). Conclusions Alterations in the macular microstructure are associated with ischemia, especially DRIL. DRIL and outer retinal layers disruption are imaging features that have important implications for local retinal sensitivity in the ischemic areas, and where the microstructure of both inner and outer retinal layers is disrupted the function is further destructed.
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Affiliation(s)
- Puying Wei
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China
| | - Chenchen Liu
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China
| | - Yanzhen Zhang
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China.
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4
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Niyousha MR, Hassanpoor N, Jafari S. Bilateral Type 1 Idiopathic Macular Telangiectasia in a Female Patient: Multimodal Imaging of a Rare Presentation. Case Rep Ophthalmol 2021; 12:373-379. [PMID: 34054487 PMCID: PMC8136330 DOI: 10.1159/000513095] [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: 08/06/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
We report a bilateral case of type 1 idiopathic macular telangiectasia (IMT) in a female patient. A 40-year-old otherwise healthy female with gradual vision loss since 2 years ago with best-corrected visual acuity of 20/400 in both eyes was referred. Her past medical history was negative for any systemic disease including diabetes and systemic hypertension. Color fundus photography showed bilateral loss of normal foveal reflex with macular edema. Fluorescein angiography demonstrated symmetric perifoveal telangiectasia mainly in the superior and nasal macula in both eyes with late staining and leakage. Spectral-domain optical coherence tomography revealed significant intraretinal fluid bilaterally and subretinal fluid in the left eye. Optical coherence tomography angiography (OCTA) revealed obvious saccular parafoveal capillary telangiectasia and capillary dropout as well as decreased vascular density in both superficial and deep capillary plexus. Deep capillary plexus involvement in OCTA was more evident than superficial plexus. Based on the patient's medical history and multimodal imaging, the diagnosis of bilateral IMT type 1 was made. The patient underwent 5 intravitreal monthly injection of bevacizumab in both eyes, which resulted in macular edema resolution. However, after 3 months of discontinuation of intravitreal bevacizumab, macular edema relapsed. In conclusion, type 1 IMT can occur bilaterally in an otherwise healthy female patient as a very rare presentation. To the best of our knowledge, this case is the 4th case of bilateral type 1 IMT reported in a female.
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Affiliation(s)
- Mohamad Reza Niyousha
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Hassanpoor
- Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sasan Jafari
- Ophthalmology Resident, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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5
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Arai Y, Takahashi H, Inoda S, Sakamoto S, Tan X, Inoue Y, Tominaga S, Kawashima H, Yanagi Y. Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study. J Clin Med 2020; 9:jcm9082360. [PMID: 32718095 PMCID: PMC7464624 DOI: 10.3390/jcm9082360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/21/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To assess the efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). METHODS This prospective multicentre intervention study evaluated 50 eyes of 50 patients enrolled from October 2016 to September 2017. The patients received intravitreal aflibercept (IVA) injections on an mTAE regimen for a total of 12 months. The main outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 12 months. RESULTS The baseline BCVA and CST were 0.33 (0.27) and 488 (171) µm (mean (standard deviation)), respectively. The BCVA and CST were significantly improved at month 12 (0.067 (0.19) LogMAR and 295 (110) µm; both p < 0.0001, paired t-test). The mean number of clinic visits and IVA injections was 6.71 (1.41) and 4.26 (0.71), respectively. The time to first recurrence from the first injection was most frequently 3 months. CONCLUSION The mTAE regimen of IVA injections for ME due to BRVO effectively improved BCVA and reduced CST, and thus might be an effective therapy to reduce the number of injections and visits.
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Affiliation(s)
- Yusuke Arai
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Hidenori Takahashi
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
- Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan;
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
- Correspondence: ; Tel.: +81-285-58-7382; Fax: +81-285-44-8365
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Shinichi Sakamoto
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Xue Tan
- Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan;
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Yuji Inoue
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Satoko Tominaga
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0431, Japan; (Y.A.); (S.I.); (S.S.); (Y.I.); (S.T.); (H.K.)
| | - Yasuo Yanagi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa 078-8802, Japan;
- Medical Retina, Singapore National Eye Centre, Singapore 168751, Singapore
- Medical Retina, Singapore Eye Research Institute, Singapore 168751, Singapore
- The Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
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6
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Modi YS, Klufas MA, Sridhar J, Singh RP, Yonekawa Y, Pecen P. Current Best Clinical Practices-Management of Retinal Vein Occlusion. JOURNAL OF VITREORETINAL DISEASES 2020; 4:214-219. [PMID: 37007445 PMCID: PMC9982258 DOI: 10.1177/2474126420906395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Retinal vein occlusion (RVO) is the second most common cause of vision loss from retinal vascular diseases in adults in the United States. Visual loss arises as a result of a host of factors, including macular ischemia and macular edema. Primary antivascular endothelial growth factor therapy is the current standard of care, with level I evidence demonstrating sustained visual gains up to 2 years after treatment in both branch and central RVO. Prompt antivascular endothelial growth factor therapy is important because delays in treatment yield lesser visual gains. Steroid therapy also improves visual outcomes in RVO but with higher rates of adverse effects, including cataract formation and ocular hypertension. Although the treatment burden can be high, these drugs have collectively revolutionized treatment outcomes in this disease state, providing improved visual outcomes over previous laser therapies.
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Affiliation(s)
- Yasha S. Modi
- Department of Ophthalmology, New York University School of
Medicine, New York, USA
| | - Michael A. Klufas
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital,
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia,
PA, USA
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute, University of Miami, Miami, FL,
USA
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute,
Cleveland Clinic, Cleveland, OH, USA
| | - Yoshihiro Yonekawa
- Mid Atlantic Retina, Retina Service, Wills Eye Hospital,
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia,
PA, USA
| | - Paula Pecen
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye
Center, University of Colorado, Aurora, CO, USA
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7
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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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8
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Hogg HJ, Di Simplicio S, Pearce MS. Ranibizumab and aflibercept intravitreal injection for treatment naïve and refractory macular oedema in branch retinal vein occlusion. Eur J Ophthalmol 2020; 31:548-555. [PMID: 32009462 DOI: 10.1177/1120672120904669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Branch retinal vein occlusion complicated by macular oedema is a common disease treated with intravitreal injection of anti-vascular endothelial growth factor. Controversy exists surrounding anti-vascular endothelial growth factor selection for both treatment naïve and refractory cases. METHODS A retrospective electronic medical record review at a single UK centre generated a cohort of 259 treatment naïve eyes from 258 patients receiving ranibizumab, aflibercept or a combination (n = 83, 97 and 79, respectively) from 2013 to 2018 with ⩾6 months follow-up. Number of intravitreal injections, visual acuity and macular oedema presence were noted at 3, 6, 12, 24, 36 and 48 months. A subgroup analysis examined refractory cases switched from ranibizumab to aflibercept (n = 77) or maintained on ranibizumab (n = 35). RESULTS Eyes receiving ranibizumab or aflibercept had equivocal vision gain at 1 year, 8.0 (95% CI 5.0-11.0) and 9.6 (7.2-12.1) Early Treatment of Diabetic Retinopathy Study letters, respectively. About 35.6% had no macular oedema at 12 months with ranibizumab compared with 50.0% with aflibercept (p = 0.07) following 5.1 (4.7-5.6) and 6.0 (5.6-6.4) intravitreal injections, respectively. Visual prognosis declined significantly as treatment delay extended (p = 0.003) which was only apparent with ⩾3 months delay. Eyes with refractory macular oedema also had equivocal functional and anatomical outcomes whether they were maintained on ranibizumab or switched to aflibercept. CONCLUSION These real world data demonstrate more modest clinical improvements from anti-vascular endothelial growth factor treatment than reported in clinical trials. The functional outcomes of ranibizumab and aflibercept in both treatment naïve and refractory cases were equivocal while the anatomical outcomes of aflibercept may be superior.
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Affiliation(s)
- Hd Jeffry Hogg
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Eye Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sandro Di Simplicio
- Newcastle Eye Centre, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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9
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Koki G, Aboubakar H, Biangoup Nyamsi P, Teperesna P, Nomo A, Epée E, Omgbwa Eballé A, Bella A, Ebana Mvogo C. Occlusions veineuses rétiniennes traitées par injections intra-vitréennes de bévacizumab à l’hôpital d’instruction, d’application et de référence des armées de Yaoundé. J Fr Ophtalmol 2020; 43:51-58. [DOI: 10.1016/j.jfo.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 08/05/2019] [Accepted: 08/20/2019] [Indexed: 10/25/2022]
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10
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Braimah IZ, Singh SR, Uplanchiwar B, Mansour AM, Chhablani J. Bevacizumab versus ziv-aflibercept in branch retinal vein occlusion. Indian J Ophthalmol 2019; 67:1109-1113. [PMID: 31238422 PMCID: PMC6611266 DOI: 10.4103/ijo.ijo_1532_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose: To compare the effectiveness of treatment with intravitreal bevacizumab (IVB) and ziv-aflibercept (IVZ) in patients with macular edema (ME) post-branch retinal vein occlusion (BRVO). Methods: Patients with treatment naïve ME post-BRVO were included retrospectively if they received either IVB (0.05 ml/1.25 mg) or IVZ (0.05 ml/1.25 mg) monotherapy with a follow up of 12 months. Results: Thirty-two and 17 eyes received IVB and IVZ, respectively. The mean improvement in best corrected visual acuity (BCVA) was 0.36 ± 0.3 logarithm of minimum angle of resolution (logMAR) in the IVB group and 0.27 ± 0.3 in the IVZ group (P = 0.35). The mean change in central macular thickness was 178.9 ± 180.9 and 173.5 ± 344.4 μm in IVB and IVZ groups, respectively (P = 0.94). The mean number of injections was higher in the IVB group (4.0 ± 1.8) compared with 1.82 ± 0.8 in the IVZ group (P < 0.0001). The IVZ group had significantly fewer number of visits (P < 0.0001) and longer maximum treatment-free intervals (P = 0.0081). Conclusion: IVZ appears to be cost-effective with the similar visual outcome and less number of visits in comparison to IVB.
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Affiliation(s)
- Imoro Z Braimah
- Department of Surgery, School of Medicine and Dentistry, University of Ghana; Eye Centre, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Hanumanthawaka Junction, Visakhapatnam, Andhra Pradesh, India
| | - Bhushan Uplanchiwar
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut; Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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11
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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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12
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Callizo J, Atili A, Striebe NA, Bemme S, Feltgen N, Hoerauf H, Bertelmann T. Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study. Graefes Arch Clin Exp Ophthalmol 2019; 257:913-920. [PMID: 30610424 DOI: 10.1007/s00417-018-04223-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2 weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38 weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated. RESULTS Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38 weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2 μm ± 138.4 μm and 538.9 μm ± 156.9 μm in BEV (P < 0.1697). At 38 weeks, CRT decreased in both groups significantly, 98.2 μm in the BEV + GRID (P = 0.02) and 141.7 μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3-6) with no significant difference between groups. CONCLUSIONS Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany.
| | - Abed Atili
- Augen Praxis Klinik Esslingen, Adler-Str6, 73728, Esslingen, Germany
| | - Nina Antonia Striebe
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
| | - Thomas Bertelmann
- Department of Ophthalmology, University Medical Center Goettingen, Robert-Koch-Str 40, 37075, Goettingen, Germany
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Nikkhah H, Karimi S, Ahmadieh H, Azarmina M, Abrishami M, Ahoor H, Alizadeh Y, Behboudi H, Daftarian N, Dehghan MH, Entezari M, Farrahi F, Ghanbari H, Falavarjani KG, Javadi MA, Karkhaneh R, Moradian S, Manaviat MR, Mehryar M, Nourinia R, Parvaresh MM, Ramezani A, Haghi AR, Riazi-Esfahani M, Soheilian M, Shahsavari M, Shahriari HA, Rajavi Z, Safi S, Shirvani A, Rahmani S, Sabbaghi H, Pakbin M, Kheiri B, Ziaei H. Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline. J Ophthalmic Vis Res 2018; 13:158-169. [PMID: 29719645 PMCID: PMC5905310 DOI: 10.4103/jovr.jovr_50_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/17/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy. METHODS Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations. RESULTS All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases. CONCLUSION The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.
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Affiliation(s)
- Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ahoor
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Alizadeh
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Reza Manaviat
- Department of Ophthalmology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Morsal Mehryar
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ramezani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Shahriari
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Saeed Rahmani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojgan Pakbin
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Outcome of “treat and monitor” regimen of aflibercept and ranibizumab in macular edema secondary to non-ischemic branch retinal vein occlusion. Int Ophthalmol 2017; 39:145-153. [DOI: 10.1007/s10792-017-0798-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
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15
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Tilgner E, Dalcegio Favretto M, Tuisl M, Wiedemann P, Rehak M. Macular cystic changes as predictive factor for the recurrence of macular oedema in branch retinal vein occlusion. Acta Ophthalmol 2017; 95:e592-e596. [PMID: 28266152 DOI: 10.1111/aos.13396] [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: 11/12/2015] [Accepted: 12/17/2016] [Indexed: 01/14/2023]
Abstract
AIM To evaluate the role of small cystic macular changes as a prognostic factor for the recurrence of macular oedema (ME) in patients with branch retinal vein occlusion (BRVO) treated with anti-VEGF drugs. METHODS We performed retrospective chart analysis of 116 patients treated with intravitreal injection of ranibizumab (IVR) or bevacizumab (IVB) for ME secondary to BRVO. At the baseline and monthly follow-up visits over a period of 12 months, a comprehensive ophthalmologic examination including best-corrected visual acuity (BCVA) and volume scan of macula using Spectral domain optical coherence tomography (SD-OCT) were performed. Patients without ME (CRT <250 μm) were screened for the presence of intraretinal cysts. In these patients, the changes in BCVA and CRT were evaluated over a period of 12 months and compared with the baseline. RESULTS In the IVR group (41 patients), 91 events of macular cysts, without a worsening of BCVA, were detected by OCT. In 89 of 91 events (97%), BCVA and CRT deteriorated significantly (p < 0.0001) within the next 4-11 (in mean 7.1 ± 2.0) weeks. BCVA decreased from 0.38 ± 0.25 to 0.49 ± 0.27 logMAR and CRT increased significantly from 223 ± 43 to 605 ± 244 μm. In the IVB group (19 patients), 54 events of cystic changes were detected. All of these patients showed significant worsening of BCVA from 0.40 ± 0.19 to 0.57 ± 0.22 logMAR and CRT from 251 ± 17 to 490 ± 147 μm within 4-10 (in mean 7.8 ± 2.8) weeks after the first presence of small macular cysts. CONCLUSION In BRVO patients treated with anti-VEGF drugs, the macular cystic changes may be used as an early indicator for impending recurrence of ME, with the decrease in BCVA in the following weeks. These patients should be scheduled for a next visit within 6-8 weeks.
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Affiliation(s)
- Eric Tilgner
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
| | - Maiara Dalcegio Favretto
- Department of Ophthalmology; São José Hospital - Dr Homero de Miranda Gomes Hospital; Santa Catarina Brazil
| | - Maria Tuisl
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
| | - Peter Wiedemann
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
| | - Matus Rehak
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
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Pierru A, Girmens JF, Héron E, Paques M. Occlusions veineuses rétiniennes. J Fr Ophtalmol 2017; 40:696-705. [DOI: 10.1016/j.jfo.2017.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
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Ivanovska Adjievska B, Boskurt S, Orovcanec N, Dimovska-Jordanova V. The outcome of low-frequency intravitreal bevacizumab therapy for macular edema in retinal vein occlusions. Clin Ophthalmol 2017; 11:1183-1190. [PMID: 28790803 PMCID: PMC5488787 DOI: 10.2147/opth.s137380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim We aimed to evaluate the 1-year efficacy and safety of low-frequency intravitreal bevacizumab in the treatment of macular edema due to retinal vein occlusions (RVOs). Methods The study comprised an interventional prospective study of patients with macular edema due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion, followed for 12 months. Treatment-naïve patients with reduced best-corrected visual acuity (BCVA) and central macular thickness (CMT) of at least 250 μm received intravitreal injection of bevacizumab. After 1 month, BCVA and optical coherence tomography (OCT) images of the macula were recorded. In patients with <30% improvement in BCVA and CMT, two more injections were applied at 1.5-month intervals. In all other patients, further injections were applied as needed. In cases with ischemic areas of retina, laser photocoagulation of the retina was performed. Results In total, 33 patients with CRVO and 55 with BRVO were treated. After 1 year, 65 eyes (73.86%) had clinically significant improvement of BCVA (>0.3 log of the minimum angle of resolution [logMAR] units) with average number of injections of 1.98. Improvement of mean BCVA in CRVO was significant (P=0.001) from baseline (1.2±0.95 logMAR units) to 1 year (0.75±0.6 logMAR units). Significant improvement of mean BCVA (P<0.001) was also found in BRVO, from 0.71±0.75 logMAR units at baseline to 0.28±0.5 logMAR units at 1 year. Baseline CMT was 852.21±298.20 μm for CRVO and 597.95±185.63 μm for BRVO. In both groups, there was significant decrease (P<0.001) in CMT after 1 year of treatment. Panretinal laser photocoagulation was done in 75.8% of all eyes with CRVO and sectoral photocoagulation in 49.1% of eyes with BRVO. Conclusion In macular edema due to RVO, intravitreal bevacizumab provides improvement in visual acuity and reduction of macular edema in a high percentage of treated eyes after 1 year, even with low number of injections.
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Affiliation(s)
| | - Salih Boskurt
- Department for Posterior Segment, European Eye Hospital, Skopje, Republic of Macedonia
| | - Nikola Orovcanec
- Department for Medical Statistics, Institute for Epidemiology and Medical Statistics, Medical Faculty, Skopje, Republic of Macedonia
| | - Vesna Dimovska-Jordanova
- Department for Retinal Diseases, University Clinic for Eyes Diseases, St Cyril and Methodius University, Skopje, Republic of Macedonia
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New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion. J Ophthalmol 2017; 2017:4936924. [PMID: 28386476 PMCID: PMC5366235 DOI: 10.1155/2017/4936924] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/07/2017] [Indexed: 12/15/2022] Open
Abstract
For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.
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Yoo JH, Ahn J, Oh J, Cha J, Kim SW. Risk factors of recurrence of macular oedema associated with branch retinal vein occlusion after intravitreal bevacizumab injection. Br J Ophthalmol 2017; 101:1334-1339. [PMID: 28232381 DOI: 10.1136/bjophthalmol-2016-309749] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/26/2016] [Accepted: 01/30/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify risk factors of recurrence of macular oedema in branch retinal vein occlusion (BRVO) after intravitreal bevacizumab (IVB) injection. METHODS The records of 63 patients who underwent IVB injection for macular oedema secondary to BRVO with at least 6 months of follow-up were reviewed. Patients were evaluated at baseline with fluorescein angiography (FA), optical coherence tomography (OCT) and ultra-wide-field fundus photography (WFP). During follow-up, OCT and WFP were repeated. The area of retinal haemorrhage, central retinal thickness (CRT), area (mm2) of capillary non-perfusion within the 1 mm (NPA1), 1-3 mm and 6 mm zones of the ETDRS circle, foveal capillary filling time, degree (°) of foveal capillary network destruction and FA pattern were analysed. RESULTS Macular oedema recurred in 41 of 63 (65.1%) eyes after initial IVB injection. A binary logistic regression model showed that NPA1 (OR=434.97; 95% CI=5.52 to 34262.12, p=0.006) and initial CRT (OR=1.004; 95% CI=1.000 to 1.008, p=0.015) were significantly associated with the recurrence of macular oedema. Receiver operating characteristic curve analysis identified an NPA1 of 0.36 mm2 (AUC: 0.735, sensitivity: 70.7%; specificity: 63.6%) and an initial CRT of 570 µm (AUC: 0.745, sensitivity: 63.4%; specificity: 77.3%) as cut-off values for predicting recurrence of macular oedema. CONCLUSIONS Patients with BRVO with non-perfusion of more than half of the 1 mm zone of the ETDRS circle or with an initial CRT >570 µm should be closely monitored for macular oedema recurrence within 6 months of IVB injection.
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Affiliation(s)
- Jun Ho Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Jaemoon Ahn
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Jaeryung Oh
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Jaehyung Cha
- Medical Science Research Center, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
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Abstract
PURPOSE To review the pathophysiology, diagnosis, and updated treatments of retinal vein occlusions (RVOs). METHODS A review of the literature was performed, focusing on the epidemiology, pathophysiology, diagnosis, and treatments (including both medical and surgical treatments) of RVO. Based on this review, a comprehensive overview was provided regarding the topic of RVO and focused on recent treatment updates. RESULTS Retinal vein occlusions have an age- and sex-standardized prevalence of 5.20 per 1,000 for any RVO, 4.42 per 1,000 for branch RVO, 0.80 per 1,000 for central RVO. Worldwide, an estimated 16.4 million adults are affected by RVOs, with 2.5 million affected by central RVO and 13.9 million affected by branch RVO. Retinal vein occlusion is recognized as an important cause of blindness and the diagnostic approaches and treatment options for RVO are reviewed and reported. The current treatment options including medical treatments (bevacizumab, ranibizumab, aflibercept, triamcinolone, and dexamethasone implants) and surgical alternatives were reviewed and reported with summaries on the corresponding strength of evidence. CONCLUSION Despite the understanding of this disease entity, challenges persist in the long-term treatment of RVO-related complications and visual loss. This review provided a detailed summary on the rationality and efficacy of recently developed treatment regimes and evaluated the potential benefit of combination therapy.
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Park J, Lee S, Son Y. Effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness and retinal vessel diameter in branch retinal vein occlusion. Int J Ophthalmol 2016; 9:999-1005. [PMID: 27500108 DOI: 10.18240/ijo.2016.07.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/21/2015] [Indexed: 01/05/2023] Open
Abstract
AIM To investigate the effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness (SFChT) and retinal vessel diameter in patients with branch retinal vein occlusion. METHODS An interventional, restrospective study of 41 eyes of 41 patients who had completed 12mo of follow-up, divided into group 1 (1.25 mg of bevacizumab, 21 eyes of 21 patients) and group 2 (2.5 mg of bevacizumab, 20 eyes of 21 patients). Complete ophthalmic examination, fluorescein angiography, enhanced depth imaging optical coherence tomography and measurement of retinal vessel diameter with IVAN software were performed at baseline and follow-up. RESULTS The SFChT changed from 279.1 (165-431) µm at baseline to 277.0 (149-413) µm at 12mo in group 1 (P=0.086), and from 301.4 (212-483) µm to 300.3 (199-514) µm in group 2 (P=0.076). The central retinal arteriolar equivalent (CRAE) changed from 128.8±11.2 µm at baseline to 134.5±8.4 µm at 12mo in group 1, and from 134.6±9.0 µm to 131.4±12.7 µm in group 2 (P=0.767). The central retinal venular equivalent (CRVE) changed from 204.1±24.4 µm at baseline to 196.3±28.2 µm at 12mo in group 1, and from 205.8±16.3 µm to 194.8±18.2 µm in group 2 (P=0.019). The mean central macular thickness (P<0.05) and average best-corrected visual acuity (BCVA; P<0.05) improved in both groups. CONCLUSION Changes in the SFChT are not statistically significant and not different according to the doses of bevacizumab. The CRAE did not show significant change, however, the CRVE showed significant decrease regardless of the dose.
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Affiliation(s)
- Jongyeop Park
- Department of Ophthalmology, Dongguk University Gyeongju Hospital, Gyeongju-si, Gyeongsangbuk-do 780-350, Korea
| | - Seungwoo Lee
- Department of Ophthalmology, Dongguk University Gyeongju Hospital, Gyeongju-si, Gyeongsangbuk-do 780-350, Korea
| | - Yengwoo Son
- Department of Ophthalmology, Dongguk University Gyeongju Hospital, Gyeongju-si, Gyeongsangbuk-do 780-350, Korea
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Moon J, Kim M, Sagong M. Combination therapy of intravitreal bevacizumab with single simultaneous posterior subtenon triamcinolone acetonide for macular edema due to branch retinal vein occlusion. Eye (Lond) 2016; 30:1084-90. [PMID: 27229707 DOI: 10.1038/eye.2016.96] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/23/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate efficacy and safety of combination therapy of intravitreal bevacizumab (IVB) with single simultaneous posterior subtenon triamcinolone acetonide (STA) for treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).MethodsThis was a prospective, randomized, interventional comparative study conducted in 45 eyes with ME secondary to BRVO who were treated primarily with IVB 1.25 mg (23 eyes, IVB group) or combination therapy of IVB 1.25 mg with a single simultaneous STA 40 mg (18 eyes, IVB/STA group). Reinjections were performed with IVB if optical coherence tomography (OCT) showed recurrent ME associated with decreased visual acuity. The main outcome measurement was the number of additional IVB injections, and changes of best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a 6-month follow-up period were compared.ResultsBCVA showed significant improvement in two groups at 6 months. In addition, CMT showed significant decrease in two groups at 6 months. No significant differences in the change of BCVA and CMT at 6 months after injection (P=0.973, P=0.639) were observed between the two groups. A statistically significant difference was found regarding the number of additional IVB injections (IVB group 0.96±0.83; IVB/STA group 0.44±0.70, P=0.034).ConclusionAlthough combination therapy of IVB with a single simultaneous STA for treatment of ME secondary to BRVO did not affect the visual outcomes compared with IVB monotherapy, it had a benefit of reducing the number of additional IVB injections.
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Affiliation(s)
- J Moon
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
| | - M Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
| | - M Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea
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Comparison of the Efficacy of Intravitreal Aflibercept and Bevacizumab for Macular Edema Secondary to Branch Retinal Vein Occlusion. J Ophthalmol 2016; 2016:8421940. [PMID: 27190640 PMCID: PMC4844878 DOI: 10.1155/2016/8421940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/21/2016] [Indexed: 11/17/2022] Open
Abstract
Fifty-two eyes of 52 patients with treatment-naïve macular edema associated with perfused branch retinal vein occlusion were retrospectively reviewed. Twenty-seven cases received PRN intravitreal bevacizumab, and 25 cases were treated by PRN intravitreal aflibercept with monthly follow-ups for 12 months. Both aflibercept and bevacizumab were effective in reduction of macular thickness and improvement of visual acuity for the participants. Both antivascular endothelial growth factor agents had similar efficacy and duration of treatment for these eyes with macular edema secondary to branch retinal vein occlusion during a 12-month period. No serious systemic or ocular adverse events were reported.
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Panakanti TK, Chhablani J. Clinical Trials in Branch Retinal Vein Occlusion. Middle East Afr J Ophthalmol 2016; 23:38-43. [PMID: 26957837 PMCID: PMC4759902 DOI: 10.4103/0974-9233.172294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disorder. The management of macular edema has changed considerably over time. The laser is considered the gold standard treatment for over two decades. However, visual recovery with laser is usually slow and incomplete. The advent of intravitreal agents, specifically anti-vascular endothelial growth factors (VEGF) have heralded a new era which promises rapid recovery of vision and quality of vision. Randomized clinical trials have reported optimal results with anti-VEGF agents (ranibizumab, bevacizumab, and aflibercept) compared to laser therapy or steroids. However, nearly 50% of the patients require repeat intravitreal anti-VEGF therapy up to 4 years after initiating therapy to sustain the visual gains. The adverse events (systemic and ocular) of these agents are minimal. Monotherapy with anti-VEGF agents have been found to provide better results than any combination with laser. This review article summarizes evidence from randomized controlled trials evaluating treatment options for the treatment of macular edema secondary to BRVO with a special focus on anti-VEGF therapy.
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Affiliation(s)
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
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Lee JY, Kim HC. Ganglion Cell Layer Thickness after Anti-Vascular Endothelial Growth Factor Treatment in Retinal Vein Occlusion. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.1.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Young Lee
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Chan Kim
- Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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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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Spectral domain optical coherence tomographic analysis of healthy retina in branch retinal vein occlusion and its response to antiangiogenic therapy. Retina 2015; 35:704-14. [PMID: 25313712 DOI: 10.1097/iae.0000000000000373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To propose a model that measures the effect of intravitreal bevacizumab (IVB) on relatively healthy retina. The purpose is to analyze the remote effect of a branch retinal vein occlusion in the healthy retina, to determine the response it may have to IVB, and to determine if IVB has an atrophic effect on the healthy retina. METHODS Retrospective, longitudinal comparative analysis of patients with branch retinal vein occlusion treated with IVB. Eyes were divided into experimental (branch retinal vein occlusion eye) and control (contralateral eye) groups. Each eye was analyzed for thickness and area. Thickness measurements were performed for total retinal thickness, inner retina thickness, and outer retina thickness. Area was measured for photoreceptors, choroid, and total retina. RESULTS Eighteen eyes of 9 patients. For thickness analysis, 1,050 scans were studied, and 126 measurements were performed on 42 scans for area analysis. No difference was observed for thickness, except for inner retina thickness. No difference was observed for area. No difference was observed when analyzing a cumulative exposure to IVB. CONCLUSION There is no evidence to suggest an atrophic effect caused by IVB when analyzing thickness or area in this experiment. This model could be used to analyze the long-term safety of IVB in larger studies.
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[Management of macular edema secondary to retinal vein occlusion]. J Fr Ophtalmol 2015; 38:253-63. [PMID: 25683131 DOI: 10.1016/j.jfo.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO. METHODS A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article. RESULTS The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters. DISCUSSION Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.
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Kwon SH, Shin JP, Kim IT, Park DH. Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.8.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Soo Hyun Kwon
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - In Taek Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Ho Park
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Keren S, Loewenstein A, Coscas G. Pathogenesis, prevention, diagnosis and management of retinal vein occlusion. World J Ophthalmol 2014; 4:92-112. [DOI: 10.5318/wjo.v4.i4.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/26/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Retinal vein occlusion (RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone (Ozurdex), bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.
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Parodi MB, Iacono P, Bandello F. Subthreshold grid laser versus intravitreal bevacizumab as second-line therapy for macular edema in branch retinal vein occlusion recurring after conventional grid laser treatment. Graefes Arch Clin Exp Ophthalmol 2014; 253:1647-51. [PMID: 25382074 DOI: 10.1007/s00417-014-2845-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/22/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To compare the effects of subthreshold grid laser treatment (SGLT) and intravitreal bevacizumab injection (IVBI) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) recurring after conventional grid laser photocoagulation. METHODS Thirty-five eyes were considered in this prospective, randomised, interventional study and treated with micropulse diode laser (SGLT subgroup) or IVBI (IVBI subgroup). SGLT was administered once, whereas IVBI (1.25 mg) was given at baseline and then on a pro re nata regimen according to ME presence on optical coherence tomography (OCT), performed at monthly examinations over a 12-month follow-up. Primary outcome measures were the mean BCVA changes over the follow-up and the decrease in mean central foveal thickness (CFT) on optical coherence tomography (OCT). Secondary outcomes included the proportion of eyes that gained at least 15 letters (approximately three lines) at the 12-month examination. RESULTS Eighteen and 17 patients were assigned to SGLT and IVBI subgroups, respectively. At baseline, the subgroups were similar with regard to mean ME duration, BCVA, and CFT. At month 12, mean CFT significantly improved from 484 μm to 271 μm in the IVBI subgroup, whereas it was unchanged in the SGLT subgroup. Mean BCVA changed from 0.92 ± 0.3 (LogMAR) to 0.99 ± 0.2 in the SGLT subgroup; in the IVBI subgroup, mean BCVA showed a statistically significant improvement from 0.94 ± 0.3 to 0.72 ± 0.2. Ten patients in the IVBI subgroup (58 %) and no patient in the SGLT subgroup gained at least three lines. CONCLUSION At the 1-year follow-up, IVBI provided a significant functional and anatomical improvement, whereas SGLT failed to demonstrate any beneficial effects. IVBI might be a useful approach in the treatment of recurrent ME secondary to BRVO already treated with conventional grid laser photocoagulation. UMIN registry, number UMIN000005014, URL: http://www.umin.ac.jp/ctr/index.htm.
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Affiliation(s)
- M Battaglia Parodi
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milano, Italy.
| | - P Iacono
- Fondazione G. B. Bietti per l'Oftalmologia, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Roma, Italy
| | - F Bandello
- Department of Ophthalmology, University Vita-Salute, San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milano, Italy
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Stewart MW. Review of the latest treatments for retinal vein occlusions: emphasis on pharmacologic therapy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.948423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sarao V, Bertoli F, Veritti D, Lanzetta P. Pharmacotherapy for treatment of retinal vein occlusion. Expert Opin Pharmacother 2014; 15:2373-84. [DOI: 10.1517/14656566.2014.956083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Valentina Sarao
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Federica Bertoli
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
| | - Daniele Veritti
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
| | - Paolo Lanzetta
- University of Udine, Department of Ophthalmology, Piazza Santa Maria della Misericordia, 33100 Udine, Italy ;
- Istituto Europeo di Microchirugia Oculare (IEMO), Udine, Italy
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