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Munk MR, Ceklic L, Stillenmunkes R, Chaudhary V, Waheed N, Chhablani J, de Smet MD, Tillmann A. Integrated Assessment of OCT, Multimodal Imaging, and Cytokine Markers for Predicting Treatment Responses in Retinal Vein Occlusion Associated Macular Edema: A Comparative Review of Anti-VEGF and Steroid Therapies. Diagnostics (Basel) 2024; 14:1983. [PMID: 39272767 PMCID: PMC11394301 DOI: 10.3390/diagnostics14171983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Retinal vein occlusion (RVO) is a significant cause of vision loss, characterized by the occlusion of retinal veins, leading to conditions such as central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Macular edema (ME), a prevalent consequence of RVO, is the primary cause of vision impairment in affected patients. Anti-VEGF agents have become the standard treatment, showing efficacy in improving visual acuity (VA) and reducing ME. However, a subset of patients exhibit a suboptimal response to anti-VEGF therapy, necessitating alternative treatments. Corticosteroids, which address inflammatory pathways implicated in ME, have shown promise, particularly in cases resistant to anti-VEGF. This review aims to identify biomarkers that predict treatment response to corticosteroids in RVO-associated ME, utilizing multimodal imaging and cytokine assessments. Baseline imaging, including SD-OCT and OCT-A, is essential for evaluating biomarkers like hyperreflective foci (HRF), serous retinal detachment (SRF), and central retinal thickness (CRT). Elevated cytokine levels, such as IL-6 and MCP-1, correlate with ME severity and poor anti-VEGF response. Early identification of these biomarkers can guide timely transitions to corticosteroid therapy, potentially enhancing treatment outcomes. The practical conclusion of this review is that integrating biomarker assessment into clinical practice enables personalized treatment decisions, allowing for earlier and more effective management of RVO-associated ME by transitioning patients to corticosteroid therapy when anti-VEGF agents are insufficient. Advanced diagnostics and machine learning may further refine personalized treatment strategies, improving the management of RVO-associated ME.
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Affiliation(s)
- Marion R Munk
- Augenarzt Praxisgemeinschaft Gutblick, 8808 Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
| | | | - Varun Chaudhary
- Department of Surgery, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Nadia Waheed
- Department of Ophthalmology, Tufts University Medical School, Boston, MA 02111, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marc D de Smet
- MicroInvasive Ocular Surgery Center, 1005 Lausanne, Switzerland
- Department of Ophthalmology, Leiden University, 2311 EZ Leiden, The Netherlands
- New York Eye and Ear Infirmary of Mt Sinai, Icahn School of Medicine, New York, NY 10029, USA
| | - Anne Tillmann
- Augenarzt Praxisgemeinschaft Gutblick, 8808 Pfäffikon, Switzerland
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Chatziralli I, Agapitou C, Dimitriou E, Kapsis P, Kazantzis D, Risi-Koziona A, Theodossiadis G, Theodossiadis P. Vitreoretinal Interface Abnormalities in Patients With Retinal Vein Occlusion in a Tertiary Referral Center. Cureus 2024; 16:e66638. [PMID: 39258085 PMCID: PMC11386936 DOI: 10.7759/cureus.66638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2024] [Indexed: 09/12/2024] Open
Abstract
PURPOSE The purpose of this study is to investigate the prevalence of vitreoretinal interface (VRI) disorders in patients with retinal vein occlusion (RVO) and to evaluate the impact of VRI abnormalities on the treatment outcomes of macular edema secondary to RVO using intravitreal aflibercept. METHODS Participants in this prospective study were consecutive patients with macular edema secondary to RVO, who received intravitreal aflibercept injections. At baseline, best-corrected visual acuity (BCVA) was assessed, and spectral domain-optical coherence tomography (SD-OCT) was performed to measure central subfield thickness (CST) and to evaluate the presence of VRI disorders, namely, vitreoretinal adhesion (VMA), vitreoretinal traction (VMT), epiretinal membrane (ERM), lamellar macular hole (LMH), and full-thickness macular hole (FTMH). The primary outcomes were the prevalence of various VRI disorders in patients with RVO and the impact of VRI disorders on BCVA and CST after aflibercept treatment in such patients. RESULTS At baseline, 16.1% of patients had VMA, 3.2% VMT, 18.3% ERM, and 1.1% LMH. There were a statistically significant improvement in BCVA and a decrease in CST in RVO patients over time. There was no statistically significant difference regarding BCVA and CST at baseline and until month 24 after treatment between patients with VRI disorders and those without VRI disorders. However, the mean number of injections during the follow-up period was higher in the group with VRI disorders (9.4±2.1) compared to those without VRI disorders (8.1±0.7, p=0.0002). CONCLUSIONS The prevalence of VRI disorders in patients with RVO was 16.1% for VMA, 3.2% for VMT, 18.3% for ERM, and 1.1% for LMH. VRI disorders were not found to affect the anatomical and visual outcomes after intravitreal aflibercept treatment in patients with RVO, although more intravitreal injections were needed in patients with VRI disorders.
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Affiliation(s)
- Irini Chatziralli
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Chrysa Agapitou
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Dimitriou
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Petros Kapsis
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Kazantzis
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexia Risi-Koziona
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Georgios Theodossiadis
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
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Alforja S, Hunt A, Nguyen V, O'Toole L, Gabrielle PH, Invernizzi A, Mehta H, Ponsioen TL, Squirrell D, Casaroli-Marano RP, Barthelmes D, Gillies MC, Zarranz-Ventura J. Three-Year Outcomes of VEGF Inhibitors in Naive Branch Retinal Vein Occlusion: Fight Retinal Blindness! Ophthalmol Retina 2024:S2468-6530(24)00189-1. [PMID: 38641007 DOI: 10.1016/j.oret.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To evaluate the 3-year outcomes of VEGF inhibitors in the treatment of cystoid macular edema due to branch retinal vein occlusion (BRVO) in an international multicenter cohort of eyes. DESIGN Multicenter, international, BRVO database study. SUBJECTS Seven hundred forty-seven patients (760 eyes) undergoing intravitreal therapy for BRVO for 3 years in a multicenter international setting. METHODS Demographics, visual acuity (VA) in logarithm of the minimum angle of resolution letters, central subfield thickness (CST), treatments, number of injections, and visits data was collected using a validated web-based tool. MAIN OUTCOME MEASURES Visual acuity gain at 3 years in logarithm of the minimum angle of resolution letters. Secondary outcome measures included anatomical results, treatment pattern, and percentage of completers. A subgroup analysis by study drug was conducted for clinical outcomes. RESULTS Mean adjusted VA change was +11 letters (95% confidence interval 9-13), mean adjusted change in CST was -176 μm (-193, -159). Median number of injections/visits was 16 of 24 at 3 years of follow-up. Most eyes received VEGF inhibitors exclusively (89%, n = 677) and as a monotherapy in 71% (n = 538). Few eyes were switched to steroids (11%, n = 83). Suspensions in treatment >180 days occurred in 26% of study eyes. Aflibercept showed greater CST reductions (-147 vs. -128 vs. -114 μm; P < 0.001) and significantly lower switching rates (14% vs. 38% vs. 33%; P < 0.001) compared with ranibizumab and bevacizumab, respectively. CONCLUSIONS This international study of 3-year BRVO outcomes after starting treatment with VEGF inhibitors found adequate visual and anatomical results in routine clinical care. Visual outcomes were similar among the different initiating VEGF inhibitors, although eyes starting with aflibercept had better anatomical outcomes and a lower switching rate. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Socorro Alforja
- Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Adrian Hunt
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Ophthalmology, Westmead Hospital, Westmead, Australia
| | - Vuong Nguyen
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | | | - Alessandro Invernizzi
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia; Eye Clínic, Department of Biomedical and Clinical Science "L. Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Hemal Mehta
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - David Squirrell
- Department of Ophthalmology, Greenlane Clinical Centre and District Health Board, Auckland, New Zealand
| | - Ricardo P Casaroli-Marano
- Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Barthelmes
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Ophthalmology, University Hospital of Zürich, Zürich, Switzerland
| | - Mark C Gillies
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Javier Zarranz-Ventura
- Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Department of Surgery, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
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The impact of laboratory findings and optical coherence tomography biomarkers on response to intravitreal anti-VEGF treatment in patients with retinal vein occlusion. Int Ophthalmol 2022; 42:3449-3457. [PMID: 35538256 DOI: 10.1007/s10792-022-02344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
AIMS To investigate potential laboratory and imaging biomarkers as treatment response predictors to intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in patients with retinal vein occlusion (RVO). METHODS Participants in this prospective study were 53 patients with treatment naïve macular edema secondary to RVO, treated with intravitreal anti-VEGF agents and followed-up for 12 months. At baseline, all participants underwent best-corrected visual acuity measurement, dilated fundoscopy, optical coherence tomography and fluorescein angiography (FFA), while full blood count and biochemical analysis of various parameters was also performed. At month 12, treatment response was examined and classified as "favorable" or "non-response". Potential associations between laboratory/imaging biomarkers and treatment response were assessed. RESULTS Univariate analysis showed that "favorable" response at month 12 after initiation of anti-VEGF treatment was correlated with baseline central subfield thickness (CST) < 464 μm (p < 0.001), absence of subretinal fluid (p = 0.004), absence of hyperreflective foci (HF) (p = 0.004), intact ellipsoid zone (EZ) and external limiting membrane (ELM) (p < 0.001 and p = 0.001, respectively), absence of epiretinal membrane (ERM) (p = 0.020) and absence of macular ischemia on FFA (p < 0.001), while increased monocytes-to-lymphocytes ratio was also associated with "favorable" treatment response (p = 0.010). All other laboratory parameters did not reach statistical significance. However, at the multivariate analysis, EZ and ELM status, HF, macular ischemia and monocytes-to-lymphocytes ratio were found to be independent predictors of treatment response. CONCLUSIONS Intact EZ and ELM, absence of HF, absence of macular ischemia and increased monocytes-to-lymphocytes ratio at baseline can predict "favorable" treatment response in patients with treatment naïve macular edema secondary to RVO.
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Zhou J, Ma H, Zhou X, Wang Q, Li W, Luo S, Cai C, Li Z, Liu D. Two-Week Central Macular Thickness Reduction Rate >37% Predicts the Long-Term Efficacy of Anti-vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion. Front Med (Lausanne) 2022; 9:851238. [PMID: 35355596 PMCID: PMC8959117 DOI: 10.3389/fmed.2022.851238] [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: 01/09/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo determine if the early response assessments can predict the long-term efficacy of anti-vascular endothelial growth factor (VEGF) treatment for macular edema secondary to retinal vein occlusion (RVO-ME).MethodsA retrospective study of patients with diagnosis of RVO-ME and intravitreal anti-VEGF treatment was conducted. Clinical characteristics including age, gender, disease subtype and disease duration were recorded at baseline. The best corrected visual acuity (BCVA and logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were recorded at baseline, 2 weeks, and every month (months 1–6) after injection. Further, we compared the early response assessments between the cured group (6-month CMT ≤ 250 μm) and the uncured group (6-month CMT > 250 μm).ResultsA total of 164 eyes in 164 patients (77 male and 87 female) were included. At each post-injection time point, both BCVA and CMT are significantly decreased from baseline (all P < 0.001). Spearman’s test showed that 2-week CMT reduction rate after the first injection was negatively correlated with BCVA at 6 months (r = −0.359, P < 0.001). Compared with the uncured group (47 cases), the cured group (117 cases) was younger (59.53 ± 11.68 vs. 65.19 ± 13.10 years old, P < 0.01), had more BRVO patients (76.1% vs. 44.7%, P < 0.01), a shorter disease duration (1.92 ± 2.43 vs. 5.05 ± 4.32 months, P < 0.01), lower baseline CMT (527.09 ± 154.95 vs. 768.96 ± 287.75 μm, P < 0.01), and lower baseline BCVA (0.86 ± 0.44 vs. 1.31 ± 0.51, P < 0.01). At each post-injection time point, the cured group had lower CMT and BCVA values when compared to the uncured group (all P < 0.01), and the 2-week CMT reduction rate was identified as the earliest response time to predict the long-term treatment efficacy. Moreover, ROC curve analysis indicated that a 2-week CMT reduction rate >37% yielded the best cut-off point for predicting the long-term cure of anti-VEGF treatment at 6 months (P < 0.001). Multivariable logistic regression confirmed that the 2-week CMT reduction rate >37% was independently associated with the 6-month cured rate (OR = 9.639, 95% Cl = 1.030–90.227, P = 0.047).ConclusionAge, disease duration, baseline CMT, and baseline BCVA are associated with visual outcomes at 6-month of anti-VEGF treatment for RVO-ME. The “2-week CMT reduction rate >37%” after the first injection is an independent factor to predict better long-term outcomes.
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Affiliation(s)
- Jialin Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huafeng Ma
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiyuan Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiuyu Wang
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weihou Li
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuai Luo
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Cai
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zefeng Li
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Danning Liu
- Department of Ophthalmology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Modi YS, Goduni L, Moini H, Gibson A, Boucher N, Lucas G, Dhoot DS. Antivascular Endothelial Growth Factor Dosing Frequency and Visual Outcomes in Macular Edema Following Central Retinal Vein Occlusion. JOURNAL OF VITREORETINAL DISEASES 2021; 5:505-512. [PMID: 37007170 PMCID: PMC9976151 DOI: 10.1177/2474126421989225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: We evaluated the relationship between dosing frequency of intravitreal antivascular endothelial growth factor (anti-VEGF) agents and visual acuity (VA) outcomes over 2 years in eyes with macular edema (ME) secondary to central retinal vein occlusion (CRVO) in the US routine clinical practice setting. Methods: This retrospective analysis assessed electronic medical records of eyes with ME secondary to CRVO that received their first anti-VEGF injection January 1, 2012, to May 31, 2016, and were followed for 1 year or more in the US-based Vestrum Health Treatment and Outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤6 or ≥7 injections/year). Results: Overall, 851 (34.6%) of 2458 eyes with ME secondary to CRVO received 6 or fewer injections, and 1607 (65.4%) received 7 or more injections through 1 year. The mean number of injections in patients receiving 6 or fewer injections and 7 or more injections was 4.7 and 8.8, respectively, and baseline mean VA was 35 and 37 letters, respectively. At year 1, mean letter gain from baseline was less in eyes receiving 6 or fewer injections vs in those receiving 7 or more injections (7.0 vs 12.2, P < .001). Mean VA at year 2 was 50 letters in eyes receiving 6 or fewer injections (n = 50) and 55 letters in eyes receiving 7 or more injections (n = 157). Conclusions: In routine clinical practice, more frequent dosing with anti-VEGF agents was associated with greater visual benefits in eyes with ME secondary to CRVO.
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Affiliation(s)
- Yasha S. Modi
- New York University Langone Health, New York, NY, USA
| | | | - Hadi Moini
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | | | - Dilsher S. Dhoot
- California Retina Consultants/Retina Consultants of America, Santa Barbara, CA, USA
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Changes in Macular Microvascular Structure in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Antivascular Endothelial Growth Factor for One Year. J Ophthalmol 2021; 2021:6645452. [PMID: 34055397 PMCID: PMC8149245 DOI: 10.1155/2021/6645452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To observe the changes in macular microvascular structure and the correlation between anatomy and visual function in patients with macular edema secondary to branch retinal vein occlusion (BRVO) treated with antivascular endothelial growth factor for one year. Methods This prospective study enrolled 39 patients (one eye per patient) who received intravitreal injections of ranibizumab for macular edema secondary to BRVO. All patients received a minimum of 3 initial monthly ranibizumab injections and criteria-driven pro re nata (PRN) dosing thereafter for visual acuity (VA) and central retinal thickness (CRT) stabilization. The follow-up period of this study was one year. The vascular density (VD) of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP), the foveal avascular zone (FAZ) area, the FAZ perimeter, the VD within a 300 μm wide ring surrounding the FAZ (FD-300), and the acircularity index (AI) were measured automatically by optical coherence tomography angiography (OCTA) at baseline, month 6, and month 12. Results Compared with those before treatment, the VD of the SCP significantly decreased 6 months after treatment (P < 0.05), while the area and perimeter of the FAZ increased significantly (P < 0.01). After 12 months of treatment, the area and perimeter of the FAZ increased significantly (P < 0.01). There was no significant difference in any parameters between 12 months and 6 months after treatment (P > 0.05). The change in BCVA was negatively correlated with the VD of the SCP at 12 months (P=0.0447, r = -0.3233). There was a relationship between the DBP and AI, and CRT was related to VD of DCP at baseline (P=0.028, 0.0209; r = 0.383, -0.384). The PERIM and AI at 12 months were significantly associated with the recurrence of macular edema, and the changes in vascular density in the SCP and PERIM were significantly associated with the number of injections within 12 months (P < 0.05). Conclusions One year after ranibizumab treatment, the area and perimeter of the FAZ were enlarged, while the VD of the SCP and DCP remained stable, which indicated that ranibizumab treatment did not improve macular blood supply and macular ischemia in BRVO patients.
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Yuksel B, Karti O, Celik O, Kerci SG, Kusbeci T. Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion. Clin Exp Optom 2021; 101:116-122. [DOI: 10.1111/cxo.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Bora Yuksel
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Ozan Celik
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | | | - Tuncay Kusbeci
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
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Costa JV, Moura-Coelho N, Abreu AC, Neves P, Ornelas M, Furtado MJ. Macular edema secondary to retinal vein occlusion in a real-life setting: a multicenter, nationwide, 3-year follow-up study. Graefes Arch Clin Exp Ophthalmol 2020; 259:343-350. [PMID: 32965652 DOI: 10.1007/s00417-020-04932-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/30/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the presence of macular edema secondary to retinal vein occlusion (RVO)-both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-3 years after diagnosis in patients who underwent intravitreal therapy and to identify potential prognostic factors and biomarkers of persistent macular edema. METHODS National multicenter, observational, exploratory, retrospective cohort study of 104 consecutive patients with macular edema secondary to RVO diagnosed from January 2014 to December 2015 with minimum 3-year follow-up time. Data analyzed included best-corrected visual acuity (BCVA), clinical and demographic data, and spectral domain optical coherence tomography parameters. RESULTS At final observation, median baseline central retinal thickness significantly improved from baseline 538 to 290 μm (p < 0.001) and complete macular edema resolution was achieved in 51.0% of patients (56.3% and 42.5% in BRVO and CRVO patients, respectively). BCVA also improved (p < 0.01). Logistic regression analysis revealed a relationship between recurrence of macular edema and disorganization of retinal inner layers (DRIL) at baseline (odds ratio = 2.88; p = 0.013). CONCLUSION Good long-term anatomical and functional outcomes are achieved with intravitreal treatments in RVO patients. Anatomical success and visual gains seen in the first year were maintained throughout the entire follow-up, though DRIL is a major risk factor for recurrence.
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Affiliation(s)
- Jorge Vasco Costa
- Ophthalmology Department, Hospital de Braga, Sete Fontes - São Vítor, 4710-243, Braga, Portugal.
| | - Nuno Moura-Coelho
- Ophthalmology Department, Centro Hospitalar Universitário Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisboa, Portugal
| | - Ana Carolina Abreu
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Pedro Neves
- Ophthalmology Department, Centro Hospitalar de Setúbal, R. Camilo Castelo Branco 175, 2910-549, Setúbal, Portugal
| | - Mário Ornelas
- Ophthalmology Department, Centro Hospitalar de Setúbal, R. Camilo Castelo Branco 175, 2910-549, Setúbal, Portugal
| | - Maria João Furtado
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Mir TA, Thomas AS, Yoon SP, Birnbaum F, Goerlitz-Jessen M, Fekrat S. Eyes With Acute, Treatment-Naïve CRVO and Foveal Intraretinal Hemorrhage: Characteristics and Outcomes. Ophthalmic Surg Lasers Imaging Retina 2020; 50:752-759. [PMID: 31877220 DOI: 10.3928/23258160-20191119-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare outcomes in eyes with central retinal vein occlusion (CRVO) presenting with (group 1) or without (group 2) fovea-involving intraretinal hemorrhage (IRH). PATIENTS AND METHODS Retrospective review of patients diagnosed with acute, treatment-naïve CRVO between January 2009 and July 2016. RESULTS One hundred fifteen (39.8%) of 289 CRVO eyes had fovea-involving IRH. At baseline, eyes in group 1 had significantly worse visual acuity (VA) (1.2 ± 0.10 logMAR vs. 0.9 ± 0.06 logMAR; P = .001) and greater central subfield thickness (CST) (610.4 μm ± 35.9 μm vs. 435.0 μm + 21.6 μm; P < .001) than eyes in group 2. Final visual outcomes were comparable between groups (1.24 ± 0.09 logMAR vs. 1.02 ± 0.08 logMAR; P = .08). Group 1 received a significantly greater number of intravitreal anti-vascular endothelial growth factor injections during the first year (7.80 ± 0.40 vs. 5.20 ± 0.40; P = .001). CONCLUSIONS Although treatment-naïve eyes with acute CRVO and fovea-involving IRH had worse VA and greater CST at presentation, the final VA was comparable to eyes without such a hemorrhage. Eyes with foveal IRH had a greater treatment burden in the first 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:752-759.].
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OCT angiography features associated with macular edema recurrence after intravitreal bevacizumab treatment in branch retinal vein occlusion. Sci Rep 2019; 9:14153. [PMID: 31578437 PMCID: PMC6775095 DOI: 10.1038/s41598-019-50637-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 09/17/2019] [Indexed: 11/24/2022] Open
Abstract
We aimed to evaluate the relationship between the capillary abnormalities including nonperfusion area (NPA) in optical coherence tomography angiography (OCTA) images and the recurrence of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF; bevacizumab). The records of 40 patients who underwent intravitreal bevacizumab injection for ME secondary to BRVO and had at least six months of follow-up were reviewed. Central retinal thickness (CRT; μm) and macular edema type were evaluated prior to treatment. After ME resolution, nonperfusion areas in the 1 mm (NPA1) and 1–3 mm (NPA3) zones on the Early Treatment Diabetic Retinopathy Study (ETDRS) circle within the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were measured using OCTA images. Furthermore, other microvascular abnormalities in the both SCP and DCP were compared between groups. ME recurred in 25 of 40 (62.5%) eyes. The NPA1 of the SCP and DCP (p = 0.002, 0.004, respectively), NPA3 of the SCP and DCP (p = 0.002, 0.008, respectively), and initial CRT (p = 0.022) differed significantly between eyes with and without ME recurrence. In multivariate logistic regression analyses, the NPA1 of the DCP (OR: 344.718; p = 0.029) and NPA3 of the SCP (OR: 4.072; p = 0.018) were significantly associated with ME recurrence. Other microvascular abnormalities were not significantly different between two groups. The central NPA and parafoveal NPA of the SCP in OCTA images correlated strongly with ME recurrence in BRVO patients after intravitreal anti-VEGF injection.
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Wei Q, Chen R, Lou Q, Yu J. Intravitreal corticosteroid implant vs intravitreal ranibizumab for the treatment of macular edema: a meta-analysis of randomized controlled trials. Drug Des Devel Ther 2019; 13:301-307. [PMID: 30666092 PMCID: PMC6333386 DOI: 10.2147/dddt.s184520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to compare the efficacy and safety of corticosteroid implant and intravitreal ranibizumab for the treatment of macular edema (ME). MATERIALS AND METHODS PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were comprehensively searched for studies comparing dexamethasone implant with ranibizumab in patients with ME. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and adverse events were extracted from the final eligible studies. RevMan 5.3 software was used to analyze the data, and the modified Jadad assessment tool was used to access the quality of outcomes. RESULTS Three randomized controlled trials (RCTs) were included in our analysis. The types of causes of ME include central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and diabetic retinopathy (DR). The ranibizumab treatment group had significantly better BCVA compared with the corticosteroid treatment group (standard mean difference [SMD] -0.80; 95% CI -1.08, -0.53; P<0.00001). The ranibizumab treatment group also had higher CST reduction compared with the corticosteroid treatment group, and there was a significant difference (weighted mean difference [WMD] 167.58; 95% CI 125.21-209.95; P<0.00001). There was no significant difference in serious adverse effects between the two groups (SMD 1.67; 95% CI 0.69, 4.05; P=0.26). However, the use of corticosteroid implant had a higher risk of intraocular pressure (IOP) (OR 6.88; 95% CI 4.53-10.44; P<0.00001) elevation and cataract (OR 3.98; 95% CI 1.89-8.37; P=0.0003) than ranibizumab treatment and fewer injections. CONCLUSIONS Compared with ranibizumab, corticosteroid implant did not have greater improved BCVA, but corticosteroid implant had less CST reduction. The advantages of corticosteroids are fewer injections, while the advantages of ranibizumab include fewer side effects.
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Affiliation(s)
- Qingquan Wei
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
| | - Rui Chen
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
| | - Qiyang Lou
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
| | - Jing Yu
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
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BETTER PROGNOSIS FOR EYES WITH PRESERVED FOVEAL DEPRESSION AFTER INTRAVITREAL RANIBIZUMAB INJECTION FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION. Retina 2018; 38:1354-1360. [PMID: 28538263 DOI: 10.1097/iae.0000000000001707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the prognosis of eyes with central retinal vein occlusion that had a preserved foveal depression at the baseline and were treated by intravitreal ranibizumab injections (IRIs). METHODS The authors reviewed the medical records of 23 eyes of 23 consecutive treatment-naive patients who received IRIs to treat the macular edema due to central retinal vein occlusion. Eyes were classified by the pre-IRI presence or absence of a foveal depression. A foveal depression was defined as a central foveal thickness that was <50 μm thinner than the average thickness at 200 μm temporal and nasal to the central fovea. The characteristics of the two groups were compared. RESULTS Seven of 23 eyes had a preserved foveal depression before the IRI. The mean number of injections within 12 months after the initial IRI was significantly fewer (P < 0.001) in eyes with foveal depression (1.6 ± 0.5) than in eyes without foveal depression (4.3 ± 1.3). The mean best-corrected visual acuity at 12 months after the initial IRI was significantly better (P = 0.003) in eyes with foveal depression (0.10 ± 0.17 logarithm of the minimum angle of resolution [logMAR] units; 20/25 Snellen units) than in eyes without foveal depression (0.77 ± 0.54 logMAR units; 20/118 Snellen units). CONCLUSION These results indicate that the prognosis is better for eyes with a foveal depression before the IRI treatment for a macular edema secondary to central retinal vein occlusion.
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RANIBIZUMAB FOR RETINAL VEIN OCCLUSION: Predictive Factors and Long-Term Outcomes in Real-Life Data. Retina 2018; 38:559-568. [PMID: 28248827 DOI: 10.1097/iae.0000000000001579] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with retinal vein occlusion (RVO), either central retinal vein occlusion or branch retinal vein occlusion, treated with intravitreal ranibizumab and to determine the predictive factors of the final visual outcome. METHODS This retrospective study included 54 treatment-naive patients with macular edema due to RVO (25 with central retinal vein occlusion and 29 with branch retinal vein occlusion), who were treated with intravitreal ranibizumab (3 monthly injections and pro re nata). Predictive factors for visual outcome were assessed. In addition, the best-corrected visual acuity change and the percentage of patients with edema resolution were evaluated. RESULTS The mean follow-up time was 47.4 ± 11.1 months. At the end of the follow-up, patients with central retinal vein occlusion gained +6.9 letters (∼1 Snellen line), whereas patients with branch retinal vein occlusion gained +15.1 letters (3 Snellen lines). Forty-eight percent of patients in central retinal vein occlusion group and 69.0% in branch retinal vein occlusion group presented resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, the presence of intraretinal fluid, the duration of RVO >3 months, the ischemic type of RVO, the cystoid type of edema, and the external limiting membrane and ellipsoid zone disruption. CONCLUSION The various predictive factors that determine the visual outcome and possibly define the patients' prognosis after ranibizumab treatment in RVO have been studied. The long follow-up period showed that ranibizumab seems to be safe and effective in the treatment of the disease.
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Rayess N, Rahimy E, Ying GS, Pefkianaki M, Franklin J, Regillo CD, Ho AC, Hsu J. Baseline choroidal thickness as a short-term predictor of visual acuity improvement following antivascular endothelial growth factor therapy in branch retinal vein occlusion. Br J Ophthalmol 2018; 103:55-59. [PMID: 29567791 DOI: 10.1136/bjophthalmol-2018-311898] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/19/2018] [Accepted: 03/05/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the association between subfoveal choroidal thickness (SFCT) and branch retinal vein occlusion (BRVO) eyes treated with antivascular endothelial growth factor (anti-VEGF) therapy. METHODS Retrospective cohort study of treatment naïve BRVO eyes treated with 3 monthly anti-VEGF injections. All patients received enhanced depth imaging spectral-domain optical coherence tomography scans to determine SFCT and central macular thickness (CMT). Baseline predictors (particularly SFCT) for functional response (best-corrected visual acuity (BCVA) gain ≥2 lines) were assessed at 3 months using univariate and multivariate analyses. RESULTS Forty eyes from 39 patients were included. Mean baseline SFCT was higher in functional responders (240.4±73.1 µm), compared with both non-responders (193.3±63.6 µm; p=0.036) and their corresponding fellow eye (202.2±67.1 µm; p=0.022). A higher baseline SFCT (for every 100 µm increase in SFCT) was found to be a positive predictor for functional response (regression coefficient: 1.1; p=0.03) on univariate analysis but not multivariate analysis. A worse baseline BCVA (for every 0.1 logMAR increase) was a positive predictor for visual improvement with an adjusted OR of 1.30 (95% CI 1.03 to 1.63; p=0.0009) on multivariate analysis. CONCLUSIONS Patients with BRVO with a worse initial BCVA are most likely to achieve visual improvement following anti-VEGF therapy. Additionally, baseline SFCT may also help predict which patients with BRVO have favourable visual outcomes. Patients with an initial choroidal thickness thicker than their fellow eye are more likely to have short-term visual improvement following treatment.
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Affiliation(s)
- Nadim Rayess
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Ehsan Rahimy
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Pefkianaki
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Jason Franklin
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Carl D Regillo
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Allen C Ho
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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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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Kanra AY, Ardagil Akçakaya A, Arı Yaylalı S, Altınel MG, Sevimli N. The Efficacy and Safety of Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Related to Retinal Vein Occlusion: Real-life Data and Prognostic Factors in a Turkish Population. Turk J Ophthalmol 2017; 47:331-337. [PMID: 29326850 PMCID: PMC5758768 DOI: 10.4274/tjo.75317] [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] [Received: 12/30/2016] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives: To evaluate the efficacy and safety of dexamethasone (DEX) implants as mono or combination therapy for macular edema in retinal vein occlusion (RVO) with real-life conditions, and to detect factors that influence final visual acuity. Materials and Methods: Twenty-five eyes with macular edema secondary to RVO underwent assessments for central macular thickness (CMT), best-corrected visual acuity (BCVA), adverse events, and also morphologic changes in optical coherence tomography at an interval of 4-8 weeks after at least one DEX implant. Results: Seventeen eyes with branch RVO and 8 eyes with central RVO were eligible for the study. The mean follow-up duration was 17 months (range, 12-26 months). Both mean BCVA (p=0.009) and CMT (p=0.006) improved significantly, and visual gains of ≥3 lines were achieved in 32% and ≥2 lines in 52% at the end of the follow-up period. The most powerful individual predictor of final visual acuity was baseline BCVA (r2=0.611, p<0.001, stepwise multiple regression), but the most efficient model was the combination of the ellipsoid zone (EZ) integrity and baseline BCVA (r2=0.766, p<0.001, stepwise multiple regression). Complication rates were very low after repeated DEX implants. Conclusion: DEX implant seems to be an effective and safe treatment for macular edema in RVO despite negative real-life factors, and visual outcomes are associated with baseline visual acuity and EZ integrity.
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Affiliation(s)
- Ayşe Yağmur Kanra
- University of Health Sciences, Ümraniye Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Aylin Ardagil Akçakaya
- Medeniyet University, Göztepe Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Sevil Arı Yaylalı
- Medeniyet University, Göztepe Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Meltem Güzin Altınel
- University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Department of Ophthalmology, İstanbul, Turkey
| | - Neslihan Sevimli
- Sultanbeyli State Hospital, Ophthalmology Clinic, İstanbul, Turkey
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Chatziralli I, Theodossiadis P, Parikakis E, Dimitriou E, Xirou T, Theodossiadis G, Kabanarou SΑ. Dexamethasone Intravitreal Implant in Diabetic Macular Edema: Real-Life Data from a Prospective Study and Predictive Factors for Visual Outcome. Diabetes Ther 2017; 8:1393-1404. [PMID: 29110201 PMCID: PMC5688995 DOI: 10.1007/s13300-017-0332-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implant and to determine the predictive factors for the final visual outcome. METHODS The study included 54 patients with DME refractory to previous antivascular endothelial growth factor (anti-VEGF) who were treated with intravitreal dexamethasone implant. Predictive factors for visual outcome were assessed. In addition, the change in best-corrected visual acuity (BCVA) and the percentage of patients with edema resolution were evaluated. RESULTS At the end of the 12-month follow-up, patients with DME gained + 5.2 letters (about 1 Snellen line), while 57.4% of patients presented total resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, phakic status, the presence of intraretinal fluid, hyperreflective foci, hard exudates, as well as external limiting membrane and ellipsoid zone disruption. The mean number of injections was 2.1. CONCLUSIONS The various predictive factors that determine the visual outcome and possibly define patient prognosis after dexamethasone intravitreal implant in DME cases have been studied. The long follow-up showed that dexamethasone intravitreal implant seems to be a safe and effective treatment for this disease, requiring a limited number of injections.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Dimitriou
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tina Xirou
- Retina Department, Red Cross "Korgialeneio-Benakeio" Hospital, Athens, Greece
| | - George Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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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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Chatziralli I, Theodossiadis G, Moschos MM, Mitropoulos P, Theodossiadis P. Ranibizumab vs. Aflibercept for Macular Edema due to Central Retinal Vein Occlusion. Ophthalmol Retina 2017; 1:355-356. [PMID: 31047523 DOI: 10.1016/j.oret.2016.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 06/09/2023]
Affiliation(s)
- Irini Chatziralli
- Second Department of Ophthalmology, Attikon Hospital, University of Athens, Athens, Greece.
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Ranibizumab versus dexamethasone implant for central retinal vein occlusion: the RANIDEX study. Graefes Arch Clin Exp Ophthalmol 2017; 255:1899-1905. [PMID: 28620704 DOI: 10.1007/s00417-017-3719-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/27/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To compare intravitreal ranibizumab and dexamethasone implant in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). METHODS Participants were 42 treatment naive patients with ME due to CRVO, who received either intravitreal 0.5 mg ranibizumab (n = 25) or intravitreal 0.7 mg dexamethasone implant (n = 17). The main outcomes included the mean change in best corrected visual acuity (BCVA) and central subfield thickness (CST) at month 12 compared to baseline in the two groups. RESULTS At month 12, there was no statistically significant difference in BCVA and CST change between the two groups. However, there was recurrence in ME at month 5 in the dexamethasone group. CONCLUSIONS Both ranibizumab and dexamethasone implant were found to be safe and effective at the 12-month follow-up in patients with ME secondary to CRVO. Since there was a recurrence in ME at month 5 in the dexamethasone group, we suggested that intravitreal injection of dexamethasone implant should be potentially administered sooner than 6 months.
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Li F, Sun M, Guo J, Ma A, Zhao B. Comparison of Conbercept with Ranibizumab for the Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion. Curr Eye Res 2017; 42:1174-1178. [PMID: 28441077 DOI: 10.1080/02713683.2017.1285943] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To confirm the therapeutic efficacy of conbercept for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS In this prospective, randomized, and comparative study, patients were randomized and divided into conbercept (n = 18) and ranibizumab (n = 17) groups. After an initial intravitreal injection of either conbercept or ranibizumab, a pro re nata (PRN) strategy was adopted based on loss of visual acuity (VA) or increase in central macular thickness (CMT). RESULTS All patients were followed for ≥6 months. Baseline best-corrected visual acuities (BCVAs) were 0.67 ± 0.37 and 0.511 ± 0.23 logMAR in the conbercept and ranibizumab groups, respectively (p = 0.087, t-test). Baseline CMTs were 512.5 ± 115.22 and 491.23 ± 114.72 µm in the conbercept and ranibizumab groups, respectively (p = 0.993, t-test). Significant improvements in BCVA and reduction of CMT were observed in both groups at each follow-up visit and compared to baseline values (p < 0.05, t-test). No significant differences in improvement of BCVA (p > 0.05, t-test) or reduction of CMT (p > 0.05, t-test) were noted in either group. Mean numbers of injections were 2.28 ± 0.96 and 2.65 ± 1.17 for the conbercept and ranibizumab groups, respectively (p = 0.478, t-test), with no statistically significant differences between the two groups. CONCLUSION Intravitreal injection of conbercept is shown to be safe and effective for the treatment of ME secondary to BRVO, based on 6-month follow-up data.
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Affiliation(s)
- Fengjiao Li
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Ming Sun
- Department of Ophthalmology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Jianlian Guo
- Department of Ophthalmology, Jinan Eighth People’s Hospital, Jinan, China
| | - Aihua Ma
- Department of Pediatrics, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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23
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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: 31] [Impact Index Per Article: 4.4] [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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24
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Chatziralli I, Theodossiadis G, Moschos MM, Mitropoulos P, Theodossiadis P. Ranibizumab versus aflibercept for macular edema due to central retinal vein occlusion: 18-month results in real-life data. Graefes Arch Clin Exp Ophthalmol 2017; 255:1093-1100. [PMID: 28214955 DOI: 10.1007/s00417-017-3613-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/18/2017] [Accepted: 02/06/2017] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The objective of this study was to compare the anatomical and functional outcomes of ranibizumab versus aflibercept for the treatment of macular edema due to central retinal vein occlusion (CRVO) in routine clinical practice. METHODS Participants in this observational study included 62 treatment-naïve patients with CRVO who received intravitreal injections of either ranibizumab or aflibercept. The demographic data, best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) characteristics were evaluated at baseline and at months 1, 2, 3, 6, 12 and 18 post-treatment. RESULTS At month 18, the mean BCVA of ranibizumab-treated eyes increased 7.9 letters, compared to 7.4 letters for eyes receiving aflibercept, with a similar number of injections. There was no statistically significant difference between the two groups in letters or in central subfield thickness at month 18. At the end of the follow-up, 50% of patients in the ranibizumab group and 42.9% in the aflibercept group showed complete resolution of macular edema. CONCLUSIONS Ranibizumab and aflibercept demonstrated similar anatomical and functional outcomes over 18-month follow-up in patients with macular edema due to CRVO, with a similar number of injections.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, Attikon Hospital, University of Athens, 28, Papanastasiou street, Agios Dimitrios, 17342, Athens, Greece.
| | | | | | | | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, Attikon Hospital, University of Athens, 28, Papanastasiou street, Agios Dimitrios, 17342, Athens, Greece
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