Combination of Ranibizumab with macular laser for macular edema secondary to branch retinal vein occlusion: one-year results from a randomized controlled double-blind trial

Abstract ObjectiveTo determine whether switching intravitreal injections of ranibizumab or aflibercept to the other will affect the interval of subsequent injections in patients with macular edema secondary to branch retinal vein occlusion (BRVO).ResultsThe medical charts of 16 eyes of 16 patients were reviewed. After injections of ranibizumab or aflibercept for >3 times/year, the type of anti-vascular endothelial growth factor agent was switched. A comparison was made of the average injection interval for the one year before switching and the interval of the first two injections post-switching. In the group that switched from ranibizumab to aflibercept (R to A group, n=8), the interval before was 85.4±6.6 days which was significantly increased to 125.9±23.2 days post-switching (P=0.0013). In the A to R group (n=8), a significant shortening from 103.9±11.8 days before to 85.9±12.6 days was observed (P=0.007). In the R to A group, the central retinal thickness at a recurrence was 522.1±79.6 µm which decreased significantly to 419.3±64.5 µm post-switching (P=0.005). The results suggest that the intervals can be different between ranibizumab and aflibercept in patients with macular edema secondary to BRVO who required repeat injections.

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Internal Limiting Membrane (ILM) Peeling for Macular Edema Secondary to Branch Retinal Vein Occlusion (BRVO)

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i1.1144 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Hussain Ahmad Khaqan ◽

Usman Imtiaz ◽

Hasnain Muhammad Baksh ◽

Hafiz Ateeq Ur Rehman ◽

Raheela Naz

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Internal Limiting Membrane ◽

Brilliant Blue ◽

Ilm Peeling ◽

Vein Occlusion ◽

Pars Plana ◽

One Year

Purpose: To find out the anatomic and functional outcomes of pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling in patients with refractory macular edema associated with branch retinal vein occlusion (BRVO). Study Design: Interventional case series. Place and Duration of Study: Ophthalmology department at Lahore General Hospital, Lahore from 2015 to 2019. Methods: Fifty-five eyes of patients presenting with refractory macular edema associated with branch retinal vein occlusion (BRVO) were recruited for this study. They were treated using 23-gauge pars plana vitrectomy and Brilliant Blue Green assisted internal limiting membrane peeling. Pre-operative and post-operative best-corrected visual acuity (BCVA) and macular edema were assessed by fluorescein angiography and optical coherence tomography (OCT). Monthly follow up was continued for one year. Results: In 46 (83.6%) eyes, central macular thickness improved from 465 ± 91 µm at baseline to 295 ± 103 µm post-operatively, (P < 0.003) at one year of followup. In nine (16.3%) eyes, there was no improvement in central macular thickness. Improvement in best-corrected visual acuity (BCVA) was seen in 43 (78.1%) eyes. Out of these 43 eyes, 37 (86%) eyes had mean 3 Snellen lines improvement while six (13.9%) eyes had 2.4 Snellen lines improvement. In 12 eyes (21.8%) BCVA did not improve. No statistically significant difference was seen in post-operative BCVA between ischemic and non-ischemic BRVO (p > 0.05). Conclusion: Twenty-three gauge vitrectomy with Brilliant Blue Green (BBG) assisted ILM peeling is effective in reducing refractory macular edema and improves visual acuity in ischemic and non-ischemic BRVO. Key Words: Internal limiting membrane, Macular edema, Retinal vein occlusion, Brilliant Blue Green.

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