Ranibizumab and retinal photocoagulation in the treatment of ischemic retinal vein occlusion

Introduction. This investigation was focused on the post-RVO (retinal vein occlusion) macular edema treatment in cases with peripheral retinal ischemia, and on methods to estimate the ischemic area. Aim. To develop an examination and treatment algorithm for patients with chronic macular edema due to ischemic RVO. Material and methods. A prospective non-randomized study included 250 patients with RVO, the mean follow-up was 24.5 ± 6.5 months. Results. The drop-out of retinal capillary perfusion was detected in 175 patients (70 %). Peripheral ischemia was found in 125 cases, that is in 50% of all RVO patients and 71.4 % of all patients with ischemia. The mean number of ranibizumab injections performed after retinal photocoagulation was 2.9 ± 1.4. Patients treated with ranibizumab monotherapy for 24 months received 10.6 ± 2.5 intravitreal injections. Conclusions. The combination of ranibizumab intravitreal injections with retinal photocoagulation in the capillary non-perfusion areas can significantly reduce the number of injections and reduce the amount of neovascular complications.

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Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes

Journal of Ophthalmology ◽

10.1155/2020/7817542 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Emilia Maggio ◽

Maurizio Mete ◽

Giorgia Maraone ◽

Marcella Attanasio ◽

Massimo Guerriero ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Clinical Setting ◽

Real Life ◽

Intravitreal Injections ◽

Intravitreal Ranibizumab ◽

Vein Occlusion ◽

The Mean ◽

Number Of Injections

Purpose. To report the long-term visual and anatomic outcomes of intravitreal injections for macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-life clinical setting. Design. Retrospective interventional case series. Methods. A total of 223 consecutive eyes with ME secondary to RVO, treated with the first three intravitreal Ranibizumab or dexamethasone injections between August 2008 and September 2018, were enrolled in the study. Subsequent retreatment was guided by best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurements, aimed at achieving macular fluid regression and BCVA stability. BCVA and CMT were recorded at baseline and at subsequent annual time points. The mean number of injections administered each year and the incidence of adverse events were recorded. Results. The mean BCVA and CMT at baseline were 0.79 logMar (SD 0.71) and 615.7 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p<0.0001) and 401.04 μm (SD 183.8; p<0.0001). Improvements remained significant at the final FU visit. Eyes with BRVO and nonischemic RVO showed significantly better visual outcomes when compared to eyes with CRVO and ischemic RVO, over the entire FU period. An average of 4.08 (SD 2.1) Ranibizumab and 1.5 (SD 0.6) Ozurdex injections were administered over the first 12 months. The number of injections decreased thereafter progressively. One eye with CRVO developed endophthalmitis and one with BRVO developed an intraocular pressure increase that was refractory to topical medications and ultimately treated with trabeculectomy. Conclusion. Intravitreal Ranibizumab and/or dexamethasone injections were found to be effective at inducing a long-lasting improvement of BCVA and CMT in a real-life clinical setting. A safety profile similar to that already well-established in Ranibizumab and dexamethasone treatment was observed, as well as a steady decrease in the number of intraocular injections required. The results support intravitreal treatments for BRVO and CRVO in patient populations with similar characteristics in similar settings.

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Sub-optimal gain in vision in retinal vein occlusion due to under-treatment in the real world: results from an open-label prospective study of Intravitreal Ranibizumab

BMC Ophthalmology ◽

10.1186/s12886-020-01757-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Raja Narayanan ◽

Aditya Kelkar ◽

Zahir Abbas ◽

Neha Goel ◽

Manoj Soman ◽

...

Keyword(s):

Clinical Trials ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Real World ◽

Intravitreal Injections ◽

Open Label ◽

Intravitreal Ranibizumab ◽

The Real ◽

Vein Occlusion ◽

The Mean

Abstract Background Macular edema secondary to retinal vein occlusion (RVO) is an important cause of loss of vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) are the standard of care in this disease, as shown in numerous randomized controlled trials. The purpose of this study was to study the efficacy and safety of ranibizumab, an anti-VEGF agent, in the real-world setting. Methods This was 48 weeks, open-label, prospective, multicentre, observational study. Patients diagnosed with ME secondary to RVO were treated with IVI of Ranibizumab 0.5 mg in real-world conditions. Efficacy was measured by improvement seen in best-corrected visual acuity (BCVA) in terms of Early Treatment of Diabetic Retinopathy Study (ETDRS) Letter Scores and change in central retinal thickness (CRT) measured by optical coherence tomography. Results One hundred eyes of 100 patients (79 with branch retinal vein occlusion and 21 with central retinal vein occlusion) were recruited in the study. The mean (standard deviation, SD) BCVA was 52.8 (21.99) letters at baseline and 62.3 (24.40) letters at week 48. From baseline, there was a significant improvement in BCVA by 7.7 letters (p = 0.001) at 48 weeks. The mean (SD) of CRT was 479.9 (216.25) μm at baseline and it decreased significantly to 284.9 (171.35) μm at week 48 (p < 0.001). During the study period, the average number of intravitreal injections was 3.5 per patient. There was no report of endophthalmitis in any eye. Conclusions Ranibizumab is well tolerated and effective in treating macular edema secondary to RVO in real-world clinical settings. However, there is under-treatment compared to controlled clinical trials, and the gain in vision is sub-optimal with under-treatment. Trial registration Clinical Trials Registry - India: CTRI/2015/07/005985.

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Correlation between macular vessel density and number of intravitreal anti-VEGF agents for macular edema associated with branch retinal vein occlusion

Scientific Reports ◽

10.1038/s41598-019-52732-2 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Ryo Tomita ◽

Takeshi Iwase ◽

Kensuke Goto ◽

Kentaro Yamamoto ◽

Eimei Ra ◽

...

Keyword(s):

Regression Analysis ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Vessel Density ◽

Intravitreal Injections ◽

Systemic Hypertension ◽

Vein Occlusion ◽

Anti Vegf ◽

The Mean

Abstract We evaluated whether the reduction of macular vessel density was correlated with the number of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents in eyes with a branch retinal vein occlusion (BRVO). The mean vessel density was determined by optical coherence tomography angiography in 29 eyes with macular edema associated with a BRVO. Our results showed that the mean vessel density in the group that had a resolution of the macular edema after one anti-VEGF injection was significantly higher than group that had a recurrence of the macular edema (P = 0.028). Single regression analysis showed that the number of intravitreal injections was significantly correlated with the reduction of the modified vessel density (r = −0.421, P = 0.023) and systemic hypertension (r = 0.377, P = 0.044). Multiple stepwise regression analysis showed that the reduction of the modified vessel density (β = −0.442, P = 0.009) and hypertension (β = 0.403, P = 0.016) were independent factors associated with the number of intravitreal injections. We conclude that the vessel density reduction can be used to predict whether recurrences of the macular edema will develop after the initial anti-VEGF injection in eyes with macular edema associated with a BRVO.

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Treatment of macular edema due to branch retinal vein occlusion with single or multiple intravitreal injections of bevacizumab

Japanese Journal of Ophthalmology ◽

10.1007/s10384-011-0114-3 ◽

2012 ◽

Vol 56 (2) ◽

pp. 159-164 ◽

Cited By ~ 13

Author(s):

Tatsuya Yunoki ◽

Akio Miyakoshi ◽

Tomoko Nakamura ◽

Kazuya Fujita ◽

Chiharu Fuchizawa ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Intravitreal Injections ◽

Vein Occlusion

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EFFICACY OF COMBINED INTRAVITREAL INJECTIONS OF BEVACIZUMAB AND TRIAMCINOLONE ACETONIDE IN PATIENTS WITH NON-RESOLVING MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

10.36106/ijar/6801974 ◽

2021 ◽

pp. 48-49

Author(s):

Haniyaa Mufti ◽

Syed Tariq Qureshi ◽

Birjees Hakak

Keyword(s):

Combination Therapy ◽

Macular Edema ◽

Triamcinolone Acetonide ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Common Adverse Effect ◽

Visual Outcome ◽

Intravitreal Injections ◽

Therapeutic Effects ◽

Vein Occlusion

Purpose: To study the effects of combined intravitreal injections of bevacizumab (IVB) and triamcinolone acetonide (IVTA) in patients with non-resolving macular edema (ME) secondary to Branch Retinal Vein Occlusion (BRVO). Methods: In a prospective observational study, 50 pseudophakic eyes of BRVO patients with non-resolving central macular edema who had received more than 3 doses of IVB previously were injected with combination therapy of 1.25 mg/0.05 ml IVB and 4 mg of IVTA and followed up for 6 months with best corrected visual acuity(BCVA), intraocular pressure(IOP) and central macular thickness(CMT) Results: The mean BCVA was logMAR 0.75±0.25 at baseline and 0.65±0.15, 0.48±0.20, and 0.22±0.25 at 6weeks, 3 months and 6 months respectively. Mean CMT at baseline was 668.32±254.66 and 434.43±99.55, 243.22±58.92, and 220.83±42.60 at 6 weeks, 3 months and 6 months respectively. Baseline IOP measured was 16.5±3.1 mmHg which progressed to 19.6±3.4mmHg and 21.4±2.8mmHg at 6 weeks and 3 months respectively and decreased to 17.3±2.2 at 6 months. The most common adverse effect seen was increase in IOP in 24(48%)patients, out of which 3(6%) patients needed to start anti-glaucoma medication (AGM). 3(6%) patients had sub-conjunctival hemorrhage(SCH). Conclusion: The prolonged therapeutic effects of combination therapy leads to outstanding anatomical and visual outcome in non resolving ME due to BRVO, with fewer doses and thus fewer adverse effects.

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Intravitreal injections during COVID-19 outbreak: Real-world experience from an Italian tertiary referral center

European Journal of Ophthalmology ◽

10.1177/1120672120962032 ◽

2020 ◽

pp. 112067212096203

Author(s):

Adriano Carnevali ◽

Giuseppe Giannaccare ◽

Valentina Gatti ◽

Gianfranco Scuteri ◽

Giorgio Randazzo ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Real World ◽

Intravitreal Injections ◽

Tertiary Referral ◽

Priority Level ◽

Tertiary Referral Center ◽

Vein Occlusion ◽

Treatment Priority ◽

Priority Levels

We report our experience during COVID-19 outbreak for intravitreal injections in patients with maculopathy. We proposed a treatment priority levels and timings; the “High” priority level includes all monocular patients; the “Moderate” is assigned to all patients with an active macular neovascularization; the patients affected by diabetic macular edema or retinal vein occlusion belong to the “Low” class. This organization allowed us to treat the most urgent patients although the injections performed had a 91.7% drop compared to the same period of 2019.

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INTRAVITREAL INJECTIONS OF ZIV-AFLIBERCEPT FOR THE TREATMENT OF A PATIENT WITH MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

Retinal Cases & Brief Reports ◽

10.1097/icb.0000000000000449 ◽

2018 ◽

Vol 12 (2) ◽

pp. 93-96 ◽

Cited By ~ 2

Author(s):

Gabriel Costa de Andrade ◽

João Rafael de Oliveira Dias ◽

André Maia ◽

Michel Eid Farah ◽

Somaia Mitne ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Intravitreal Injections ◽

Vein Occlusion

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Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study

Journal of Clinical Medicine ◽

10.3390/jcm9082360 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2360

Author(s):

Yusuke Arai ◽

Hidenori Takahashi ◽

Satoru Inoda ◽

Shinichi Sakamoto ◽

Xue Tan ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Treat And Extend ◽

Vein Occlusion ◽

Corrected Visual Acuity ◽

Intravitreal Aflibercept ◽

Central Subfield Thickness ◽

The Mean ◽

First Recurrence

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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The Difference Of Visual Acuity And Macular Thickness Post Bevacizumab Therapy In Secondary Macular Edema Retinal Vein Occlusion

Journal of Agromedicine and Medical Sciences ◽

10.19184/ams.v4i2.7875 ◽

2018 ◽

Vol 4 (2) ◽

pp. 110

Author(s):

Citra Rahmadani ◽

Nur Khoma Fatmawati ◽

Rahmat Bakhtiar

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Secondary Data ◽

Macular Thickness ◽

Vein Occlusion ◽

Before And After ◽

Quasi Experimental ◽

The Mean ◽

The Difference

Retinal vein occlusion is the second most common cause of blindness in retinal vascular disease after diabetic retinopathy and may lead to complications of macular edema. Bevacizumab is an influential treatment as an anti vascular endothelial growth factor (VEGF). This study aims to determine the difference of visual acuity and macular thickness before and after treatment of Bevacizumab. This is a quasi experimental study in patients with secondary macular edema retinal vein occlusion who meets the inclusion criteria. Visual acuity and macular thickness were evaluated after one month of treatment. This study was conducted for two months since May-June 2017 by collecting secondary data from medical record at SMEC Samarinda from January 2016 – June 2017. Data were analyzed using Wilcoxon. Sixteen eyes from 16 patients were diagnosed with macular edema secondary retinal vein occlusion given bevacizumab treatment. The mean visual acuity before therapy was 1.106 LogMAR ± 0.509 and increased to 0.889 logMAR ± 0.608 (p = 0.116) after treatment while the mean macular thickness before therapy was 504.06 μm ± 301.273 and decreased to 348.81 μm ± 181.17 (p = 0.017) after treatment. There was a significant effect on the decrease in macular thickness but no significant effect on visual acuity improvement in patients with macular edema secondary retinal vein occlusion at SMEC Samarinda. Keywords: Retinal vein occlusion, macular edema, bevacizumab

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Comparison of ranibizumab and subthreshold micropulse laser in treatment of macular edema secondary to branch retinal vein occlusion

European Journal of Ophthalmology ◽

10.1177/1120672117750056 ◽

2018 ◽

Vol 28 (6) ◽

pp. 690-696 ◽

Cited By ~ 2

Author(s):

Yelda Buyru Özkurt ◽

Sezen Akkaya ◽

Sibel Aksoy ◽

Mert Hakan Şimşek

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Laser Treatment ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Intravitreal Ranibizumab ◽

Micropulse Laser ◽

Vein Occlusion ◽

Subthreshold Micropulse Laser ◽

The Mean

Purpose: To compare the effects of intravitreal ranibizumab injection and yellow (577 nm) subthreshold micropulse laser treatment in patients with macular edema following non-ischemic branch retinal vein occlusion. Methods: The medical records of 51 patients who underwent intravitreal ranibizumab (0.5 mg) injection or subthreshold micropulse laser for the treatment of macular edema due to branch retinal vein occlusion were retrospectively reviewed. Subthreshold micropulse laser was administered with a 10% duty cycle, 100 μm spot diameter, 200 ms exposure time. The patients received an injection or laser treatment at baseline and were, then, retreated as needed and were followed for 12 months. The mean best corrected visual acuity changes over the follow-up and the decrease in the mean central macular thickness were evaluated. Results: A total of 27 and 24 patients were assigned to intravitreal ranibizumab and subthreshold micropulse laser subgroups, respectively. The mean number of treatment was 3.81 of intravitreal ranibizumab group and 1.5 of subthreshold micropulse laser group (p < 0.05). The subgroups were similar with regard to the mean score of best corrected visual acuity at baseline, at 1, 6, and 12 months (p > 0.05). The decrease in the mean central macular thickness was significant in both intravitreal ranibizumab and subthreshold micropulse laser groups at 1, 6, and 12 months than that of values at baseline (p < 0.05). No new ocular or systemic adverse events were observed. Conclusion: Our study results showed that intravitreal ranibizumab or yellow subthreshold micropulse laser treatment for macular edema due to branch retinal vein occlusion was not found to be superior to each other for reducing macular thickness and increasing visual acuity for 1-year period. Based on these results, subthreshold micropulse laser may be a useful alternative approach in the treatment of macular edema secondary to branch retinal vein occlusion.

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