Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in Central Retinal Vein Occlusion : Are Loading Dose Necessary ?

Background : Ranibizumab (anti-VEGF) given monthly for six doses, is effective in central retinal vein occlusion (CRVO). However, the cost and adherence to complete Ranibizumab regiment is a burden for developing countries. Aim : To present two CRVO cases with satisfactory outcome after partial regiment of ranibizumab injections. Case presentation : A 52-year old male came with sudden, painless visual decline of the left eye (LE). Best corrected visual acuity (BCVA) was 0.4. Relative afferent pupillary defect (RAPD) was positive on LE. Anterior segment was normal. Fundus examination revealed a cup-disc ratio (CDR) of 0.4, macular edema (ME), scattered hemorrhages, dilated and tortuous retinal veins. Patient was diagnosed with CRVO and was given two monthly injections before stopping treatment. Patient came with worsened VA, was then given another injection. After 6 months, his BCVA was 0.8. Similarly, a 32- year old male came with sudden painless decline of vision of LE (BCVA 0.15). Anterior segment was normal. Fundus examination showed CDR of 0.3, ME, multiple scattered pre-retinal hemorrhages, dilated and tortuous retinal veins. Patient was similarly diagnosed with CRVO of LE and given two monthly injections. Final BCVA after six months follow-up was 0.9. Conclusion : Both cases showed improvement in VA despite having partial regiment of ranibizumab injections.

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Treatment Patterns and Clinical Outcomes for Central Retinal Vein Occlusion in the Antivascular Endothelial Growth Factor Era

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419878922 ◽

2019 ◽

Vol 4 (1) ◽

pp. 13-21

Author(s):

Jeannette Y. Stallworth ◽

Akshay S. Thomas ◽

Ryan Constantine ◽

Sandra S. Stinnett ◽

Sharon Fekrat

Keyword(s):

Growth Factor ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Treatment Patterns ◽

Vein Occlusion ◽

Anti Vegf ◽

Antivascular Endothelial Growth Factor ◽

Endothelial Growth Factor ◽

Central Retinal Vein

Purpose: This article describes treatment patterns and visual outcomes for central retinal vein occlusion (CRVO) in the antivascular endothelial growth factor (anti-VEGF) era. Methods: A retrospective cohort study of eyes diagnosed with CRVO between 2009 and 2016 was conducted. Treatment history and visual acuity (VA) measurements were abstracted from medical records and analyzed. Results: A total of 476 eyes of 476 patients (median age 67 years, median follow-up 25.4 months) were included. Optical coherence tomography was obtained in 93.9% and fluorescein angiography in 80% of cases on presentation. Mean VA at presentation and final visit was 20/60 and 20/94, respectively, for eyes with nonischemic CRVO, whereas that of ischemic cases remained worse than 20/800 at final follow-up. Intravitreal bevacizumab was the most common first treatment (42.2%). Intravitreal steroid was the first treatment in 3.6% and ultimately administered in 11.3% of eyes. In the first year, an average of 5.2 ± 3.6 and 2.2 ± 3.4 anti-VEGF injections were given in treatment-naive and nontreatment-naive eyes, respectively. Conclusions: In our real-world cohort, anti-VEGF injection burden and frequency are lower than in published clinical trials. Visual outcomes in both ischemic and nonischemic eyes with CRVO are poorer than expected and worse than those recorded in controlled trial settings.

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The clinical relevance of ultra-widefield angiography findings in patients with central retinal vein occlusion and macular oedema receiving anti-VEGF therapy

Eye ◽

10.1038/s41433-021-01553-7 ◽

2021 ◽

Author(s):

Luke Nicholson ◽

Clara Vazquez-Alfageme ◽

Piyali Sen ◽

Namritha V. Patrao ◽

Tunde Peto ◽

...

Keyword(s):

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Macular Oedema ◽

Anterior Segment ◽

Posterior Pole ◽

Vein Occlusion ◽

Anti Vegf ◽

Area Distribution ◽

Prospective Longitudinal ◽

Central Retinal Vein

Abstract Aims To report, using ultra-widefield angiography (UWFA) the area, distribution, and change in retinal capillary nonperfusion (RCNP) at baseline and 100 weeks in eyes with central retinal vein occlusion (CRVO) receiving anti-VEGF for macula oedema. Methods Prospective longitudinal multi-centre cohort study. Adults with CRVO treated with anti-VEGF therapy for macular oedema underwent UWFA at baseline and week-100. The area, distribution, and change in total, peripheral and posterior pole RCNP were determined. Results Of 153 eyes at baseline, mean area of RCNP was 34.3DA and 12 (7.8%) had ≥75DA RCNP. More than 10DA RCNP was present in the temporal periphery in 75.8% of eyes vs. 10.5% in the nasal periphery. At week-100, mean RCNP was 42.1DA with a median change from baseline of 3.3DA 95% CI [0.4, 7.3]; p < 0.01. Of 146 eyes with ≤10DA of posterior pole RCNP at baseline, 16/146 (11.0%) progressed to >10DA at week-100. These eyes had a median increase in total RCNP of 69.7DA [95% CI 27.2–85.4] vs 0DA [0.0–1.4]; p < 0.001 for those who did not, and two developed neovascular glaucoma. Larger baseline area of RCNP and history of glaucoma were risk factors for posterior pole RCNP developing. Conclusions With UWFA, significant baseline RCNP was identified in the majority of CRVO patients, notably in the temporal periphery, but large increases over 100 weeks were uncommon. Development of >10DA posterior pole RCNP is a marker for widespread RCNP and in such cases the risk of anterior segment neovascularisation is not abolished by concomitant anti-VEGF therapy.

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Effect of Intravitreal Anti-Vascular Endothelial Growth Factor Treatment on the Retinal Gene Expression in Acute Experimental Central Retinal Vein Occlusion

Ophthalmic Research ◽

10.1159/000330279 ◽

2012 ◽

Vol 47 (3) ◽

pp. 157-162 ◽

Cited By ~ 8

Author(s):

Franziska Drechsler ◽

Patricia Köferl ◽

Margrit Hollborn ◽

Peter Wiedemann ◽

Andreas Bringmann ◽

...

Keyword(s):

Gene Expression ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Vascular Endothelial ◽

Vein Occlusion ◽

Endothelial Growth Factor ◽

Central Retinal Vein ◽

Growth Factor Treatment

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Verteporfin photodynamic therapy for anterior segment neovascularization secondary to ischaemic central retinal vein occlusion

Clinical and Experimental Ophthalmology ◽

10.1111/j.1442-9071.2008.01723.x ◽

2008 ◽

Vol 36 (3) ◽

pp. 232-237 ◽

Cited By ~ 4

Author(s):

Maurizio Battaglia Parodi ◽

Pierluigi Iacono ◽

Giuseppe Ravalico

Keyword(s):

Photodynamic Therapy ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Anterior Segment ◽

Vein Occlusion ◽

Central Retinal Vein

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Correlation from Undiluted Vitreous Cytokines of Untreated Central Retinal Vein Occlusion with Spectral Domain Optical Coherence Tomography

The Open Ophthalmology Journal ◽

10.2174/1874364101307010011 ◽

2013 ◽

Vol 7 (1) ◽

pp. 11-17 ◽

Cited By ~ 6

Author(s):

MJ Koss ◽

M Pfister ◽

F Rothweiler ◽

R Rejdak ◽

R Ribeiro ◽

...

Keyword(s):

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Serous Retinal Detachment ◽

Monocyte Chemoattractant Protein 1 ◽

Vein Occlusion ◽

Treatment Naïve ◽

23 Gauge ◽

Endothelial Growth Factor ◽

Central Retinal Vein ◽

Sd Oct

Purpose: To correlate inflammatory and proangiogenic key cytokines from undiluted vitreous of treatment-naïve central retinal vein occlusion (CRVO) patients with SD-OCT parameters. Methods: Thirty-five patients (age 71.1 years, 24 phakic, 30 nonischemic) underwent intravitreal combination therapy, including a single-site 23-gauge core vitrectomy. Twenty-eight samples from patients with idiopathic, non-uveitis floaterectomy served as controls. Interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF-A) levels were correlated with the visual acuity (logMar), category of CRVO (ischemic or nonischemic) and morphologic parameters, such as central macular thickness-CMT, thickness of neurosensory retina-TNeuro, extent of serous retinal detachment-SRT and disintegrity of the IS/OS and others. Results: The mean IL-6 was 64.7pg/ml (SD ± 115.8), MCP-1 1015.7 ( ± 970.1), and VEGF-A 278.4 ( ± 512.8), which was significantly higher than the control IL-6 6.2 ± 3.4pg/ml (P=0.06), MCP-1 253.2 ± 73.5 (P<0.0000001) and VEGF-A 7.0 ± 4.9 (P<0.0006). All cytokines correlated highly with one another (correlation coefficient r=0.82 for IL-6 and MCP-1; r=0.68 for Il-6 and VEGF-A; r=0.64 for MCP-1 and VEGF-A). IL-6 correlated significantly with CMT, TRT, SRT, dIS/OS, and dELM. MCP-1 correlated significantly with SRT, dIS/OS, and dELM. VEGF-A correlated not with changes in SD-OCT, while it had a trend to be higher in the ischemic versus the nonischemic CRVO group (P=0.09). Conclusions: The inflammatory cytokines were more often correlated with morphologic changes assessed by SD-OCT, whereas VEGF-A did not correlate with CRVO-associated changes in SD-OCT. VEGF inhibition alone may not be sufficient in decreasing the inflammatory response in CRVO therapy.

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Potential Anti-Vascular Endothelial Growth Factor Therapies for Central Retinal Vein Occlusion

Drugs ◽

10.2165/11640820-000000000-00000 ◽

2012 ◽

Vol 72 (16) ◽

pp. 2063-2071 ◽

Cited By ~ 3

Author(s):

Marta S. Figueroa ◽

Inés Contreras

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Vascular Endothelial ◽

Vein Occlusion ◽

Endothelial Growth Factor ◽

Central Retinal Vein

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The Effect of Antivascular Endothelial Growth Factor Therapy on the Development of Neovascular Glaucoma after Central Retinal Vein Occlusion: A Retrospective Analysis

Journal of Ophthalmology ◽

10.1155/2014/317694 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Christina L. Ryu ◽

Adrian Elfersy ◽

Uday Desai ◽

Thomas Hessburg ◽

Paul Edwards ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Central Retinal Vein Occlusion ◽

Significant Risk ◽

Case Series ◽

Neovascular Glaucoma ◽

Vein Occlusion ◽

Anti Vegf ◽

Central Retinal Vein

Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes.Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG.Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average.Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes.

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Tractional retinal detachment (‘crunch’ phenomenon) from intravitreal anti-vascular endothelial growth factor injection in central retinal vein occlusion

BMJ Case Reports ◽

10.1136/bcr-2020-240506 ◽

2021 ◽

Vol 14 (4) ◽

pp. e240506

Author(s):

Albert John Bromeo ◽

Amadeo Veloso ◽

Sweet Jorlene Lerit ◽

Myron Carlo Gomez

Keyword(s):

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Retinal Detachment ◽

Central Retinal Vein Occlusion ◽

Vascular Endothelial ◽

Tractional Retinal Detachment ◽

Vein Occlusion ◽

Anti Vegf ◽

Endothelial Growth Factor ◽

Central Retinal Vein

Tractional retinal detachment is an uncommon complication of intravitreal anti-vascular endothelial growth factor (VEGF) injection wherein the drug triggers tractional retinal detachment as a result of fibrovascular membrane contraction. We present a case of a 42-year-old hypertensive woman diagnosed with chronic central retinal vein occlusion on both eyes. The right eye had total retinal detachment and neovascular glaucoma, while the left eye had retinal neovascularisation. Panretinal photocoagulation and intravitreal anti-VEGF injection was started on the left eye. However, she was lost to follow-up. She returned 4 months later with extensive tractional retinal detachment involving the macula on the left eye. She subsequently underwent vitrectomy with endolaser and silicone oil tamponade on the left eye. The anti-VEGF ‘crunch’ results from regression of fibrovascular proliferation with a concurrent increase in fibrosis, resulting in worsening retinal traction. With the widespread use of anti-VEGF agents, ophthalmologists need to be aware of this vision-threatening complication.

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