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Murakami T, Okamoto F, Sugiura Y, Morikawa S, Okamoto Y, Hiraoka T, Oshika T. Contrast sensitivity and quality of life following intravitreal ranibizumab injection for central retinal vein occlusion. Br J Ophthalmol 2023; 107:254-260. [PMID: 34452939 DOI: 10.1136/bjophthalmol-2021-319863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/17/2021] [Indexed: 01/27/2023]
Abstract
SYNOPSIS/PRECIS We investigated the relationship between contrast sensitivity (CS) and vision-related quality of life (VR-QOL) in patients with central retinal vein occlusion following ranibizumab intravitreal injection; CS showed a stronger association with VR-QOL than visual acuity. BACKGROUND/AIMS To investigate the relationship between CS, VR-QOL and optical coherence tomography (OCT) findings in patients with cystoid macular oedema secondary to central retinal vein occlusion (CRVO-CMO) following intravitreal injection of ranibizumab. METHODS This was a multicentre, open-label, single-arm, prospective study. The study included 23 patients with CRVO-CMO who were followed up for 12 months after treatment. The best-corrected visual acuity (BCVA), letter contrast sensitivity (LCS) and OCT images were obtained every month. For VR-QOL assessment, the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was administered to the patients before treatment and at 3, 6 and 12 months following treatment. RESULTS The LCS and VFQ-25 composite score improved significantly from baseline to 12 months following treatment. The multiple regression analysis revealed that the LCS of the affected eye and BCVA of the fellow eye were related to the VFQ-25 composite score following treatment. The LCS improvement showed a significant correlation with the improvement in the VFQ-25 composite score, whereas the BCVA improvement was not correlated with the improvement in the VFQ-25 composite score. Stepwise multiple regression analyses revealed that, at the time of macular oedema resolution, the distance between the external limiting membrane and retinal pigment epithelium (ELM-RPE) and average ganglion cell-inner plexiform layer (GCIPL) thickness were associated with LCS. CONCLUSION CS had a stronger association with VR-QOL than with BCVA in patients with CRVO-CMO. With the resolution of macular oedema, CS was associated with ELM-RPE thickness and average GCIPL thickness.
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Affiliation(s)
- Tomoya Murakami
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Yoshimi Sugiura
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Shohei Morikawa
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Yoshifumi Okamoto
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan.,Department of Ophthalmology, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
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DeCarlo DK, Gao L, McGwin G, Owsley C, Kwon M. Repeatability and Validity of MNREAD Test in Children With Vision Impairment. Transl Vis Sci Technol 2020; 9:25. [PMID: 33384883 PMCID: PMC7757625 DOI: 10.1167/tvst.9.13.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the test-retest reliability and validity of the MNREAD test for use in children with vision impairment (VI) and to compare their performance on the test to that of normally sighted children. Methods Children with VI (n = 62) and without VI (n = 40) were administered the MNREAD test and the Basic Reading Inventory (BRI) on two study visits, 1 to 3 weeks apart. The maximum reading rate, critical print size, and reading acuity were determined for the MNREAD test, and test-retest reliability was evaluated. The reading rate for the MNREAD test was compared to the BRI results. Results Strong correlations between visits were found for all MNREAD parameters (0.68-0.99). Older, but not younger, children with VI read significantly more slowly on both the MNREAD and the BRI than children with normal vision (P < 0.05). Reading rates between the two tests were strongly correlated (r = 0.88). For the MNREAD test, the reading rate increased 4.4 words per minute (wpm) per year for VI and 10.6 wpm/y for those with normal vision. For the BRI, the reading rate increased by 5.9 wpm/y for VI and 9.7 wpm/y for those with normal vision. Poorer visual acuity was associated with slower reading rates on the MNREAD test but not on the BRI, as the MNREAD relies largely on visual factors but the BRI also relies on linguistic and grammar skills. Conclusions The MNREAD test are reliable and valid for use in children with vision impairment. Translational Relevance The MNREAD test can be utilized by clinicians, as they are a quick, easy-to-administer method for evaluating reading vision in children with VI.
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Affiliation(s)
- Dawn K DeCarlo
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Optometry, School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Liyan Gao
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - MiYoung Kwon
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Asano T, Kunikata H, Yasuda M, Nishiguchi KM, Abe T, Nakazawa T. Ocular microcirculation changes, measured with laser speckle flowgraphy and optical coherence tomography angiography, in branch retinal vein occlusion with macular edema treated by ranibizumab. Int Ophthalmol 2020; 41:151-162. [PMID: 32894391 DOI: 10.1007/s10792-020-01562-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study searched for early predictive vascular biomarkers for visual outcomes in eyes with macular edema caused by branch retinal vein occlusion (BRVOME). METHODS Twenty-four eyes of 24 subjects with BRVOME were treated with the intravitreal injection of ranibizumab (IVR) for at least 6 months. We measured mean blur rate (MBR) in the optic nerve head (ONH) and vessel density (VD) in the macula with laser speckle flowgraphy and optical coherence tomography angiography, respectively. RESULTS Six-month post-IVR best-corrected visual acuity (BCVA) was correlated positively with age, pre-IVR BCVA, 1-month post-IVR BCVA, 3-month post-IVR BCVA and pre-IVR systolic blood pressure (P < 0.001, P < 0.001, P < 0.001, P < 0.001 and P = 0.02, respectively) and negatively with pre-IVR overall MBR, 1-month post-IVR overall MBR, 6-month post-IVR overall MBR, 3-month post-IVR deep retinal capillary plexus (DCP) VD and 6-month post-IVR DCP VD (P = 0.03, P = 0.03, P = 0.02, P = 0.01 and P = 0.005, respectively). Furthermore, a multiple regression analysis showed that pre-IVR overall MBR (β = - 0.67, P = 0.009) was among independent prognostic factors predicting 6-month post-IVR BCVA. Six-month post-IVR DCP VD was also correlated with overall MBR at all time points. CONCLUSION ONH blood flow may be a pre-IVR biomarker of both visual outcomes and post-IVR deep macular microcirculation in eyes with BRVOME.
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Affiliation(s)
- Toshifumi Asano
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. .,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Masayuki Yasuda
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Koji M Nishiguchi
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Tanabe H, Obana A, Yamamoto S, Ichikumi K, Gohto Y, Seto T, Moriyama T. Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion. PLoS One 2020; 15:e0235897. [PMID: 32649680 PMCID: PMC7351188 DOI: 10.1371/journal.pone.0235897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives To investigate the potential utility of MNREAD acuity charts and contrast/glare sensitivity (CGS) assessment for evaluating the efficacy of an initial treatment with ranibizumab (Lucentis®) for branch retinal vein occlusion (BRVO). Methods Intravitreal injections of ranibizumab were administered in 43 eyes of 43 treatment-naïve patients with BRVO. Efficacy was assessed 1 month later. Best-corrected far/near visual acuity (BCFVA/BCNVA), MNREAD parameters (reading acuity [RA], maximum reading speed [MRS], critical print size [CPS]), CGS (CS/GS), and central macular thickness (CMT) in optical coherence tomography (OCT) before and after treatment were evaluated. The area (superior/inferior) affected by BRVO was determined by fluorescein angiography. Results All parameters improved significantly following treatment (p < 0.05), and all MNREAD and CGS parameters were significantly correlated with BCVA in the treated eye before and after treatment (p < 0.01). The changes in BCFVA, BCNVA, MRS, and CS were significantly correlated with the amount of change in CMT (p < 0.007; r = 0.415, 0.528, -0.465, and -0.508, respectively). MRS exhibited a percentage change that was significantly correlated with that in CMT (p < 0.007; r = -0.511). Additionally, MRS exhibited the lowest threshold CMT (397 μm) at which the most significant change in improvement was observed. CMT was less likely to improve if BRVO occurred at a superior site than if it occurred at an inferior site (0.05 < p = 0.07 < 0.1). Conclusions MNREAD and CGS testing were useful for evaluating BRVO treatment efficacy. MRS might be a valuable index for evaluating treatment success and making treatment decisions.
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Affiliation(s)
- Hirotaka Tanabe
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- * E-mail: (AO); (HT)
| | - Akira Obana
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
- * E-mail: (AO); (HT)
| | - Sachiko Yamamoto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kiyomi Ichikumi
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuko Gohto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takahiko Seto
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Takanobu Moriyama
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
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Shalchi Z, Mahroo O, Bunce C, Mitry D. Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion. Cochrane Database Syst Rev 2020; 7:CD009510. [PMID: 32633861 PMCID: PMC7388176 DOI: 10.1002/14651858.cd009510.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Branch retinal vein occlusion (BRVO) is one of the most commonly occurring retinal vascular abnormalities. The most common cause of visual loss in people with BRVO is macular oedema (MO). Grid or focal laser photocoagulation has been shown to reduce the risk of visual loss. Limitations to this treatment exist, however, and newer modalities may have equal or improved efficacy. Antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) has recently been used successfully to treat MO resulting from a variety of causes. OBJECTIVES To investigate the efficacy and gather evidence from randomised controlled trials (RCTs) on the potential harms of anti-vascular endothelial growth factor (VEGF) agents for the treatment of macular oedema (MO) secondary to branch retinal vein occlusion (BRVO). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); MEDLINE Ovid; Embase Ovid; the ISRCTN registry; ClinicalTrials.gov; and the WHO ICTRP. The date of the last search was 12 June 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating BRVO. Eligible trials had to have at least six months' follow-up where anti-VEGF treatment was compared with another treatment, no treatment, or placebo. We excluded trials where combination treatments (anti-VEGF plus other treatments) were used; and trials that investigated the dose and duration of treatment without a comparison group (other treatment/no treatment/sham). DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data using standard methodological procedures expected by Cochrane. The primary outcome was the proportion of participants with an improvement from baseline in best-corrected visual acuity of greater than or equal to 15 letters (3 lines) on the Early Treatment in Diabetic Retinopathy Study (ETDRS) Chart at six months and 12 months of follow-up. The secondary outcomes were the proportion of participants who lost greater than or equal to 15 ETDRS letters (3 lines) and the mean visual acuity (VA) change at six and 12 months, as well as the change in central retinal thickness (CRT) on optical coherence tomography from baseline at six and 12 months. We also collected data on adverse events and quality of life (QoL). MAIN RESULTS We found eight RCTs of 1631 participants that met the inclusion criteria after independent and duplicate review of the search results. These studies took place in Europe, North America, Eastern Mediterranean region and East Asia. Included participants were adults aged 18 or over with VA of 20/40 or worse. Studies varied by duration of disease but permitted previously treated eyes as long as there was sufficient treatment-free interval. All anti-VEGF agents (bevacizumab, ranibizumab and aflibercept) and steroids (triamcinolone and dexamethasone) were included. Overall, we judged the studies to be at moderate or unclear risk of bias. Four of the eight studies did not mask participants or outcome assessors, or both. One trial compared anti-VEGF to sham. At six months, eyes receiving anti-VEGF were significantly more likely to have a gain of 15 or more ETDRS letters (risk ratio (RR) 1.72, 95% confidence interval (CI) 1.19 to 2.49; 283 participants; moderate-certainty evidence). Mean VA was better in the anti-VEGF group at six months compared with control (mean difference (MD) 7.50 letters, 95% CI 5.29 to 9.71; 282 participants; moderate-certainty evidence). Anti-VEGF also proved more effective at reducing CRT at six months (MD -57.50 microns, 95% CI -108.63 to -6.37; 281 participants; lower CRT is better; moderate-certainty evidence). There was only very low-certainty evidence on adverse effects. There were no reports of endophthalmitis. Mean change in QoL (measured using the National Eye Institute Visual Functioning Questionnaire VFQ-25) was better in people treated with anti-VEGF compared with people treated with sham (MD 7.6 higher score, 95% CI 4.3 to 10.9; 281 participants; moderate-certainty evidence). Three RCTs compared anti-VEGF with macular laser (total participants = 473). The proportion of eyes gaining 15 or more letters was greater in the anti-VEGF group at six months (RR 2.09, 95% CI 1.44 to 3.05; 2 studies, 201 participants; moderate-certainty evidence). Mean VA in the anti-VEGF groups was better than the laser groups at six months (MD 9.63 letters, 95% CI 7.23 to 12.03; 3 studies, 473 participants; moderate-certainty evidence). There was a greater reduction in CRT in the anti-VEGF group compared with the laser group at six months (MD -147.47 microns, 95% CI -200.19 to -94.75; 2 studies, 201 participants; moderate-certainty evidence). There was only very low-certainty evidence on adverse events. There were no reports of endophthalmitis. QoL outcomes were not reported. Four studies compared anti-VEGF with intravitreal steroid (875 participants). The proportion of eyes gaining 15 or more ETDRS letters was greater in the anti-VEGF group at six months (RR 1.67, 95% CI 1.33 to 2.10; 2 studies, 330 participants; high-certainty evidence) and 12 months (RR 1.76, 95% CI 1.36 to 2.28; 1 study, 307 participants; high-certainty evidence). Mean VA was better in the anti-VEGF group at six months (MD 8.22 letters, 95% CI 5.69 to 10.76; 2 studies, 330 participants; high-certainty evidence) and 12 months (MD 9.15 letters, 95% CI 6.32 to 11.97; 2 studies, 343 participants; high-certainty evidence). Mean CRT also showed a greater reduction in the anti-VEGF arm at 12 months compared with intravitreal steroid (MD -26.92 microns, 95% CI -65.88 to 12.04; 2 studies, 343 participants; moderate-certainty evidence). People receiving anti-VEGF showed a greater improvement in QoL at 12 months compared to those receiving steroid (MD 3.10, 95% CI 0.22 to 5.98; 1 study, 307 participants; moderate-certainty evidence). Moderate-certainty evidence suggested increased risk of cataract and raised IOP with steroids. There was only very low-certainty evidence on APTC events. No cases of endophthalmitis were observed. AUTHORS' CONCLUSIONS The available RCT evidence suggests that treatment of MO secondary to BRVO with anti-VEGF improves visual and anatomical outcomes at six and 12 months.
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Affiliation(s)
- Zaid Shalchi
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Omar Mahroo
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Danny Mitry
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Royal Free Hospital, NHS Foundation Trust, London, UK
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Tao Y, Huang C, Liu M, Sun L, Li L, Wei Y, Yu X, Wang H. Short-term effect of intravitreal conbercept injection on major and macular branch retinal vein occlusion. J Int Med Res 2019; 47:1202-1209. [PMID: 30678515 PMCID: PMC6421366 DOI: 10.1177/0300060518819613] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of intravitreal conbercept injection on major and macular branch retinal vein occlusion (BRVO). METHODS This retrospective analysis involved 43 patients with BRVO (major BRVO n = 24; macular BRVO, n = 19) who were diagnosed by fluorescein fundus angiography (FFA) and injected with intravitreal conbercept. The following outcomes were measured at baseline and follow-up (1-6 months): best-corrected visual acuity (BCVA), central foveal thickness (CFT), total retinal volume in a 6-mm diameter section of the macula, choroidal thickness under the central fovea of the macula, relative area of retinal hemorrhage, complications, and times when repeated injection was performed. RESULTS There were significant differences between the two groups in terms of BCVA, CFT, and total retinal volume in a 6-mm diameter section of the macula at 6 months after treatment. Choroidal thickness under the central fovea of the macula and relative area of retinal hemorrhage showed no significant differences between the two groups at 6 months after treatment; however, they significantly differed from baseline measurements. CONCLUSION In general, intravitreal injection of conbercept may have a better short-term effect in patients with macular BRVO than in patients with major BRVO.
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Affiliation(s)
- Yuan Tao
- 1 Department of Ophthalmology, Jinan Second People's Hospital, Jinan, Shandong, P.R. China
| | - Chao Huang
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Min Liu
- 3 Department of Ophthalmology, Jinan Eighth People's Hospital, Jinan, Shandong, P.R. China
| | - Liyuan Sun
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Linlin Li
- 4 Department of Ophthalmology, People's Hospital of Qihe County, Qihe, Shandong, P.R. China
| | - Yuhua Wei
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Xiaoting Yu
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Hong Wang
- 2 Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
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PREDICTORS OF REFRACTORY MACULAR EDEMA AFTER BRANCH RETINAL VEIN OCCLUSION FOLLOWING INTRAVITREAL BEVACIZUMAB. Retina 2018; 38:1166-1174. [PMID: 28489696 DOI: 10.1097/iae.0000000000001674] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the predictors of refractory macular edema (ME) that develops despite multiple bevacizumab injections in patients with branch retinal vein occlusion (BRVO). METHODS A total of 107 patients who followed at least 2 years were assigned to 2 groups: a refractory group (n = 56) and a responsive group (n = 51). Baseline characteristics, treatment response at 3 months, and fluorescein angiographic findings at 6 months were compared. Then we tried to identify factors associated with refractory ME development. RESULTS Compared to the responsive group, the refractory group had older age, longer pre-treatment duration, and shorter occlusion distance from disk. At 3 months, the refractory group exhibited lower visual acuity, thicker central retinal thickness (CRT), and larger proportion of external limiting membrane (ELM) and outer plexiform layer disruption. After 6 months, proportion of unresolved vein occlusion, macular ischemia, number of microaneurysms, and non-perfusion areas were higher in the refractory group. Refractory ME was associated with pre-treatment duration ≥3 months, short occlusion distance from disk, thick CRT and ELM disruption at 3 months, and unresolved vein occlusion at 6 months. CONCLUSION If BRVO-ME patients exhibit the above-mentioned characteristics, they may have refractory ME, which should inform treatment decisions.
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Buyru Özkurt Y, Akkaya S, Aksoy S, Şimşek MH. Comparison of ranibizumab and subthreshold micropulse laser in treatment of macular edema secondary to branch retinal vein occlusion. Eur J Ophthalmol 2018; 28:690-696. [PMID: 29696993 DOI: 10.1177/1120672117750056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Yelda Buyru Özkurt
- 1 Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Sezen Akkaya
- 1 Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Sibel Aksoy
- 1 Department of Ophthalmology, Fatih Sultan Mehmet Training and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Mert Hakan Şimşek
- 2 Ophthalmology Clinic, Sultanbeyli Ersoy Hospital, İstanbul, Turkey
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Hong IH, Park SP. Quantitative physiological measurements to evaluate the response of antivascular endothelial growth factor treatment in patients with neovascular diseases. Indian J Ophthalmol 2017; 65:559-568. [PMID: 28724811 PMCID: PMC5549406 DOI: 10.4103/ijo.ijo_278_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Antivascular endothelial growth factor (VEGF) treatment is still used intravitreally worldwide for various neovascular diseases, despite other available, approved treatments. We performed a systematic search of the literature focused on visual physiology studies. We used the online biomedical search engine PubMed and searched key words including “M-chart,” “Preferential Hyperacuity Perimetry,” “microperimetry,” (MP) “electroretinography,” and “contrast sensitivity” to estimate treatment efficacy of anti-VEGF treatments in a quantitative manner. Many studies were identified which used a variety of methodologies, disease entities, injected agents, and patient populations, making it difficult to obtain a direct comparison of their results. However, favorable functional outcomes achieved using current quantitative methods would lend further confidence to the effectiveness of a treat-and-extend protocol using intravitreal anti-VEGF for the management of patients with neovascular diseases. Despite anti-VEGF's wide use, a well-designed longitudinal multicenter study to systematically evaluate and compare different physiological methods or parameters in patients with neovascular diseases is still lacking, though it would benefit therapeutic decisions.
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Affiliation(s)
- In Hwan Hong
- Department of Ophthalmology, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
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Çakmak HB, Arikan Yorgun M, Toklu Y, Mutlu M. Intravitreal PRN ranibizumab treatment for macular edemadue to branch retinal vein occlusion. Turk J Med Sci 2017; 47:40-46. [PMID: 28263518 DOI: 10.3906/sag-1509-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 04/21/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To evaluate the effect of intravitreal pro re nata (PRN) ranibizumab treatment from the start on the best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) in macular edema (ME) due to branch retinal vein occlusion (BRVO). MATERIALS AND METHODS Patients with ME secondary to BRVO, who were treated on a PRN basis after a single intravitreal ranibizumab injection, were retrospectively evaluated. The main outcome measures were changes in BCVA and CRT as measured by optical coherence tomography. RESULTS The number of injections over 6 months was 2.43 ± 1.16. The mean BCVA of the patients was 0.84 ± 0.10 logMAR at baseline and 0.41 ± 0.06 at the 6th month (P < 0.001). Mean BCVA of the ischemic BRVO group was 1.06 ± 0.68 logMAR at baseline and 0.44 ± 0.30 logMAR at the 6th month (P < 0.05). Similarly, the mean BCVA of the nonischemic BRVO group was 0.77 ± 0.53 logMAR at baseline and 0.41 ± 0.36 logMAR at the 6th month (P < 0.05). Between groups, there was no significant difference in mean BCVA at any examination. CONCLUSION Intravitreal ranibizumab is a safe and effective treatment option for ME due to ischemic and nonischemic BRVO using PRN from the start.
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Affiliation(s)
- Hasan Basri Çakmak
- Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mücella Arikan Yorgun
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Yasin Toklu
- Department of Ophthalmology, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Melek Mutlu
- Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
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Analysis of Potential Ischemic Effect of Intravitreal Bevacizumab on Unaffected Retina in Treatment-Naïve Macular Edema Due to Branch Retinal Vein Occlusion: A Prospective, Interventional Case-Series. PLoS One 2016; 11:e0162533. [PMID: 27618696 PMCID: PMC5019367 DOI: 10.1371/journal.pone.0162533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 08/24/2016] [Indexed: 11/19/2022] Open
Abstract
Background To study potential ischemic effects of intravitreal Bevacizumab (IVB) on unaffected retina in treatment-naive eyes with macular edema secondary to branch retinal vein occlusion (BRVO) and contralateral eyes secondary to systemic absorption. Methods and Findings Prospective, interventional series included 27 treatment-naive eyes with BRVO and macular edema. Exclusion criteria: Eyes with diabetic retinopathy, glaucoma, vasculitides, papilledema or systemic neurologic condition. Subjects underwent complete ophthalmological examination including fluoroscein angiography (FA), optical coherence tomography (OCT) and multifocal electroretinogram (mf-ERG). All subjects received single 1.25 mg/0.05ml IVB injection. Two observers measured all parameters; inter-observer agreements were expressed as kappa values. Paired t-test was used to compare values at baseline and follow-up. The statistical analysis was done using SPSS for Windows, Version 14.0. (Chicago, SPSS Inc.) Presenting mean CFT (central foveal thickness) was 499.5(+/-229.7) μm, mean BCVA (best corrected visual acuity) was 0.64(+/-0.41) logMAR. At last follow-up, mean CFT was 267.9(+/-159.3) μm (P<0.001), 95% CI [127.18, 422.32]; mean BCVA was 0.28(+/-0.24) logMAR. Respectively, mean N1 and P1 amplitudes of mfERG in 'unaffected quadrant' at presentation were -6.10(+/-4.00) nV/deg2 and 17.17(+/-11.54)nV/deg2; and -5.33(+/-1.30)nV/deg2 and 15.29(+/-4.69)nV/deg2 at final follow-up (P = 0.631 and 0.197, respectively), (95% CIs [-0.93, 1.42] and [-4.22, 1.08] respectively). In fundus quadrant of fellow eyes corresponding to unaffected quadrant in treated eyes, mean N1 and P1 amplitudes at presentation were -5.39(+/-1.56)nV/deg2 and 15.89(+/-3.89)nV/deg2; and -5.39(+/-1.90)nV/deg2 and 15.9(+/-5.52)nV/deg2 (P = 0.380 and 0.208), (95% CIs [-0.57, 1.28] and [-4.1, 1.1]) at last follow-up, respectively. Limitations: This study analysed the effects with a single injection of bevacizumab. However, whether ischemic adverse effects will emerge with repeated IVB injections as a consequence of cumulative dosing needs further investigation. The setting of our study being a tertiary care centre, the numbers of fresh BRVO cases without prior intervention were limited. Thus, the limitations of our study include a small sample size with a small follow-up period. No major ocular/systemic adverse event was observed in the study period. Conclusion No evidence of progressive ischaemia attributable to single bevacizumab treatment was observed in this study. However, a larger prospective study involving subjects with cumulative dosing of bevacizumab and a longer follow-up could provide a better understanding of the potential ischaemic effects of bevacizumab or other anti-VEGF agents.
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Rezar S, Eibenberger K, Bühl W, Georgopoulos M, Schmidt-Erfurth U, Sacu S. Anti-VEGF treatment in branch retinal vein occlusion: a real-world experience over 4 years. Acta Ophthalmol 2015; 93:719-25. [PMID: 26109209 DOI: 10.1111/aos.12772] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/26/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine long-term outcome of intraocular antagonism of vascular endothelial growth factor (VEGF) in macular oedema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS A total of 28 consecutive patients were treated with either intravitreal bevacizumab (IVB) or intravitreal ranibizumab (IVR) in the first series and were evaluated after a mean follow-up of 5 years for their functional and anatomical outcome. RESULTS Time between onset of macular oedema and initial treatment was 5.2 ± 0.4/0.1 ± 0.1 (IVB/IVR) months. A mean of 4 intravitreal injections were given per patients in the first 6 months. In months 7-12 intravitreal injections decreased to 2 and further decreased in the second year (months 13-18: 1.14; months 19-24: 0.5) and third year (months 25-30: 0.4; months 31-36: 0.2). After the fourth year, only two of the 28 patients received further treatment. Average visual acuity (VA) increased by 16 letters after 1 year (p < 0.01) and although not statistically significantly, by a mean of 5 letters (p = 0.3) at long-term evaluation (IVB-group). However, after mean of 5 years, central retinal sensitivity (CRS) improved by 3.6 dB (p = 0.01) and central retinal thickness (CRT) decreased by 161 μm (p = 0.02). In the IVR-group, VA and CRS increased significantly (31 letters and respectively 4.4 dB, p < 0.001) and CRT decreased by 229 μm (p < 0.001) after long-term follow-up. Final functional results were significantly better in patients with treatment initiation <3 months (79 versus 55 letters, p = 0.01). Microvascular abnormalities were detected in 88% (21 of 24 patients), hyperfluorescence in 42% (10 of 24 patients) on wide-field fluorescein angiography in both groups. CONCLUSIONS Inhibition of VEGF provides substantial long-term benefits for patients with ME secondary to BRVO. Early treatment with anti-VEGF agents and extended therapeutic surveillance was associated with improved visual recovery.
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Affiliation(s)
- Sandra Rezar
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | | | - Wolf Bühl
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
| | | | | | - Stefan Sacu
- Department of Ophthalmology; Medical University of Vienna; Vienna Austria
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[Management of macular edema secondary to retinal vein occlusion]. J Fr Ophtalmol 2015; 38:253-63. [PMID: 25683131 DOI: 10.1016/j.jfo.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO. METHODS A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article. RESULTS The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters. DISCUSSION Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.
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Hussain N, Hussain A. Retino-choroidal ischemia in central retinal vein occlusion. Saudi J Ophthalmol 2014; 28:325-8. [PMID: 25473353 DOI: 10.1016/j.sjopt.2014.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 02/10/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022] Open
Abstract
A 41-year-old gentleman with insulin dependent diabetes had decreased vision in the right eye due to non-ischemic central retinal vein occlusion with macular edema. One month following intravitreal ranibizumab, he developed retino-choroidal ischemia with further loss of vision. Authors show the fluorescein angiographic transition from non-ischemic central retinal vein occlusion to retino-choroidal ischemia.
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Affiliation(s)
- Nazimul Hussain
- Department of Ophthalmology, Al Zahra Hospital, Sharjah, United Arab Emirates
| | - Anjli Hussain
- Buhairah Corniche, Al Majaz Street 3, Sharjah, United Arab Emirates
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Nghiem-Buffet S, Fajnkuchen F, Buffet M, Ayrault S, Le Gloahec-Lorcy A, Grenet T, Delahaye-Mazza C, Quentel G, Cohen SY. Intravitreal Ranibizumab and/or Dexamethasone Implant for Macular Edema Secondary to Retinal Vein Occlusion. Ophthalmologica 2014; 232:216-22. [DOI: 10.1159/000365639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/28/2014] [Indexed: 11/19/2022]
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Hikichi T, Higuchi M, Matsushita T, Kosaka S, Matsushita R, Takami K, Ohtsuka H, Kitamei H, Shioya S. Two-year outcomes of intravitreal bevacizumab therapy for macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol 2013; 98:195-9. [PMID: 24215032 PMCID: PMC3913112 DOI: 10.1136/bjophthalmol-2013-303121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aim To determine the 2-year outcomes of intravitreal bevacizumab (IVB) injections in eyes with macular oedema (ME) following branch retinal vein occlusion (BRVO). Methods Of 105 consecutive eyes (105 treatment-naïve patients) with ME following BRVO, 89 eyes were followed for 2 years after the first injection. During the 2-year follow-up period, patients were examined at least every 3 months and received an IVB injection (1.25 mg/0.05 mL) if they met prespecified retreatment criteria. Rescue grid laser was permitted based on the findings of the Branch Vein Occlusion Study. Results The baseline logarithm of the minimum angle of resolution visual acuity (VA) was 0.64±0.24 (mean±SD), which significantly (p=0.001) improved 1 month after the first injection to 0.39±0.22. One year after the first injection, VA improved significantly (p=0.001) to 0.33±0.21 and remained 0.34±0.21 until 2 years after the first injection (p=0.001). The changes in foveal thickness were correlated with those of VA during the 2-year follow-up period with a mean of 3.8±1.5 injections (including the first injection). Conclusions This relatively large case series study showed favourable 2-year outcomes using bevacizumab to treat ME following BRVO. Bevacizumab provides substantial long-term benefits in the treatment of ME following BRVO.
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Affiliation(s)
- Taiichi Hikichi
- Department of Ophthalmology, Ohtsuka Eye Hospital, , Sapporo, Japan
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Chatziralli IP, Jaulim A, Peponis VG, Mitropoulos PG, Moschos MM. Branch retinal vein occlusion: treatment modalities: an update of the literature. Semin Ophthalmol 2013; 29:85-107. [PMID: 24171809 DOI: 10.3109/08820538.2013.833271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. METHODS Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search. RESULTS Treatment modalities were analyzed. CONCLUSIONS There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).
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Bai YJ, Huang LZ, Zhou AY, Zhao M, Yu WZ, Li XX. Antiangiogenesis Effects of Endostatin in Retinal Neovascularization. J Ocul Pharmacol Ther 2013; 29:619-26. [PMID: 23545016 DOI: 10.1089/jop.2012.0225] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yu-jing Bai
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Lv-zhen Huang
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Ai-yi Zhou
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Min Zhao
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wen-zhen Yu
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiao-xin Li
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China
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Prospective study of peripheral panretinal photocoagulation of areas of nonperfusion in central retinal vein occlusion. Retina 2013; 33:56-62. [PMID: 23269405 DOI: 10.1097/iae.0b013e3182641875] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the effect that panretinal photocoagulation to peripheral areas of retinal vascular nonperfusion has on the visual acuity and injection frequency of ranibizumab in eyes with previous central retinal vein occlusion. METHODS Patients enrolled in a prospective study of ranibizumab for central retinal vein occlusion were imaged with wide-field angiography using the Optos P200 system. Laser photocoagulation was carried out and the extent of laser photocoagulation was evaluated with repeat wide-field angiography. Injection of ranibizumab was based on an as needed strategy throughout the study. The injection frequency in the 6 months before laser was compared with a 6-month period starting 2 months after the laser photocoagulation. The visual acuity was measured by Early Treatment Diabetic Retinopathy Study protocol refraction at both the end of the 6-month follow-up period and at the time of laser photocoagulation. RESULTS There were 10 patients treated in this study with a mean number of 1,757 spots of laser photocoagulation in the peripheral retina. The injection frequency in the 6-month lead-in period was 3.4 and in the 6-month follow-up period was 3.1, a difference that was not significant (P = 0.26). The visual acuity at the time of laser photocoagulation was 54.2 letters (approximate Snellen equivalent of 20/80) and at the end of the observation period was 51.4 letters, a difference that was not significant (P = 0.33). CONCLUSION In this small study, laser photocoagulation to peripheral areas of nonperfusion as visualized by wide-field angiography did not result in either decreased injection frequency or improved visual acuity in eyes with central retinal vein occlusion treated with ranibizumab.
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Mitry D, Bunce C, Charteris D. Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion. Cochrane Database Syst Rev 2013:CD009510. [PMID: 23440840 DOI: 10.1002/14651858.cd009510.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Branch retinal vein occlusion (BRVO) is one of the most common occurring retinal vascular abnormalities. The pathogenesis of BRVO is thought to involve both retinal vein compression and damage to the vessel wall, possibly leading to thrombus formation at sites where retinal arterioles cross retinal veins. The most common cause of visual loss in patients with BRVO is macular oedema (MO). Grid or focal laser photocoagulation has been shown to reduce the risk of visual loss and improve visual acuity (VA) in up to two thirds of individuals with MO secondary to BRVO, however, limitations to this treatment exist and newer modalities have suggested equal or improved efficacy. Recently, antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) has been used successfully to treat MO resulting from a variety of causes. As elevated intraocular levels of VEGF have been demonstrated in patients with retinal vein occlusions there is a strong basis for the hypothesis that anti-VEGF agents may be beneficial in the treatment of vascular leakage and MO. OBJECTIVES To investigate the efficacy and safety of intravitreal anti-VEGF agents for preserving or improving vision in the treatment of MO secondary to BRVO. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2012), EMBASE (January 1980 to August 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2012, the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 7 August 2012 and the clinical trials registers on 10 September 2012. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTS of at least six months duration where anti-VEGF treatment was compared with another treatment, no treatment, or placebo. We excluded trials where combination treatments (anti-VEGF plus other treatments) were used and trials that investigated the dose and duration of treatment without a comparison group (other treatment/no treatment/sham). DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data. The primary outcome was the proportion of participants with an improvement from baseline in best-corrected visual acuity (BCVA) of greater than or equal to 15 letters (3 lines) on the Early Treatment in Diabetic Retinopathy Study (ETDRS) Chart at six months and at 12 months of follow-up. The secondary outcomes we report are the proportion of participants who lost greater than or equal to 15 ETDRS letters (3 lines) and the mean VA change at six months and any additional follow-up intervals as well as the change in central retinal thickness on optical coherence tomography (OCT) from baseline and final reported follow-up, the number and type of complications, the number of additional interventions administered and any adverse outcomes. Where available, the cost benefit and quality of life data reported in the primary studies is presented. MAIN RESULTS We found one RCT and one quasi-RCT that met the inclusion criteria after independent and duplicate review of the search results. The studies used different anti-VEGF agents and different study groups which were not directly comparable.One multi-centre RCT (BRAVO) conducted in the USA randomised 397 individuals and compared monthly intravitreal ranibizumab (0.3 mg and 0.5 mg) injections with sham injection. The study only included individuals with non-ischaemic BRVO. Although repeated injections of ranibizumab appeared to have a favourable effect on the primary outcome, approximately 50% of the ranibizumab 0.3 mg group and 45% of the ranibizumab 0.5 mg group received rescue laser treatment which may have an important effect on the primary outcome. In addition, during the six-month observation period 93.5% of individuals in the sham group received intravitreal ranibizumab (0.5 mg). This cross-over design limits the ability to compare the long-term impact of ranibizumab versus a pure control group.The second trial was a small study (n = 30) from Italy with limitations in study design that reported a benefit of as-required intravitreal bevacizumab (1.25 mg) over laser photocoagulation in MO secondary to BRVO. We present the evidence from these trials and other interventional case series. AUTHORS' CONCLUSIONS The available RCT evidence suggests that repeated treatment of non-ischaemic MO secondary to BRVO with the anti-VEGF agent ranibizumab may improve clinical and visual outcomes at six and 12 months. However, the frequency of re-treatment has not yet been determined and the impact of prior or combined treatment with laser photocoagulation on the primary outcome is unclear. Results from ongoing studies should assess not only treatment efficacy but also, the number of injections needed for maintenance and long-term safety and the effect of any prior treatment.
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Affiliation(s)
- Danny Mitry
- Moorfields Eye Hospital NHS Foundation Trust, London,
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Abstract
Excessive blood vessel growth is a key feature of many retinal diseases, and recently, anti-VEGF therapy has been successfully applied to treat neovascular age-related macular degeneration (AMD), diabetic macular edema, and retinal vein occlusion. In this issue of the JCI, Kurihara et al. reveal an essential role of Vegfa in maintaining choroid vasculature and cone photoreceptors, critical for central and color vision. Their findings suggest that therapeutic approaches to blocking VEGF signaling in retinal diseases might have unexpected detrimental side effects and that the development of alternative strategies might be necessary.
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Affiliation(s)
- Susan E Quaggin
- The Samuel Lunenfeld Research Institute, Mount Sinai Hospital, and Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Siegel RA, Dreznik A, Mimouni K, Bor E, Weinberger D, Bourla DH. Intravitreal Bevacizumab Treatment for Macular Edema due to Branch Retinal Vein Occlusion in a Clinical Setting. Curr Eye Res 2012; 37:823-9. [DOI: 10.3109/02713683.2012.678542] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim M, Yu SY, Kim ES, Bae SH, Park JH, Yu HG, Kwak HW. Intravitreal Ranibizumab for Macular Edema Secondary to Retinal Vein Occlusion. Ophthalmologica 2012; 227:132-8. [DOI: 10.1159/000334906] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022]
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Mitra A, Lip PL. Review of anti-vascular endothelial growth factor therapy in macular edema secondary to central retinal vein occlusions. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Keane PA, Sadda SR. Retinal vein occlusion and macular edema - critical evaluation of the clinical value of ranibizumab. Clin Ophthalmol 2011; 5:771-81. [PMID: 21750610 PMCID: PMC3130914 DOI: 10.2147/opth.s13774] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Indexed: 01/14/2023] Open
Abstract
Retinal vein occlusions (RVOs) constitute the second most common cause of retinal vascular disease after diabetic retinopathy, with a prevalence of between 1% and 2% in persons older than 40 years of age. Despite the existence of numerous potential therapeutic options, none is entirely satisfactory, and many patients with RVO suffer irreversible visual loss. Fortunately however, the recent introduction of antivascular endothelial growth factor (VEGF) agents, such as ranibizumab (Lucentis®, Genentech, South San Francisco, CA) and bevacizumab (Avastin®, Genentech), offers a potentially new treatment approach for clinicians managing this disorder. The results of the BRAVO and CRUISE trials have provided the first definitive evidence for the efficacy and safety of ranibizumab in the treatment of RVO. As a result, ranibizumab has recently been approved by the US Food and Drug Administration for the treatment of RVO-associated macular edema. In this review, we provide a critical evaluation of clinical trial data for the safety and efficacy of ranibizumab, and address unresolved issues in the management of this disorder.
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Affiliation(s)
- Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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