First Author: M.Rybarikova CZECH REPUBLIC
Co Author(s): J. Rehak B. Babkova I. Sinova M. Sin
Back to previous
A retrospective evaluation of the experience in the treatment of retinal vein vascular endothelial growth factor inhibitors (ranibizumab and aflibercept) on patients treated at our clinic in the period from OCT/2013 to JAN/2017.
The treatment took place at The Department of Ophtalmology - Faculty of Medicine and Dentistry Olomouc Czech Republic (OCT/2013-JAN/2017). Most of the patients were sent to our specialised centre from regional ophthalmologists.
A total of 53 patients with central retinal vein occlusion (CRVO) were distributed to Group 1: Central retinal vein occlusion treated with ranibizumab (43 patients) and Group 2: central retinal vein occlusion treated with aflibercept (10 patients). The diagnosis evaluation of the CRVO begins with an anamnesis review and a complete ophthalmologic examination. Cooperation with a practitioner is required in order to assure the best compensation of risk factors to adjust therapy; the factors being: hypertension, diabetes mellitus, hyperlipidemia; and in the group of patients under 50 was also performed examination of hypercoagulable state, particularly factor V Leiden and activated Protein C resistance. The ophthalmologic examination during the treatment period included the best corrected visual acuity, slit-lamp examination and fundoscopy, colour fundus photography, central retinal thickness (CRT) was measured with optical coherence tomography and fluorescein angiography. We were able to use the ultra-widefield fluorescein angiography from OCT/2015. Detection of the peripheral retinal ischaemia during follow–ups and vascular endothelial growth factor inhibitors treatment were direct implications for laser photocoagulation. We checked intraocular pressure values as well and, if necessary, treated the secondary neovascular glaucoma.
Group 1: From the baseline until month 3, 66.7% patients gained ≥ 5 letters, mean of 12.4 letters. Mean CRT decreased by 229.1 µm. The mean number of intravetreal ranibizumab injections in this group during this period was 1.95. At month 6, 69% patients gained ≥ 5 letters, mean of 10.8 letters. Mean CRT decreased by 247 µm and the mean number of injections was 3,23. At month 12, 71.1% patients gained ≥ 5 letters, mean of 10.7 letters. Mean CRT decreased by 265.2 µm and the mean number of injections was 4.82. Group 2: From baseline until month 3, 90% patients gained ≥ 5 letters, mean of 26.4 letters. Mean CRT decreased by 364,5 µm. The mean number of intravitreal aflibercept injections in this group during this period was 2.67. At month 6, 85,7% patients gained ≥ 5 letters, mean of 18.3 letters. Mean CRT decreased by 553.7 µm and the mean number of injections was 4,17. At month 12, 50% patients gained ≥ 5 letters, mean of 2.5. Mean CRT decreased by 409.7 µm and the mean number of injections was 6.67.
Based on the available experience we conclude that the use of intravitreal vascular endothelial growth factor inhibitors has important role and may be beneficial in early intervention in the most patients with RVO treatment. Long-term monitoring is necessary to maintain the reduction of macular edema and improvement of vision.