Session Title: Quick Fire Free Paper Session 04
Session Date/Time: Sunday 29/09/2013 | 11:00-13:00
Paper Time: 12:35
Venue: Hall C (Level 1)
First Author: C.Farinha PORTUGAL
Co Author(s): J. Marques A. Baltar A. Santos M. Cachulo
To evaluate the long term results of intravitreal ranibizumab (IVR) in the treatment of macular edema due to central retinal vein occlusion (CRVO), and to identify predictive factors of functional improvement using multimodal retinal imaging, after 3 or more years of treatment.
Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Associação para a Investigação Biomédica e Inovação em Luz e Imagem, Coimbra, Portugal.
The medical records of CRVO patients treated with IVR for macular edema and with minimum follow-up of 3 years were retrospectively analyzed. Sixteen eyes of 16 patients meeting the inclusion criteria were included. All patients performed a cross sectional evaluation with best–corrected visual acuity (BCVA), fundoscopy, color fundus photography, fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT) in both retinal and choroidal mode, and fundus autofluorescence (FAF). Perifoveal capillary network disruption status was assessed in FA. Morphologic characterization of the retina was performed using SD-OCT to evaluate the relative contribution of several variables, including photoreceptor inner segment/outer segment (IS/OS), external limiting membrane (ELM) and retinal pigment epithelium (RPE) status, in final outcomes. Retinal and choroidal thicknesses (CT) were manually measured in the fovea and 1 and 3 mm apart in both the horizontal and vertical meridians, and the central retinal thickness (CRT) acquired by automated fast macular thickness map was also recorded. Their predictive value in final visual outcome was also statistically assessed.
Sixteen eyes of 16 patients were included, with a mean age of 67.7±13.7 years. Mean follow-up was 42.9±8.7 months and the mean time between diagnosis and first treatment with IVR was 5.3±5.3 months. The total number of injections performed at the end of follow-up was 6.9 in average, but with decreasing need during follow-up: 4.1 in the first year, 1.7 in the second, 0.9 in the third, and only one patient needed injections by the fourth year of treatment (n=12). Mean BCVA increased from 47.1±26.0 letters (L) to 55.4±23.6 L, with a final mean gain of 8.3±14.5 L (p=0.042). BCVA was maintained (variation ≤5L) in 6 eyes (37.5%) and another 6 (37.5%) had a final gain ≥15L. Mean automated CRT decreased from 689.6±213.1 μm to 303.9±160.3 μm (p=0.003). Final mean subfoveal and macular CT were 284.2±93.7 μm and 254.0±78.8 μm. Disruption of the perifoveal capillary network was found in all eyes. Final BCVA correlated with initial BCVA (R=0.822, p<0.001) and with disruption of the IS/OS line (R=-0.542, p=0.030), RPE (R=-0.597, p=0.015) and ELM (R=-0.494, p=0.052, borderline). Only 2 eyes progressed to proliferative disease and there were no reported systemic or vision-threatening complications.
The long term results of intravitreal injection of ranibizumab in the management of macular edema associated with CRVO confirms that this is currently a good treatment option, with significant improvement in functional and morphologic outcomes after more than 3 years of follow-up. Importantly this was achieved with decreasing need of reinjection and with no recorded significant adverse effects. Final visual acuity correlated with initial BVCA and with qualitative retinal morphologic findings on OCT, rather than with quantitative parameters.