First Author: T.Borges PORTUGAL
Co Author(s): M. Neves R. Massa M.J. Furtado M. Gomes M. Lume A. Meireles 0 0 0 0 0 0 0 0 0
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Central and Branch Retinal Vein Occlusions (BRVO) are together the second most common retinal vascular diseases affecting the retina and secondary macular edema, a major cause of vision loss. Its pathogenesis remains poorly understood, but it’s believed that hydrodynamic imbalance and both ischemic and inflammatory mediators contribute to macular edema formation. The purpose of this study is to evaluate the long-term safety and efficacy of the use of anti-vascular endothelial growth factor (VEGF), bevacizumab or ranibizumab, alone or in association with other therapeutic options, laser photocoagulation and/or intravitreal triamcinolone, in the treatment of macular edema secondary to BRVO.
Centro Hospitalar do Porto - Ophthalmology Department.
Retrospective, nonrandomized, interventional case series of 35 eyes of 35 patients with diagnosed BRVO initially treated with 0,5 mg intravitreal Ranibizumab (Lucentis®, Novartis) and afterwards with 1,25 mg intravitreal Bevacizumab (Avastin®, Genentech). Patients were evaluated at the first year in a monthly basis and thereafter at least every three months. Retreatment, if needed, was based on clinical findings and Optical Coherence Tomography. Scatter or macular photocoagulation was performed whenever the investigator found it useful (retinal nonperfusion or leaking macular capillaries as evidenced in fluorescein angiography). 2 mg of triamcinolone were injected in macular edema refractory to anti-VEGF. Patients were divided into 3 groups. Group 1 (13 patients) was treated with anti-VEGF (Ranibizumab and/or Bevacizumab). Group 2 (13 patients) was treated with anti-VEGF and photocoagulation. Group 3 (9 patients) was treated with anti-VEGF, photocoagulation and triamcinolone. Groups were assessed according to best corrected visual acuity (BCVA), number of treatments, presence of macular edema and complications.
60% of the patients were male and 40% female. The average age was 67 years. The prevalence of right eyes was 57% and of left eyes 43%. The mean follow-up was 26 months (minimum of 9 months, maximum of 61 months). Group 1 had a mean of 3,5 intravitreal injections of anti-VEGF, improved BCVA from 20/63 to 20/32, and 54% had no macular edema at the end of follow-up. Group 2 had a mean of 4,3 intravitreal injections of anti-VEGF, 2,4 sessions of photocoagulation, improved BCVA from 20/200 to 20/63, and 31% had no macular edema at the end of follow-up. Group 3 had a mean of 9 intravitreal anti-VEGF or triamcinolone, 1,5 sessions of photocoagulation, improved BCVA from 20/125 to 20/100, and 44% had no macular edema at the end. During the follow-up 7 patients (20%) from all groups developed glaucoma, 3 (9%) had retinal neovascularization elsewhere, 2 (6%) developed retinal collateral vessels, and 1 (3%) had vitreous hemorrhage.
Anti-VEGF therapy, alone or in association with laser photocoagulation and triamcinolone, showed safety and efficacy for edema secondary to BRVO. It resulted in a promising gain of BCVA, but requires a high injection frequency.