Session Title: Vascular Diseases and Diabetic Retinopathy III
Session Date/Time: Saturday 19/09/2015 | 16:30-18:00
Paper Time: 17:50
First Author: : B.Shah UNITED KINGDOM
Co Author(s): : C. Quijano E. Normando S. Younis
PURPOSE:Central Retinal Vein Occlusion (CRVO) is a common retinal vasculature disease associated with a dramatic risk of permanent sight loss. To date, the most effective therapeutic strategies that aim to reduce CRVO devastating complications are the inhibitors of the Vascular Endothelial Growth Factor (VEGF) and the administration of intraocular steroids. The aim of our study was to review and compare the efficacy of three different current therapeutic approaches namely: Ranibizumab intravitreal injections, Aflibercept intravitreal injections, and Dexamethasone intravitreal implant for the treatment of macular oedema secondary to CRVO.
The study was conducted on 30 patients attending the Macula Clinic at the Western Eye Hospital, London UK over a period of 2 years.
A retrospective review of 30 patients diagnosed with CRVO and secondary macular oedema was conducted. In our study, 10 patients received 2.5mg/0.05ml of Aflibercept, 10 patients received 0.5mg/0.05ml Ranibizumab and 10 patients were dosed with 0.7mg Dexamethasone implant to make three treatment groups. Study assessment included change in the best corrected visual acuity (BCVA) measured in LogMAR and change in central retinal thickness (CRT) measured by Cirrus HD-OCT. Complications and side effects were also recorded accordingly. P values less than 0.05 were considered significant.
The group treated with Aflibercept showed a significant reduction in the mean CRT of 526 ± 253μm vs 291 ± 123μm, (p less than 0.005). The average reduction of CRT was 45% after treatment. The mean BCVA pre injection was 0.79 LogMAR vs 0.83 LogMAR post injection. The average number of injections was 3.1. The group treated with Ranibizumab showed a reduction of the mean CRT 551 ± 205μm vs 448 ± 207μm, (p less than 0.11). The average reduction was 18% in CRT after treatment. The mean BCVA pre injection was 0.69 LogMAR vs 0.44 LogMAR post injection (p less than 0.06). The average number of injections was 4.4. The group treated with Dexamethasone implant showed a significant reduction in the mean CRT 476 ±127μm vs 283± 80μm (p less than 0.004). The average reduction in CRT was 40% after treatment. The mean BCVA pre injection was 0.74 LogMAR vs 0.79 LogMAR post injection (p less than 0.82). The average number of injections was 1.8. There were no reported complications or side effects in the Aflibercept or Ranibizumab group, however 30% of the patients in the Dexamethasone group had a rise in intraocular pressure over 35 mm/Hg.
Our research indicates that intravitreal anti-VEGF pharmacotherapy is effective in the treatment of macular oedema secondary to CRVO to some extent. The Aflibercept group showed the most significant CRT improvement with less number of injections compared to Ranibizumab (3.1 vs 4.4), however improvement of BCVA in the Aflibercept group was not significant. The Ranibizumab group had the most significant BCVA improvement, however the CRT change was not significant. Despite the Dexamethasone implant showing a significant reduction in the CRT after treatment, the average percentage was less when compared to Aflibercept, with no improvement in BCVA seen. In addition, the Dexamethasone implant showed a higher frequency of adverse events such as rise in the intraocular pressure in almost one third of the patients. Those who experienced a rise in intraocular pressure required topical antihypertensive therapy. Although preliminary, our results suggest that intravitreal administration of Aflibercept is more effective in the treatment of macular oedema secondary to CRVO compared to Ranibizumab and Dexamethasone implants.