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ABSTRACT Purpose: To evaluate the effectiveness of intravitreal bevacizumab injections following a single dexamethasone implant in the treatment of macular edema secondary to branch and central retinal vein occlusion. Methods: This was a prospective interventional non-comparative study, 44 eyes of patients with naïve macular edema related to branch and central retinal vein occlusion were treated with a dexamethasone implant. Patients were followed-up at four-week intervals from the second to the sixth month. If persistent or recurrent macular edema occurred during this period, the patient was treated with intravitreal bevacizumab injections on an as-needed basis. The outcome measures were best-corrected visual acuity and central macular thickness changes. Results: The mean best-corrected visual acuity changed from 0.97 ± 0.33 LogMAR at baseline to 0.54 ± 0.40 at the six-month post-implant examination (p<0.00001). Improvement ≥3 Snellen lines were seen in 20 eyes (45.54%). The mean central macular thickness at baseline was 670.25 ± 209.9 microns. This had decreased to 317.43 ± 112.68 microns at the six-month follow-up (p<0.00001). The mean number of intravitreal bevacizumab injections received in the six months post-implant was 2.32. The mean time from dexamethasone implant to first anti-VEGF injection was 3.45 months. Conclusions: Intravitreal bevacizumab injections following a single dexamethasone implant were found to improve best-corrected visual acuity and central macular thickness in patients with macular edema due to branch and central retinal vein occlusion at six months, with few intravitreal injections required.
RESUMO Objetivo: Avaliar a eficácia da combinação de injeções intravítreas de bevacizumabe em olhos com edema macular secundário à oclusão de ramo e da veia central da retina após um único implante de dexametasona. Métodos: Foi realizado um estudo prospectivo intervencionista não comparativo com 44 olhos de pacientes com edema macular relacionado à oclusão de ramo e veia central da retina, sem tratamento prévio e tratados com um único implante de dexametasona, que foram acompanhados em intervalos de quatro semanas do segundo ao sexto mês. Se fosse constatado edema macular persistente ou recorrente durante esse período, os pacientes eram tratados com injeções intravítreas de bevacizumabe em um regime ajustado conforme a necessidade. Foram estudadas a melhor acuidade visual corrigida e alterações da espessura macular central. Resultados: A média da melhor acuidade visual corrigida mudou de 0,97 ± 0,33 LogMAR iniciais para 0,54 ± 0,40 no exame de 6 meses (p<0,00001). Vinte olhos (45,54%) melhoraram 3 linhas de Snellen ou mais. A média da espessura macular central inicial foi de 670,25 ± 209,9 μm e diminuiu para 317,43 ± 112,68 μm na visita de 6 meses (p<0,00001). O número médio de injeções intravítreas de bevacizumabe em 6 meses foi de 2,32 e o tempo médio entre o implante de dexametasona e a primeira injeção de anti-VEGF foi de 3,45 meses. Conclusão: Injeções intravítreas de bevacizumabe após um único implante de dexametasona podem proporcionar um aumento da melhor acuidade visual corrigida e diminuição da espessura macular central aos 6 meses em pacientes com edema macular devido à oclusão de ramo e da veia central da retina, com poucas injeções intravítreas.
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ABSTRACT Purpose: To investigate the effects of epiretinal membrane formation on the clinical outcomes of intravitreal dexamethasone implantation for macular edema secondary to branch retinal vein occlusion. Methods: This retrospective interventional case series includes the treatment of naive patients with macular edema secondary to non-ischemic branch retinal vein occlusion who underwent intravitreal dexamethasone implantation. The patients were divided into two groups as follows: Group 1 (n=25), comprised of patients with macular edema secondary to branch retinal vein occlusion without epiretinal membrane, and Group 2 (n=16), comprised of patients with macular edema secondary to branch retinal vein occlusion with an epiretinal membrane. Corrected visual acuity, central macular thickness, and central macular volume values were measured before and after treatment. The clinical outcomes of the groups were compared. Results: Mean age and male-to-female ratio were similar between the two groups (p>0.05, for both). The baseline and final corrected visual acuity values, central macular thickness, and central macular volumes of the groups were similar (p>0.05, for all). All the parameters were significantly improved after intravitreal dexamethasone implantation treatment (p<0.001, for all). The changes in central macular thickness and volume were also similar (p>0.05, for both). The mean number of intravitreal dexamethasone implantations was 2.1 ± 1.0 (range, 1-4) in Group 1 and 3.0 ± 1.2 (range, 1-5) in Group 2 (p=0.043). Conclusion: Epiretinal membrane formation had no effects on the baseline and final clinical parameters, including corrected visual acuity and central macular thickness and volume. The only parameter affected by the presence of epiretinal membrane formation is the number of intravitreal dexamethasone implantations, a greater number of which is needed for macular edema secondary to branch retinal vein occlusion with an epiretinal membrane.
RESUMO Objetivo: Investigar os efeitos da formação de uma membrana epirretiniana nos resultados clínicos da implantação intravítrea de dexametasona para edema macular secundário à oclusão de um ramo da veia retiniana. Métodos: Esta série retrospectiva de casos intervencionais inclui o tratamento de indivíduos com edema macular secundário à oclusão não isquêmica de um ramo da veia retiniana, sem tratamento prévio e que foram submetidos a implantação intravítrea de dexametasona. Os indivíduos foram divididos em dois grupos: Grupo 1 (n=25), composto por indivíduos com edema macular secundário à oclusão de um ramo da veia retiniana sem a presença de uma membrana epirretiniana, e Grupo 2 (n=16), composto por indivíduos com edema macular secundário à oclusão de um ramo da veia retiniana com a presença de uma membrana epirretiniana. Os valores da acuidade visual corrigida, espessura macular central e volume macular central foram obtidos antes e após o tratamento. Os resultados clínicos dos grupos foram comparados. Resultados: A média de idade e a proporção entre homens e mulheres foram semelhantes nos dois grupos (p>0,05 para ambos os valores). Os valores iniciais e finais da acuidade visual corrigida, espessura macular central e volume macular central foram semelhantes nos dois grupos (p>0,05 para todos os valores). Todos os parâmetros melhoraram significativamente após o tratamento com implante de dexametasona intravítrea (p<0,001 para todos os parâmetros) e as alterações na espessura macular central e no volume macular central também foram semelhantes (p>0,05 para ambos os valores). O número médio de implantações intravítreas de dexametasona foi 2,1 ± 1,0 (faixa de 1-4) no Grupo 1 e 3,0 ± 1,2 (faixa de 1-5) no Grupo 2 (p=0,043). Conclusão: A formação de uma membrana epirretiniana não tem efeitos sobre os parâmetros clínicos iniciais e finais, incluindo a acuidade visual corrigida, a espessura macular central e o volume macular central. O único parâmetro afetado pela formação de uma membrana epirretiniana é o número de implantações intravítreas de dexametasona, sendo necessário um número maior de implantações em casos de edema macular secundário à oclusão de um ramo da veia retiniana com a presença de uma membrana epirretiniana.
Subject(s)
Humans , Female , Male , Retinal Vein Occlusion , Macular Edema , Epiretinal Membrane , Retinal Vein Occlusion/complications , Retinal Vein Occlusion/drug therapy , Dexamethasone , Macular Edema/etiology , Macular Edema/drug therapy , Retrospective Studies , Epiretinal Membrane/complicationsABSTRACT
Objective To compare the one year efficacy of intravitreal injection with ranibizumb for macular edema (ME) secondary to ischemic and non-ischemic central retinal vein occlusion (CRVO).Methods A total of 88 patients (88 eyes) with ME secondary to CRVO were enrolled in this retrospective study.The best corrected visual acuity (BCVA) was detected by the Early Treatment Diabetic Retinopathy Study Chart.The optical coherence tomography was used to measure the foveal retinal thickness (CRT) and macular edema volume.The patients were divided into non-ischemic group and ischemic group,44 eyes of 44 patients in each group.There was no significant differences in age (t=0.650,P=0.517) and gender (x2=0.436,P=0.509) between the two groups.Compared with the ischemic group,the CRT was significantly decreased in the non-ischemic group (t=-2.291,P=0.024),and the edema volume in the macular area was significantly reduced (t=-2.342,P=0.022).All eyes were treated with continuous intravitreal injection of ranibizumab three times,and repeated injections were performed as needed.The patients without obvious ME regression after treatment were combined with triamcinolone acetonide injection.The patients with peripheral retinal non-perfusion area were combined with peripheral retinal laser photocoagulation.The follow-up was 1 year.The number of injections was counted.The changes of BCVA,CRT and edema volume in the macular area were compared between the two groups.Results During the 1-year follow-up period,88 eyes were injected 1 to 10 times,with the mean of 4.51 ±2.33.The number of injections in the ischemic group and non-ischemic group were 4.55± 1.59 and 4.48 ± 2.91,respectively.There was no significant difference in the average number of injections between the two groups (t=0.136,P=0.892).The number of acetonide injections and laser treatment in the ischemic group was significantly higher than that in the non-ischemic group (t=3.729,9.512;P＜0.001).At the last follow-up,compared with the ischemic group,the BCVA was increased (t=8.128),the CRT was decreased (t=-7.029) and the edema volume in the macular area was decreased (t=-7.213) in the non-ischemic group (P＜ 0.001).Conclusion Compared with ME secondary to ischemic CRVO,intravitreal injection of ranibizumab for ME secondary to non-ischemic CRVO has the better outcome of vision improvement and edema regression as well as less fiequent of acetonide injections and laser treatment.
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Macular edema (ME) secondary to central retinal vein occlusion (CRVO) often cause severe visual impairment.Intravitreal anti-vascular endothelial growth factor agents and steroids can effectively eliminate ME and improve visual function,but the visual outcome is affected by multiple factors.Retinal blood flow,especially the macular microcirculation,has significant correlation with visual outcome.Ischemic CRVO,especially patients with severe damage in the deep and superficial vascular layer of the macular zone,usually have poor visual outcome.In addition,the integrity of the multi-layer retinal structure closely correlates with the visual outcome.Patients with intact ellipsoid zone,external limit membrane beneath the fovea have good visual recovery.Additionally,good baseline visual acuity,positive response to treatment in early phase,young age and timely treatment usually brings about better visual outcome.
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ABSTRACT Purpose: The aim of the present study was to evaluate visual acuity (VA) and central macular thickness (CMT) to assess the influence of serous retinal detachment (SRD) in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Sixty-one eyes with BRVO from 61 patients with ME were analyzed and divided into two groups according to the spectral domain optical coherence tomography (OCT) findings of SRD and cystoid macular edema (CME). All patients underwent complete ophthalmic examinations and OCT measurements (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Patients with marked retinal hemorrhage, diabetic retinopathy, previous laser photocoagulation, and/or intravitreal injection were excluded. Results: The mean age of included patients (37 males, 24 females) was 65.4 ± 11.4 (53-77) years. There were 21 patients with SRD and 40 patients with CME. All of the 21 patients with SRD had CME. VA was significantly worse in the SRD group compared with the CME (non-SRD) group (0.82 ± 0.34 logMAR vs 0.64 ± 0.38 logMAR; P=0.005). Conversely, CMT was significantly greater in the SRD group than in the CME group (465 ± 115 µ vs 387 ± 85 µ; P=0.00004). Conclusion: SRD may be associated with decreased VA. The prognosis of patients with BRVO and SRD requires further investigation.
RESUMO Objetivo: O objetivo deste estudo foi investigar a acuidade visual (VA) e espessura macular central (CMT) para avaliar a influência do descolamento seroso da retina (SRD) em olhos com edema macular (ME) secundário a oclusão de ramo da veia da retina (BRVO). Método: Sessenta e um olhos de 61 pacientes com oclusão de ramo da veia da retina e edema macular foram analisados e divididos em dois grupos, de acordo com os achados na a tomografia de coerência óptica por domínio espectral (OCT), de edema macular cistóide (CME) e descolamento seroso da retina. Todos os pacientes foram submetidos a exame oftalmológico completo e exame de tomografia de coerência óptica (Cirrus, Carl Zeiss Meditec Inc, Dublin, CA). Os pacientes com hemorragia acentuada da retina, retinopatia diabética, fotocoagulação a laser e/ou injeção intravítrea prévia foram excluídos. Resultados: A idade média dos pacientes (37 homens, 24 mulheres) foi de 65,4 ± 11,4 (53-77) anos. Havia 21 pacientes com SRD e 40 pacientes com edema macular cistóide. Todos os 21 pacientes com SRD também apresentaram edema macular cistóide. VA foi significativamente pior no grupo SRD do que no grupo edema macular cistóide (non-SRD) (0,82 ± 0,34 vs 0,64 ± 0,38 logMAR, p=0,005). Por outro lado, a espessura macular central foi significativamente maior no grupo descolamento seroso da retina do que no grupo edema macular cistóide (465 ± 115 µ vs 387 ± 85 µ, p=0,00004). Conclusão: Observou-se que o descolamento seroso da retina em si pode estar relacionado à diminuição de acuidade visual. Os prognósticos dos pacientes com oclusão de ramo da veia da retina e descolamento seroso da retina precisam ser adequadamente investigados.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Macula Lutea , Macular Edema/physiopathology , Retinal Detachment/physiopathology , Retinal Vein Occlusion/physiopathology , Visual Acuity/physiology , Fluorescein Angiography , Macula Lutea/physiopathology , Macular Edema/etiology , Macular Edema/pathology , Prognosis , Retrospective Studies , Retinal Detachment/etiology , Retinal Vein Occlusion/complications , Tomography, Optical CoherenceABSTRACT
Background Macular edema is one of the serious complications of central retinal vein occlusion (CRVO),and the present therapies are laser coagulation and intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs.Conbercept is humanized-monoclonal VEGF antibody and used for the treatment of retinal vascular diseases.However,fewer studies were focused on its application in macular edema secondary to CRVO.Objective The aim of this study was to compare the effectiveness and safety of conbercept with triamcinolone acetonide(TA)by intravitreal injections for macular edema secondary to CRVO. Methods A non-randomized controlled study was carried out under the approval of the informed consent of patients.Sixty eyes of 60 patients with macular edema secondary to CRVO were included in Weifang Yidu Central Hospital from March 2012 to August 2013.The eyes were divided into the conbercept group and TA group with 30 for each group.Conbercept and TA of 0.05 ml were intravitreally injected in different groups,and the best corrected visual acuity(BCVA),central macular thickness(CMT)measured by OCT,intraocular pressure(IOP)and relavant complications were examined before injection and 1 week,1 month,3 months and 6 months after injection.The treatment outcomes were compared intergrouply and along with time. Results The BCVA was evidently better in 1 week,1 month,3 months and 6 months after injection than that before injection both in conbercept group and TA group(all at P＜0.01),and the BCVA of TA group was better than that of conbercept group 1 week after injection(P＜0.05).The CMT values of Conbercept were(572.00± 100.01),(325.12±91.55),(280.00±92.37),(258.65 ±88.65),(300.00±87.64)μm,and those of TA group were(570.00± 102.21),(345.12±89.31),(290.00±80.27),(309.65 ±84.13)and(303.00±90.59)μm,and CMT value after injection was significantly lower in 1 week,1 month,3 months and 6 months after injection than that before injection both in the conbercept group and the TA group(all at P＜0.05),and CMT value was evidently reduced in the conbercept group compared with the TA group 3 months after injection(P＜0.05).The IOP was(15.20±3.52),(21.20±3.80),(26.40±4.00),(23.60±3.73)and(21.50±3.27)mmHg in the TA group before injection and 1 week,1 month,3 months and 6 months after injection,showing significnatly elavation after injection(all at P＜0.05),and the IOP at different time points was higher in the TA group than that in the conbercept group(all at P＜0.05).However,there was no considerable change of IOP before and after injection in conbercept group(all at P＜0.05). Conelutions Both conbercept and TA are effective for macular edema secondary to CRVO by intravtreal injection.Compared with TA,conbercept is much safer because of less risk of IOP rising after intravtreal injection.