Case of acute vision loss after injectable remdesivir with anticoagulants and overdose of antibiotics: A late report

A woman reported decreased vision in the right eye since hospitalization for COVID-19. Vision in the right eye was 6/18 and in the left eye was counting fingers. Her left eye had cataract and right eye was pseudophakic with earlier documented good recovery. In the right eye, she had branch retinal vein occlusion (BRVO) with macular edema documented on optical coherence tomography (OCT). It was suspected that it might be an ocular manifestation of COVID-19 which had not been reported and had worsened. An overdose of antibiotics or remdesivir might also be responsible for the same. She was advised anti-VEGF injections and was kept under treatment.

Micropulse laser combined with intravitreal injection of Ranibizumab in the treatment of macular edema secondary to non-ischemic branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of micropulse laser combined with intravitreal injection of ranibizumab in the treatment of macular edema(ME)secondary to non-ischemic branch retinal vein occlusion(BRVO).METHODS: A total of 200 cases(200 eyes)of non-ischemic BRVO secondary to ME who were treated in our hospital from January 2020 to March 2022 were selected and divided into the control group(100 cases, 100 eyes)and the observation group(100 cases, 100 eyes)by random number table. The control group was given intravitreal injection of ranibizumab, and the observation group was given micropulse laser combined with intravitreal injection of ranibizumab. The best corrected visual acuity(BCVA), central macular thickness(CMT), subfoveal choroidal thickness(SFCT), total number of injections, macular leakage and complications were compared between two groups.RESULTS: After treatment, the BCVA of the two groups were improved, and the BCVA of the observation group was better than those in the control group at 1, 3, 6 and 12mo after treatment(all P<0.05). After treatment, the CMT and SFCT of the two groups decreased, and the CMT and SFCT of the observation group was lower than those in the control group at 1, 3, 6 and 12mo after treatment(all P<0.05). The total number of injections in the observation group during the treatment period was less than that in the control group [(4.06±1.12)times vs.(5.32±1.15)times](t=5.852, P<0.001). The leakage rates of the control group and the observation group after 12mo of treatment were 69.0% and 27.0% respectively, with statistical significance between the two groups(χ2=35.337, P<0.001). The incidence of complications in the control group and observation group were 11.0% and 5.0% respectively, with no statistical significance between the two groups(χ2=2.446, P=0.118).CONCLUSION: Micropulse laser combined with intravitreal injection of ranibizumab has a significant clinical efficacy in the treatment of ME secondary to non-ischemic BRVO, which is safe and can improve patients' vision and ME, reduce the total doses of ranibizumab without increasing the incidence of complications.

Evaluation of the predictive effect of parafoveal blood flow density of macula on the number of intravitreal Conbercept injections in patients with branch retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate blood flow density within 300μm(FD-300)around the foveal avascular zone(FAZ)in optical coherence tomography angiography(OCTA)of patients with macular edema(ME)complicated with non-ischemic branch retinal vein occlusion(BRVO), and to explore and evaluate the predictive effect of this parameter on the number of intraocular drug injections.METHODS: A retrospective case study. A total of 50 patients(50 eyes)who were diagnosed as non-ischemic BRVO combined with ME and received intravitreal conbercept(IVC)in the Affiliated Eye Hospital of Nanjing Medical University from January 2021 to March 2022 were selected, and they were treated with 3+PRN regimen. The 25 cases(25 eyes)treated with intraocular injection ≤5 times were classified as group B, and 25 cases(25 eyes)treated with intraocular injection >5 times were classified as group C, and 25 fellow eyes were randomly selected as control group A. OCTA was used to scan the macular area in 3mm×3mm to collect images of retinal blood flow, the central macular thickness(CMT)and FD-300. The CMT, best-corrected visual acuity(BCVA), and FD-300 were compared between the two groups at baseline, 1, 3, 6 and 12mo after the third injection.RESULTS: The BCVA(LogMAR)of the affected eye in both groups B and C at 1, 3, 6 and 12mo after the third injection was significantly lower than baseline(all P<0.05); the CMT and FD-300 were significantly lower than baseline(all P<0.05). Pearson correlation analysis showed that the change of BCVA(LogMAR)was positively correlated with the baseline FD-300 and CMT(group B: r=0.77, 0.70, all P<0.01; group C: r=0.89, 0.78, all P<0.01). The number of intraocular injections was negatively correlated with the baseline FD-300(group B: r=-0.63, P<0.01; group C: r=-0.71, P<0.01). Logistic regression analysis showed that the FD-300 at baseline is a factor that affects the number of intraocular drug injection.CONCLUSION: IVC can effectively alleviate macular edema of the affected eye,improve visual acuity and reduce FD-300. The eyes with worse BCVA and lower FD-300 at baseline may require more injections of anti-VEGF. Observation of FD-300 with OCTA can better predict eventual vision recovery of non-ischemic BRVO with ME before treatment.

Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study

Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow?up. The post?T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre?existing glaucoma and lost to follow?up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post?injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post?T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed. Conclusion: A secondary IOP spike post?IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field

Efficacy of Conbercept combined with laser photocoagulation in the treatment of macular edema secondary to ischemic BRVO / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe and analyze the efficacy of Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation in the treatment of macular edema(ME)secondary to ischemic branch retinal vein occlusion(BRVO).<p>METHODS: Totally 71 patients(71 eyes)diagnosed as ME secondary to ischemic BRVO during the period from March 2016 to March 2019 were retrospectively included, and they were divided into laser group(<i>n</i>=33, 33 eyes)and combined group(<i>n</i>=38, 38 eyes)according to the different treatment methods. The patients in the laser group all received 577nm yellow subliminal micropulse laser photocoagulation, and the patients in the combined group all received Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation. The best corrected visual acuity(BCVA), central macular thickness(CMT)and total macular volume(TMV)were compared between the two groups before treatment and at 1, 2, 3, 6, 9 and 12mo after surgery, and the therapeutic efficacy was observed and the occurrence of complications were recorded.<p>RESULTS:There were statistically significant differences in the BCVA, CMT and TMV between the two groups before and after treatment(<i>P</i><0.05), and the BCVA, CMT and TMV in the two groups at 1, 2, 3, 6, 9 and 12mo after treatment were significantly lower than those before treatment(<i>P</i><0.05), and the differences between the two groups were statistically significant(<i>P</i><0.05). During follow-up, there were 30 eyes with once laser photocoagulation, 7 eyes with twice and 1 eye with 3 times in combined group, and there were 16 eyes with once laser photocoagulation, 14 eyes with twice and 3 eyes with 3 times in laser group(<i>Z</i>=2.670, <i>P</i><0.05). There were 3 eyes of corneal epithelial exfoliation on the 1d after vitreous injection in combined group, and the symptoms disappeared after symptomatic treatment. All patients did not have serious complications such as persistent intraocular pressure increase, retinal detachment and intraocular inflammation.<p>CONCLUSION: Conbercept combined with 577nm yellow subliminal micropulse laser photocoagulation has a significant efficacy in the treatment of ME secondary to ischemic BRVO, and it can effectively improve the visual acuity and promote the macular edema absorption, and it is safe and reliable.

A Study Of Clinical Profile And Visual Outcome In Patients Undergoing Vitrectomy For Vitreous Hemorrhage

Background:Aim&Objective:To study the epidemiology of vitreous hemorrhage in patients presenting without retinal detachment. To study various etiology of vitreous hemorrhage. To study visual outcome in patients with non resolving vitreous hemorrhage required vitrectomy surgery. To study prognostic factors (age, sex,andvitreous hemorrhage in diabetic patients, hypertensivepatients, ARMD, Ealesdiseases) affecting visual outcome in vitreous hemorrhage. Material And Methods:Study included34patients out of which 13 have diabetes, 6 have hypertension, 7have both diabetes and hypertension, 6have past history of tuberculosis and 2 have no systemic illne ss. Examination includedpreoperative and postoperative best corrected visual acuity, slit lamp examination, intraocular pressure, ultrasound B scan and dilated funduswith indirect ophthalmoscope. Result:Majority patients (38. 2%) were in the age group of 51-60 years with the mean age 51. 35 years. Males [73. 5%] had higher incidence of vitreous hemorrhage than females and Incidence of vitreous hemorrhage was higher in lower socio-economic group. Diabetes Mellitus andHypertension werethe most common co-morbidities with Proliferative diabetic retinopathy,Eales diseases and Branch Retinal vein occlusion are the important Risk factors for vitreous hemorrhage. Most common presenting symptom of vitreous hemorrhage is sudden loss of vision [52. 9%] followed by gradual loss of vision and blurring loss of vision. Patients who received pan retinal photocoagulation and Anti-vegf have better visual outcome post-operativel. Pan retinal photocoagulation, Epiretinal membrane, traction band,macular edema,andchoroidalneovascular membrane are the intraoperative findings noted intra-operatively. Preoperatively most of the cases of vitreous hemorrhage had visual acquity in the group of Perception of light and finger counting close to face. Post-operatively 15 patients have visual acuity in group of 6/18-6/9. Among them 8 were PDR,4 cases of Eales disease and 3 were BRVO cases. Visual acuity of 8 cases belongs to group of 6/60 –6/24 which include 5 PDR , 2 BRVO and 1 Ealesdisease. Post-operatively 7 patients developed complications. Raised IOP seen in 3 cases which includes 2 PDR cases and 1 Eales disease. Cataractous lens noticed in 2 PDR cases. Retinal detachment developed in 1 PDR case. Revitreous hemorrhage occurred in 1 Eales disease. 2 cases underwent re-surgery. Revitrectomy done in 1 case of Eales disease for re-vitreous hemorrhage. Re-vitrectomy with silicone oil insertion done in 1 PDR case for retinal detachment. Conclusion:Visual impairment due to Vitreous hemorrhagemay be prevented by early detection of cause by appropriate investigations and treatment.

A Retrospective Study Of Pre And Post Treatment OCT( Optical Coherence Tomography)In Patients Of BRVO (Branch Retinal Vein Occlusion)With Macular Edematreated With Intravitreal Injection Bevacizumab(1.25mg/0.05ml) Attending Ophthalmology Department Of Ter

Background:Retinal vein occlusion (RVO) is the second most common sight threatening retinal vascular disorder after diabetic retinopathy. Retinal vein occlusion is a common form of retinal vascular disease, especially in middle-aged and older individuals. Occlusion results due to thrombotic effect on the retinal vein . BRVO is classified according to the anatomical location as major or macular. Major BRVO refers to occlusion of a retinal vein that drains one of the quadrants. Macular BRVO refers to occlusion of a venule within the macula. BRVO is further classified into perfused (non-ischemic) or non-perfused (ischemic). Ischemic BRVO is defined as > 5 disc diameters of nonperfusion on fluorescein angiography (FA).Objectives:To study pre and post treatment (Intravitreal Bevacizumab 1.25mg/0.05ml)OCTin patients with macular edema secondary to BRVO. Material And Methods:30 Eyes of 30 patients of BRVO with macular edema were studied retrospectively who attended eye opd during Sept-2012 to Aug-2014 according inclusion and exclusion criteria Afterroutine ophthalmic examination with slitlamp biomicroscopy and dilated fundus examination with indirect ophthalmoscope and preop OCT done for CFT(central foveal thickness)patient underwent intravitreal injection anti VEGF.Posttreatment OCTof these patients were reviewed after 1 week and 1 month retrospectively.Result:Significant improvements in CFT were observed in these patients after treatment. Results were analyzed based on the duration Of the treatment given, after 1 week and after 1 month.Conclusion:Early diagnosis & treatment of the pathology contributes to the better visual outcome.

Comparison of ranibizumab alone versus ranibizumab with targeted retinal laser for branch retinal vein occlusion with macular edema

Purpose: To determine the effect of ultra-widefield fluorescein angiography (UWFFA)-guided targeted retinal photocoagulation (TRP) in branch retinal vein occlusion (BRVO) with macular edema after intravitreal Ranibizumab (RBZ). Methods: 33 eyes of 32 treatment naïve patients diagnosed as BRVO with macular edema were prospectively randomized to 0.5 mg Ranibizumab only (RBZ group) (n = 17) or Ranibizumab with UWFFA-guided laser (RBZ + TRP group) (n = 16). Both groups received three injections at monthly intervals and PRN henceforth. RBZ + TRP group additionally underwent UWFFA-guided TRP of peripheral capillary nonperfusion areas 1 week post injection. Outcome measures included improvement in visual acuity, central subfoveal thickness (CST), and the number of injections required with a minimum follow-up of 9 months. Results: Both groups showed significant improvement in mean BCVA (25.7 ± 8.19 letters, P < 0.001 vs. 23.38 ± 7.56 letters, P < 0.001; in RBZ and RBZ + TRP group, respectively) and reduction in mean central subfoveal thickness (379.12 ± 242.7 ?m, P < 0.001 vs. 253.75 ± 137.9 ?m, P < 0.001 in RBZ and RBZ + TRP group, respectively) at 9 months. The number of injections in the RBZ group (5.76 ± 1.3) was significantly greater than RBZ + TRP (4.06 ± 0.99) (P < 0.001). Both groups had significant improvement in contrast sensitivity and mean deviation on visual fields; however, the difference between the groups was not significant (P = 0.62 and P = 0.79, respectively). Conclusion: UWFFA-guided TRP reduced the number of injections of Ranibizumab in patients having BRVO with macular edema, while maintaining similar benefits in the improvement of BCVA, central subfoveal thickness without deleterious effect on the visual field, and contrast sensitivity.

Baseline Characteristics and Risk Factors for Retinal Vein Occlusions

Introduction: Venous obstructive disease of the retina iscausing significant visual morbidity affecting quality of lifeof patient. Incidence of CRVO is 0.8 per 1000 persons and 4.4per 1000 persons for BRVO. RVO most commonly affects thevenous blood supply of entire retina [CRVO] or a quadrantdrained by one of the branches [BRVO] less commonlysuperior or inferior half of retina alone is affected [HRVO].Study Aimed to study demographic characteristics and riskfactors of Retinal Vein Occlusions (Both CRVO and BRVO)Material and methods: This is a cross sectional observationstudy. It included 208 patients [64 CRVO patients and 144BRVO patients]at Retina department, Sarojini Devi EyeHospital, Hyderabad. Study was conducted for 1 year and 7months.Results: Hypertension stands alone as the most significantrisk factor (P Value is 0.005). Other factors studied likeUrban Background, Lack of physical Activity, Diabetes,Hyperlipidemias, CVA, CAD etc. though were present in goodnumbers in the cases studied but they were not statisticallysignificant.Conclusion: Hypertension, Diabetes and Raised SerumLipids are significant risk factors for Retinal Vein Occlusionsin South Indian population

Efficacy of Optical Coherence Tomography Angiography in Measuring the Foveal Avascular Zone Area in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate the efficacy of optical coherence tomography angiography (OCTA) by measuring the foveal avascular zone (FAZ) area in patients with branch retinal vein occlusion (BRVO). METHODS: Thirty four eyes of 34 patients with BRVO were retrospectively reviewed. The area of the FAZ was calculated using fluorescein angiography (FAG) and OCTA. The FAZ area was divided into two groups according to the presence of macular edema, which was determined based on the central foveal thickness (300 µm), and then the measured areas were compared. RESULTS: Pearson's correlation analysis revealed a significant positive correlation between FAG and the superficial capillary plexus (SCP) in OCTA with or without macular edema (r = 0.845, p = 0.001). However, there was not a significant correlation between FAG and the deep capillary plexus (DCP) in OCTA (r = 0.001, p = 0.996). In addition, the FAZ area measured by FAG and OCTA in the SCP showed a significant agreement between the two methods (intraclass correlation coefficient [ICC] = 0.916, p = 0.001). However, there was no significant relation found for the FAZ area between FAG and OCTA in the DCP (ICC = 0.001, p = 0.501). CONCLUSIONS: In the patients with BRVO, OCTA can be used to measure the FAZ areas in both the SCP and DCP, beyond measurement of the FAZ area at the two-dimensional cross section used during FAG. The FAZ area in the SCP via OCTA showed a statistically significant correlation with the FAZ area determined by FAG, but there was no such correlation in the DCP. That said, the FAZ area in the DCP was positively correlated with a decrease in visual acuity among the patients, which may be an indicator of visual prognosis.

Multiple extra macular branch retinal vein occlusions in hyperhomocysteinemia.

Hyperhomocysteinemia is a well-known modifiable risk factor for thromboembolism. Retinal vascular occlusion in patients having hyperhomocysteinemia is a known entity, particularly in young patients. However, multiple extra macular branch retinal vein occlusion (BRVO) is a rare condition, which can be a presentation of this disease. We present a patient who had multiple extra macular BRVO; on complete systemic workup, he was found to have raised homocysteine levels.

Role of anti vascular endothelial growth factor (VEGF) in ophthalmology.

Vascular endothelial growth factor (VEGF), is a naturally occurring signal protein which is proinflammatory, stimulates angiogenesis and potent inducer of vascular permeability. Its role in normal physiology includes in embryonic development, wound healing and bone repair, neovascularization following MI and demonstrated in brain, kidney and GI mucosa. VEGF is responsible for many retinal diseases by causing new vessel growth and by increasing leakage and causing retinal swelling. Their use in ophthalmology includes in both anterior and posterior segment pathologies. This article explains the role of VEGFs, their mechanism of action, anti VEGFs, classification, their use, various studies and other aspects.

Combined Therapy of Bevacizumab and Grid Photocoagulation for Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To evaluate clinical outcomes of a combined therapy of intravitreal bevacizumab and grid laser photocoagulation for macular edema in branch retinal vein occlusion (BRVO). METHODS: In the present retrospective study, medical records of patients who were treated with intravitreal bevacizumab injection for macular edema due to BRVO were reviewed. The eyes were divided into 2 groups, the combined therapy group of intravitreal bevacizumab and grid laser photocoagulation, and the monotherapy group of intravitreal bevacizumab. Visual acuity and central subfield macular thickness were investigated at 1, 2 and 6 months. Recurrence rate was compared between the 2 groups. RESULTS: Among 49 eyes, 18 eyes underwent macular grid photocoagulation and 31 eyes did not receive laser treatment. Laser photocoagulation was performed at 1.2 months after injection on average. Visual acuity improved significantly at 2 and 6 months in the combined therapy group, and at 1, 2 and 6 months in the monotherapy group. Macular thickness decreased significantly compared to baseline at all visits in both groups. There was no significant difference in visual acuity and foveal thickness between the 2 groups. Recurrence at 6 months was significantly less frequent in the combined therapy group (3 eyes, 17%) then in the monotherapy group (14 eyes, 45%, p = 0.046). CONCLUSIONS: Combined grid photocoagulation after intravitreal bevacizumab injection lowered the recurrence rate of macular edema complicated with BRVO.

Impact of Intravitreal Bevacizumab Injection on Life Quality in Patients with Branch Retinal Vein Occlusion

PURPOSE: To evaluate the impact of intravitreal bevacizumab injection on visual function and vision-related quality of life (VR-QOL) in patients with branch retinal vein occlusion (BRVO) using the Korean version of the National Eye Institute Visual Function Questionnaire 25 (K-NEI-VFQ-25). METHODS: This study included 32 normal control subjects and 32 patients with BRVO. The Korean version of NEI-VFQ-25 was answered by the patients with BRVO before and 3 months after intravitreal bevacizumab injection, as well as by normal control subjects. Clinical data were collected, including central macular thickness (CMT), total macular volume (TMV) (using time-domain optical coherence tomography [OCT]), and best corrected visual acuity (BCVA). RESULTS: Visual acuity, CMT, and TMV significantly improved 3 months after intravitreal bevacizumab injections. No bevacizumab-related systemic or ocular adverse effects following intravitreal drug injections were observed. Significant improvement in the VFQ-25 composite score was observed in patients with BRVO. Subscale scores, including general vision, near activities, distance activities, social functioning, mental health, role difficulties, dependency, and peripheral vision, improved after injection. However, subscale scores regarding general health, ocular pain, driving, and color vision did not improve significantly. CONCLUSIONS: Intravitreal bevacizumab injection appears to be an effective treatment for visual function, as well as VR-QOL in macular edema secondary to BRVO. However, improvement of driving function and color vision appears to require a longer recovery time than visual function.

Effects of Intravitreal Bevacizumab Injection in 3 Types of Macular Edema Secondary to Branch Retinal Vein Occlusion

PURPOSE: To compare the effects of intravitreal bevacizumab injection (IVB) in 3 types of macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: Patients with macular edema secondary to BRVO with at least 1-year follow-up after IVB were included in the present retrospective study. The authors classified the macular edema into 3 types according to OCT findings: diffuse macular edema (type 1), cystoid macular edema (type 2), and serous retinal detachment (type 3). The clinical outcome indicators were best corrected visual acuity, central macular thickness (CMT), and total number of injections. RESULTS: The total injection number was significantly higher in type 2 than type 3 (p = 0.02). Changes in CMT were significantly different between type 2 and type 3 (p = 0.03). CMT decreased significantly after IVB in all types of macular edema. CONCLUSIONS: Morphologic classification of macular edema with OCT is useful for predicting efficacy of IVB in macular edema secondary to BRVO.

Evaluation of Glaucomatous Damage in the Fellow Eyes of Patients With Unilateral Retinal Vein Occlusion

PURPOSE: To investigate the visual field (VF) and retinal nerve fiber layer (RNFL) status of the fellow eyes in patients with unilateral retinal vein occlusion (RVO). METHODS: Fifty patients with unilateral RVO and 35 normal control subjects wereconsecutively recruited. Humphrey VF parameters and RNFL status using scanning laser polarimetry with variable corneal compensation (GDx-VCC) were compared between the fellow eyes of the patients with unilateral RVO and control eyes. We also assessed the risk factors for the development of glaucomatous damage in the fellow eyes of unilateral RVO patients. RESULTS: Twelve fellow eyes out of 50 patients with unilateral RVO showed glaucomatous VF and RNFL changes assessed by GDx-VCC. VF indices and RNFL thickness parameters in the study group were significantly lower than those in the control group (p<0.05). Increased age and vertical cup-to-disc ratio were significantly associated with severity of VF and RNFL damage in the fellow eye of unilateral RVO patients (p<0.05). CONCLUSIONS: The fellow eyes in patients with unilateral RVO showed significantly worse VF indices and lower RNFL thickness than normal control eyes. The glaucomatous change should be carefully monitored in the fellow eyes of unilateral RVO patients.

Early and Late Intravitreal Bevacizumab Injection in Macular Edema Due to Branch Retinal Vein Occlusion

PURPOSE: To compare the effects of early and late intravitreal injection of bevacizumab in patients with macular edema (ME) due to branch retinal vein occlusion (BRVO). METHODS: The study sample included 56 eyes of 56 patients who received intravitreal bevacizumab injection for ME due to BRVO and were followed up with at least six months of observation. We retrospectively divided eyes into two classes that included 36 eyes with a disease duration of 3 months (late treatment group). We assessed the effects of injection on the best corrected visual acuity (BCVA), central retinal thickness and IOP at one, three, and six months after treatment. RESULTS: There was no statistically significant differences in terms of sex, age, number of injections, ischemia, pre-injection visual acuity and central retinal thickness between the two treatment groups. Improvements in central retinal thickness were observed in both groups but were not significantly different between the groups. Visual acuity improved in both groups after treatment; the improvement was significantly better in the early treatment group observed three and six months after treatment. IOP did not change after treatment in either group. CONCLUSIONS: In cases of ME due to BRVO, early intravitreal bevacizumab injection is more effective than late injection for maintaining and improving visual acuity.

Different Effect of IVTA in the Management of Macular Edema Secondary to Perfusion and Ischemic Type BRVO

PURPOSE: To investigate the improvement of visual acuity with the different effects of ischemic and perfusion type branched retinal vein occlusion (BRVO), and explore the relationship between defects of the macular capillary network and intravitreal injection of triamcinolone acetonide (IVTA) for treatment of BRVO secondary to macular edema. METHODS: We compared macular capillary network condition, improvement of visual acuity due to ischemic range, and decrease of macular edema between 23 perfusion type BRVO patients and 21 ischemic type BRVO patients who were treated with IVTA for BRVO secondary to macular edema. RESULTS: Both ischemic and perfusion type BRVO exhibited decreased macular edema and showed meaningful improvements in visual acuity (P<0.01), but did not show a relationship between the defects in the macular capillary network and improvement of visual acuity. No differences were seen in macular capillary network defects between ischemic and perfusion type BRVO. CONCLUSIONS: IVTA had an effect on the decrease in macular edema and improvement of visual acuity for both ischemic and perfusion type BRVO. However, defects in the macular capillary network do not seem to have any effect on the improvement of visual acuity.

The Effect of Posterior Vitreous Detachment on Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To quantitatively compare the role of posterior vitreous detachment in macular edema associated with branch retinal vein occlusion (BRVO) using OCT. METHODS: A retrospective study of 36 eyes with BRVO-associated macular edema was carried out from November 2003 to February 2005. There was posterior vitreous detachment (PVD) in 23 eyes [PVD (+) group], and vitreoretinal attachment on the fovea in 31 eyes [PVD (-) group]. PVD was detected with an indirect ophthalmoscope or 90D lens. The foveal thicknesses of the two groups were measured and compared. RESULTS: The mean foveal thicknesses of the PVD (-) and PVD (+) groups were 398.0+/-217.2 micrometer and 233.6+/-80.6 micrometer, respectively (p=0.000, Mann-Whitney test). The mean BCVA (log MAR) was 0.77+/-0.52 in the PVD (-) group and 0.40+/-0.37 in the PVD (+) group (p=0.002, Mann-Whitney test). CONCLUSIONS: The extent of macular edema associated with BRVO was significantly less in the PVD(+) group and BCVA was significantly better in the PVD (+) group as well.

Combination of Laser Treatment and Intravitreal Triamcinolone Injection for Macular Edema with Branch Retinal Vein Occlusion

PURPOSE: To examine the clinical effect of combination method of laser treatment and intravitreal triamcinolone (TA) injection for patient of macular edema with branched retinal vein occlusion (BRVO). METHODS: fifteen patients, -(15 eyes), 7 malse and 8 females, with macular edema associated with BRVO were included in the study. The mean age was 59.47 years old. The response to treatment was monitored functionally by visual acuity assessment and anatomically by Optical Coherence Tomography(OCT) for macular thickness. Four milligrams of TA were injected into the vitreous cavity. The clinical outcome and complication were reviewed, retrospectively. RESULTS: After the combination method of laser treatment and intravitreal TA injection, 13 (87%), 12 (80%), 13 (87%) of the 15 eyes showed improved the mean visual acuity at 1-, 2-, and 6-month follow-ups retrospectively. Central macular thickness as measured by OCT decreased by 37% (312.5 +/- 9 micrometer), 42% (282.1 +/- 556 micrometer), and 56% (276.9 +/- 76 micrometer), at the same follow-ups from an initial pretreatment mean of 495.9 +/- 114 micrometer. The post-operative complications were intraocular pressure elevation (1 eye, 7%), and cataract (3 eyes, 20%). However, there were no serious postoperative complication such as retinal detachment, vitreous hemorrhage, and endophthalmitis. CONCLUSIONS: The combination method of laser treatment and intravitreal TA injection may be useful for treating patient of macular edema with BRVO.