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.

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.

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.

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.

Macular Hemodynamics before and after Retinal Photocoagulation in Branch Retinal Vein Occlusion using Heidelberg Retina Flow meter(HRF )

To investigate the pathogenesis of macular edema in branch retinal vein occlusion(BRVO)and its attributing factors, we measured the macular circulation using HRF(Heidelberg Retina Flowmeter)before, 1 hour, 1 day, and 1 month after grid laser photocoagulation in 12 patients. After laser photocoagulation, the macula circulation significantly increased in 8 eyes(group 1), and remained unchanged in 4 eyes(group 2). Mean postoperative macular circulation of group 1 was blood volume 136.2%, blood flow 148.0%, and blood velocity 144.4%. And mean postoperative macular circulation of group 2 was blood volume 103.8%, blood flow 97.8%, and blood velocity 98.8%. The mean age of the patient was higher in group 1(group1:mean age 59.0, group 2:mean age 43.5, p=0.0008)and the interval between the onset of BRVO and photocoagulation was longer in group 1 than in group 2(group 1:12.4 months, group 2:4.3 months, p=0.0233). Our results suggest that retinal autoregulation may play an important role in the resolution of macular edema in BRVO after grid photocoagulation. Therefore the evaluation of retinal autoregulation using HRF is important in determining the treatment guide line and the prognosis of photocoagulation.

Measurement of Blood Retina Barrier in Branch Retinal Vein Occlusion (BRVO)

Vitreous fluorophotometry was used to measure blood retinal barrier permeability to fluorescein in 15 patients with branch retinal vein occlusion(BRVO). Mean posterior vitreous fluorescein concentration(3mm) was 20.0 +/- 11.3(ng/ml) in affected eyes, and 2.99 +/- 1.22(ng/ml) in unaffected eyes. There was a statistically significant difference between the affected eye and unaffected eye(p<0.05). Also there was a correlation between the hemorrhage area and the posterior vitreous fluorescein concentration(r2=0.819). This study revealed that the permeability of blood retinal barrier was increased in BRVO as compared to the contralateral eye, and the higher permeability values were associated with the extent of area involved.

Evaluation of Retinal Circulation Times in Branch Retinal Vein Occlusions with Scanning Laser Ophthalmoscope

To investigate retinal hemodynamics in branch retinal vein occlusion(BRVO), we measured retinal circulation times using scanning laser ophthalmoscope(SLO) and studied the relationships with clinical findings. Arm-retina time(ART) and arteriovenous passage time(AVP) were measured in 35 eyes of 35 patients. Mean ART was 13.05 sec. ART showed no difference with sex and systemic diseases, but increased withage. AVP of occluded branch was much longer than those of other branches. AVP was delayed according to the size of capillary nonperfusion area, but showed no difference according to the duration of disease and macular edema. These results suggest that SLO is an useful method for studying retinal hemodynamics in BRVO.

Arteriovenous Crossing Patterns in Branch Retinal Vein Occlusion

The study was designed to evaluate the relative anatomic position of the crossing vessels at the site of occlusion in eyes with branch retinal vein occlusion(BRVO). Fluorescein angiography and fundus photography of 33 eyes(33 patients) with BRVO were used to examine the relative position of artery and vein at occluded crossings. Three separate comparison groups were formed by identifying corresponding arteriovenous crossings for each occluded crossing in: (1) the ipsilateral but opposite vessel arcade within eyes affected by BRVO patients; (2) the same quadrant in unaffected eyes of BRVO patients; and (3) the same quadrant in eyes of patients without BRVO, matched by age and sex with the BRVO patients. The site of obstruction of the branch vein was an arteriovenous crossing in all affected eyes. In 97% of eyes with BRVO, the artery was located anterior to the vein at the obstructed site. In the three comparison groups the artery was anterior to the vein in 73%, 68%, 59% of the crossings, respectively, yielding statistically significant differances for first group(P<0.02), second graup(P<0.01) and third group(P<0.001) of control crossings compared with BRVO crossings.

Retinal circulation times in branch retinal vein occlusion

To investigate the retinal hemodynamics in branch retinal vein occlusion (BRVO), we measured retinal circulation times using scanning laser ophthalmoscope (SLO) and studied their relationships with clinical findings. Arm-retina time (ART) and arteriovenous passage time (AVP) were measured in 30 eyes of 30 patients. Mean ART was 13.07 seconds. ART showed no difference in relation to sex and systemic diseases, but increased with age. Mean AVPs were 3.00 sec. and 3.39 sec. in superotemporal and inferotemporal BRVO, respectively. AVPs were delayed significantly in occluded branch of retinal veins. AVP was delayed three-fold when the area of capillary nonperfusion was over 6 disc area, but showed no difference according to the duration of disease or macular edema. These results suggest that SLO may be a useful tool for studying retinal hemodynamics in BRVO.

Laser Photocoagulation for Macular Edema in Branch Retinal Vein Occlusion

We observed 44 eyes of 43 patients who were diagnosed as macular edema in branch retinal vein occlusion(BRVO) by fluorescein angiogram, which had been followed up over 6 months after argon-green laser photocoagulation. In our cases, sixth decade of age was most commonly affected and there were no significant difference in sexual prevalence and laterality. Eighty six percent was 0.5 or less in initial visual acuity and 59.1% was 0.5 or more in final visual acuity. Increased visual acuity of 2 lines or more was 61.4% and decrease was only 9.1%. After laser treatment, visual improvements of each comparing group were as follow: 60.7% in superotemporal and 62.5% in inferotemporal, 56.5% in hypertensive patients and 66.7% in normotensive patients, 61.5% in below 6 months from onset of symptom until entry into laser photocoagulation and 61.1% in over 7 months, and there were no significant statistical difference.

Clinical Observation of the Bilateral Retinal Vein Occlusion

The clinical evaluation was done in eighteen eyes of nine patients with bilateral BRVO in aspects of onset, visual acuity, interval between onset of one eye and the other, sex ratio, associated systemic diseases, location of the affected vein, the effect of macular edema on visual acuity and ocular complications. The onset of age was from fifty one to sixty eight years. Eight patients were women, and one patient was man. Hypertension was the most common associated systemic disease. Ten eyes (55.5%) of bilateral BRVO were affected the superior temporal branch vein, the sites of occlusion were not more than two disc diameters from the optic disc in fifteen eyes (83.3%). The complications of seevere visual loss had macular edema, macular capillary nonperfusion, retinal neovascularization and vitreous hemorrhage. Among of six numbers who could be followed up more than one year, and visual acuity of five eyes with macula edema were decreased than five other eyes developed one year or later. Eyes that were more than five disc diameters of capillary nonperfusion, as visualized with fluorescence angiography were thirteen (72.2%). Of these eyes, six (46.1 %) eyes occured retinal neovascularization, five of those had macular capillary nonperfusion. four of those were 0.1 in final vision. Three of four eyes with vitreous hemorrhage were very slowly improved in visual acuity, but another was decreasing in visual acuity due to other ocular complications We thought that woman with history of BRVO due to hypertension in sixth and seventh decades should be followed up the other eye for three years.