ABSTRACT
PURPOSE: To evaluate the efficacy of combined treatment with intravitreal bevacizumab (IVB) and triamcinolone acetate (IVT) for patients with macular edema secondary to branch retinal vein occlusion (BRVO). MATERIALS AND METHODS: Retrospective analysis of 20 eyes injected with 1.25 mg IVB and 2 mg IVT for clinically identified BRVO within 8 weeks of onset. All patients lacked concomitant ocular pathology and completed 6 months' follow-up. Clinical examination including LogMAR visual acuity (VA) and central macular thickness (CMT) by spectralis optical coherence tomography (OCT) was performed preoperatively and at 1, 3 and 6 months post-operatively. RESULTS: Mean patient age was 61.3 years with a mean BRVO diagnosis time of 3 weeks at presentation. VA improved from logMAR 1.08 preoperatively to Mean logMAR VA of 0.55 ± 0.17 at 1 month (P < 0.001), 0.56 ± 0.21 at 3 months (P < 0.001), and 0.38 ± 0.1 at 6 months (P < 0.001) Mean CMT improved from 482 ± 107 µm preoperatively to 319 ± 53 µm at 1 month (P < 0.001), 344 ± 89 µm at 3 months (P < 0.001), and 241 ± 29 µm at 6 months (P < 0.001). Mean IOP preoperatively was 16.5 mmHg, 21 mmHg at 1 month, and 15 mmHg at 6 months. Six out of 20 patients (30%) were re-injected with IVB and IVT at 3 months. CONCLUSIONS: Early combined treatment with IVB and IVT is effective in improving anatomic and functional outcomes in patients with macular edema secondary to BRVO.
Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Retinal Vein Occlusion/drug therapy , Triamcinolone Acetonide/administration & dosage , Angiogenesis Inhibitors/administration & dosage , Bevacizumab , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Follow-Up Studies , Glucocorticoids/administration & dosage , Humans , Intravitreal Injections , Male , Middle Aged , Retinal Vein Occlusion/pathology , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual AcuityABSTRACT
BACKGROUND AND OBJECTIVE: Chronic macular hole and inability to maintain prone positioning remain poor prognostic markers for successful macular hole closure. The authors revisited the role of autologous platelets as an adjunct to internal limiting membrane (ILM) peeling of chronic macular holes in patients unable to maintain prone positioning. PATIENTS AND METHODS: A retrospective case study was conducted on 13 eyes of 13 patients with full-thickness chronic macular hole (> 24 months). Each patient was unable to maintain prone positioning due to medical and physical comorbidities. Each eye was treated with pars plana vitrectomy, ILM peeling, autologous platelets, and C(3)F(8) gas tamponade. No positioning was advised postoperatively. All patients had complete ophthalmic examinations preoperatively and 1 day and 1, 3, and 6 months postoperatively with optical coherence tomography. Outcome measures were anatomic closure based on Tornambe classification, final best-corrected visual acuity, and improvement of quality of vision. RESULTS: All 13 patients completed 6 months' follow-up. Macular hole duration ranged from 2 to 5 years. There was a 100% macular hole closure rate at 1 and 6 months postoperatively. All patients reported subjective improvement in visual acuity as an improvement of an absolute central scotoma. At 6 months postoperatively, 38% of patients reported improved best-corrected visual acuity. There were no recurrences. CONCLUSION: Autologous platelets and ILM peeling may function synergistically to enhance chronic macular hole closure in patients unable to maintain prone positioning.
