Comparison of anti-vascular endothelial growth factors, laser treatments and a combination of the both for treatment of central retinal vein occlusion

AIM：To compare changes in visual acuity and macular edema in patients with central retinal vein occlusion（CRVO）treated with intravitreal injections of bevacizumab,macular grid photocoagulation combined with pan retinal photocoagulation（PRP）,or both（bevacizumab＋grid＋PRP）.· METHODS：Our study is a retrospective cohort clinical study that examined patients that suffered from ischemic CRVO with macular edema.Study inclusion criteria were ischemic CRVO with macula edema and the availability of complete medical records for at least 12 mo after treatment.Excluded were patients with diabetes or any other retinal disease.We reviewed the medical records of patients treated in one ophthalmology departmentcomparing changes in visual acuity and macular edema in patients treated with intravitreal injections of bevacizumab vs those that were treated with macular grid photocoagulation and PRP or both.The main outcome measures were the differences in best corrected visual acuity（BCVA） and in macular thickness,as assessed by optical coherence tomography,between the enrollment and the final follow up visits.· RESULTS：Sixty-five patients met inclusion criteria.There were no statistically significant differences among the three groups in the mean changes in macular thickness as measured by ocular coherence tomography（131.5±41.2,108.6±29.2,and 121.1±121.1,P=0.110）,or in visual acuity（0.128±0.077,0.088±0.057,and 0.095±0.065）,for intravitreal injections,macular grid photocoagulation＋PRP and a combination of the treatments,respectively,P =0.111.The proportions of patients with macular edema after treatment were：26.1%,28.6%,and 14.3%,respectively,P=0.499.· CONCLUSION：Similar benefit was observed for intravitreal injections,laser photocoagulation,or a combined regimen in the treatment of CRVO.A nonstatistically significant trend for reduction in macular edema was observed following combined treatment.

Radial optic neurotomy in treating central retinal vein occlusion: a Meta-analysis

AIM： To assess the feasibility of radial optic neurotomy （RON） in central retinal vein occlusion （CRVO） treatment with a Meta-analysis.METHODS： Electronic databases were searched for comprehensive articles that compared efficacy of RON with that of other treatments in CRVO. Study quality was assessed and risk ratio （RR） and 95% confidence interval （Cl） with fix or random-effects model were calculated according to the heterogeneity. RESULTS： A total of 200 eyes from 5 studies were included. The results indicated that no significant differences were found between groups with and without RON in improvement of visual acuity （VA） at 6mo follow- up （pooled RR 0.51, 95%CI 0.22 to 1.18, P=0.117） while improvement of VA showed significantly favourable in patients receiving RON treatment at 12mo follow-up （pooled RR 2.27, 95% CI 1.31 to 3.95, P=0.004）. For complications, RON treatment was more effective in reducing neovascular glaucoma （pooled RR 0.45, 95%CI 0.21 to 0.97, P=0.042） but was comparable in retinal detachment （pooled RR 2.41, 95%CI 0.51 to 11.39, P=0.267） and vitreous hemorrhage （pooled RR 0.91, 95%CI 0.33 to 2.46, P=0.847）. CONCLUSION： Compared with some certain treatment modalities, RON might offer better VA at 12mo and decrease the rate of neovascular glaucoma without changing the rate of retinal detachment and vitreous hemorrhage. Further studies are required considering the limitation of the research.