Dexamethasone implant for refractory macular edema secondary to diabetic retinopathy and retinal vein occlusion

AIM:To evaluate the efficacy,timing of retreatment and safety of dexamethasone(DEX)implant on macular edema(ME)secondary to diabetic retinopathy(DME)and retinal vein occlusion(RVO-ME)patients who were refractory to anti-vascular endothelial growth factor(VEGF)treatment.METHODS:This retrospective study included 37 eyes received at least one DEX implant treatment for DME or RVO-ME between January 1,2019,and January 1,2023.These refractory DME and RVO-ME cases received at least 5 anti-VEGF injections and failure to gain more than 5 letters or a significant reduction in central retinal thickness(CRT).The best corrected visual acuity(BCVA)and CRT were measured at baseline,and at 1,3,4 and 6mo post-DEX implant injection.Adverse events such as elevated intraocular pressure(IOP)and cataract were recorded.RESULTS:For RVO cases(n=22),there was a significant increase in BCVA from 0.27±0.19 to 0.35±0.20 at 6mo post-DEX injection(P<0.05)and CRT decreased from 472.1±90.6 to 240.5±39.0μm at 6mo(P<0.0001).DME cases(n=15)experienced an improvement in BCVA from 0.26±0.15 to 0.43±0.20 at 6mo post-DEX implant injection(P=0.0098),with CRT reducing from 445.7±55.7 to 271.7±34.1μm at 6mo(P<0.0001).Elevated IOP occurred in 45.9% of patients but was well-controlled with topical medications.No cases of cataract or other adverse events were reported.CONCLUSION:DEX implants effectively improve BCVA and reduce CRT in refractory DME and RVO-ME.Further research with larger cohorts and longer follow-up periods is needed to confirm these findings and assess long-term outcomes.

Comparison of efficacy of conbercept,aflibercept,and ranibizumab ophthalmic injection in the treatment of macular edema caused by retinal vein occlusion:a Meta-analysis

AIM:To evaluate and compare the anatomical and functional outcomes and negative effects of the three anti-vascular endothelial growth factor(VEGF)drugs in the treatment of macular edema(ME)due to retinal vein occlusion(RVO)based on the evidence pooled from current clinical trials and observational studies.METHODS:A systematic literature search was conducted on nine online databases from inception until April 30,2022.The main endpoints were best corrected visual acuity(BCVA),central macular thickness(CMT),and adverse events(AEs).Cumulative Meta-analysis was conducted to synthesize the outcomes of the drugs.The retrieved data were analyzed using Stata software(version 12.0).RESULTS:A total of 20 studies comprising 1674 eyes met the inclusion criteria to the Meta-analysis.It was observed that conbercept and aflibercept had better visual acuity effects compared with ranibizumab at 1mo[weight mean difference(WMD)=-0.03,P=0.001;WMD=-0.05,P=0.019],but the effects were not different from that of ranibizumab at 6mo.Moreover,there was not statistically significant dif ference in the propor tion of patients gaining≥15 letters at 12-24mo between aflibercept and ranibizumab[odds ratio(OR)=1.16,P=0.427].Conbercept had higher mean CMT change effects at 1mo(WMD=-14.43,P=0.014)and 6mo(WMD=-35.63,P≤0.001)compared with ranibizumab.Meanwhile,the mean CMT change effects at 1mo(WMD=-10.14,P=0.170),6mo(WMD=-26.98,P=0.140)and 12-24mo(WMD=-12.34,P=0.071)were comparable among the groups.Similarly,AEs were not significantly different among the treatments(OR=0.75,P=0.305;OR=1.04,P=0.89).The stability of effect size of mean BCVA and CMT improved with the increase in sample size.Aflibercept and conbercept required fewer injections compared with ranibizumab.CONCLUSION:This is the first study to evaluate the efficacy and AEs of intravitreal administration of conbercept,ranibizumab,and aflibercept in the treatment of RVOME.Intravitreal aflibercept or conbercept results in better mean change in vision and CMT reduction compared with ranibizumab.Conbercept can be considered to be a promising and innovative drug with good anti-VEGF effects.

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.

Differential analysis of aqueous humor cytokine levels in patients with macular edema secondary to diabetic retinopathy or retinal vein occlusion

AIM:To evaluate the difference and the correlation between the concentrations of cytokines in the aqueous humor of eyes with macular edema secondary to diabetic retinopathy(DR)or retinal vein occlusion(RVO).METHODS:This is a retrospective case control study.The aqueous humor samples were collected during intravitreal injection of anti-vascular endothelial growth factor(VEGF)for patients diagnosed with macular edema secondary to DR(DME)or RVO(RVO-ME)at Xijing Hospital from August 2021 to July 2022.Meanwhile,aqueous humor samples during vitrectomy from patients with idiopathic macular hole(IMH)were also collected and served as controls.The aqueous humor concentrations of VEGF,platelet-derived factor(PDGF),interleukin(IL)-6,IL-8,IL-18,tumor necrosis factor-α(TNF-α)and monocyte chemoattractant protein 1(MCP-1)were measured with Human Premixed Multi-Analyte Kit(Luminex).The difference of the aqueous cytokines and the correlation between the two diseases were analyzed.RESULTS:A total of 40 eyes of 38 patients were enrolled in the study,including 13 eyes of 11 DME patients(DME group),16 eyes of 16 RVO-ME patients(RVO-ME group)and 11 eyes of 11 IMH patients(control group).The VEGF,PDGF,IL-6,IL-8,and MCP-1 levels of the aqueous humor were higher in both DME and RVO-ME groups compared with the control group(all P<0.05),the levels of TNF-αwas higher in the DME group than in the control group(P<0.05).The VEGF,IL-6,MCP-1,and TNF-αlevels in the aqueous humor were significantly higher in the DR group than those in the RVO group(all P<0.05).Correlation analyses revealed that there were complex positive correlations between IL-6,IL-8,IL-18,MCP-1,and TNF-αlevels in the aqueous humor of eyes with two diseases.CONCLUSION:Although ischemic and inflammatory factors are similarly involved in the pathogenesis of DME and RVO-ME,the roles of these factors are more significant or more likely to be activated in DR patients,suggesting different treatment strategies should be considered for the two diseases.

Optical coherence tomography angiography for macular microvessels in ischemic branch retinal vein occlusion treated with conbercept:predictive factors for the prognosis

AIM:To evaluate the predicative factors of visual prognosis using optical coherence tomography angiography(OCTA)in ischemic branch retinal vein occlusion(BRVO)patients with macular edema(ME)after anti-vascular endothelial growth factor(VEGF)treatment.METHODS:In this retrospective analysis,data from 60 patients(60 eyes)with a definite diagnosis of ischemic BRVO with ME by fundus fluorescein angiography(FFA)were studied.The eyes with ME according to spectral domain optical coherence tomography(SD-OCT)underwent intravitreal conbercept(IVC)and 3+pro re nata(PRN)regimen.The injection times were recorded.Two weeks after injection,fundus laser photocoagulation was performed in the non-perfusion area of the retina.The patients were followed up once a month for 6mo.The bestcorrected visual acuity(BCVA),foveal avascular zone(FAZ),and A-circularity index(AI),at 6mo and the baseline were compared.RESULTS:All patients showed significant improvement in BCVA from 0.82±0.32 to 0.39±0.11 logMAR(P<0.001).The mean central macular thickness(CMT)significantly decreased from 476.22±163.54 to 298.66±109.23μm.Both the FAZ area and AI at 6mo were significantly higher than those at the baseline:the FAZ area increased(0.38±0.02 vs 0.39±0.02 mm^(2),P<0.05);the AI increased(1.27±0.02 vs 1.31±0.01,P=0.000).The baseline BCVA showed a significantly positive correlation with the baseline FAZ area,FAZ perimeter(PERIM)and AI,final visual gain(FVG)and injection times,respectively(P<0.001).FVG showed a significantly negative correlation with the FAZ area,PERIM,AI and injection times,but a significantly positive correlation with vessel densities(VDs)300μm area around FAZ(FD-300;P<0.001).Injection times was positively correlated with the baseline FAZ area,and AI,but inversely correlated with the baseline FD-300(P<0.001).However macular ischemia was noted in 5 cases during follow-up.CONCLUSION:Using OCTA to observe macular ischemia and quantify parameters can better predict the final visual prognosis of patients before treatment.The changes in FAZ parameters may influence the visual prognosis and injection times.

Intravitreal anti-VEGF agents, oral glucocorticoids, and laser photocoagulation combination therapy for macular edema secondary to retinal vein occlusion: preliminary report

AIM： To evaluate the efficacy and safety of combined anti-vascular endothelial growth factor （VEGF） agents, oral glucocorticoid, and laser photocoagulation therapy for macular edema （ME） secondary to retinal vein occlusion （RVO）. METHODS： This study included 16 eyes of 16 patients with RVO-associated ME. Patients were initially treated with oral prednisone and an intravitreal anti-VEGF agent. Two weeks later, patients underwent standard laser photocoagulation. Best-corrected visual acuity （BCVA）, central retinal thickness （CRT）, and retinal vessel oxygenation were examined over 12mo. RESULTS： Patients received 1.43＋0.81 anti-VEGF injections. Mean baseline and 12-month IogMAR BCVA were 0.96±0.51 （20/178） and 0.31±0.88 （20/40）, respectively, in eyes with central retinal vein occlusion （CRVO） （P〈0.00）, and 1.02±0.45 （201209） and 0.60±0.49 （20/80）, respectively, in eyes with branch retinal vein occlusion （BRVO） （P〈0.00）. At 12mo, CRT had significantly decreased in eyes with CRVO （P〈0.00） and BRVO （P〈0.00）. Venous oxygen saturation had significantly increased in eyes with CRVO （P〈0.00） and BRVO （P〈0.00）. No examined parameters were significantly different between the 2 RVO groups. No serious adverse effects occurred. CONCLUSION： Anti-VEGF, glucocorticoid, and photocoagulation combination therapy improves visual outcome, prolongs therapeutic effect, and reduces the number of intravitreal injections in eyes with RVO- associated ME.

Comparison of one and three initial monthly intravitreal ranibizumab injection in patients with macular edema secondary to branch retinal vein occlusion

AIM： To compare three initial monthly intravitreal ranibizumab（IVR） injections followed by pro re nata（PRN） dosing with one initial monthly IVR injections followed by PRN dosing for macular edema（ME） secondary to branch retinal vein occlusion（BRVO）.METHODS： Forty-two eyes of 42 patients who had IVR injections for BRVO were retrospectively studied. Eighteen eyes received 1 initial IVR injection（1＋PRN group） and 24 eyes received 3 monthly IVR injections（3＋PRN）. At 1, 3, 6 and 12mo; spectral-domain optical coherence tomography（SD-OCT） was performed. Central macular thickness（CMT）, the integrity of the external limiting membrane（ELM）, the presence of subretinal fluid, cyst size, the presence of inner segment/outer segment（IS/OS） defect were determined.RESULTS： At baseline the mean CMT was 521.3±153.2 μm in the 3＋PRN group while it was 438.1±162.4 μm in 1＋PRN group. At the final visit, mean CMT was 278.3±87.8 μm in the 3＋PRN group and 285.2±74.2 μm in the 1＋PRN group（P=0.079）. The changes in CMT over the entire study period were also comparable in both groups（243±160 μm in the 3＋PRN group, and 152.9±175.3 μm in the 1＋PRN group; P=0.090）. At baseline, best-corrected visual acuity（BCVA） was 0.92±0.60 logarithm of the minimal angle of resolution（logMAR） in the 3＋PRN group, while it was 0.72±0.46 logMAR in the 1＋PRN group. Final BCVA was 0.42±0.55 logMAR in the 3＋PRN group and 0.38±0.50 logMAR in the 1＋PRN group（P=0.979）. Additionally, the BCVA changes from baseline to final visit were not significantly different（-0.50±0.45 logMAR in the 3＋PRN group, and-0.33±0.39 logMAR in the 1＋PRN group; P=0.255）.CONCLUSION： No significant differences in the anatomical or functional results are found between 3＋PRN and 1＋PRN regimens in the patients receiving ranibizumab for ME secondary to BRVO. Intact IS/OS and baseline BCVA are good predictor of the visual gain, while baseline CMT is a good predictor of the anatomical gain.

Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.

Comparison of intravitreal ranibizumab and bevacizumab for the treatment of macular edema secondary to retinal vein occlusion

AIMTo compare the efficacy of ranibizumab and bevacizumab for macular edema due to retinal vein occlusion (RVO).

Anti-VEGF reduces inflammatory features in macular edema secondary to retinal vein occlusion

AIM: To investigate the anti-inflammatory effect of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF) in patients with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: Twenty-eight eyes from twenty-eight treatment-na?ve patients(14 males and 14 females) with RVO-ME were included in this retrospective study.The retinal vein occlusion(RVO) was comprised of both central retinal vein occlusion(CRVO,n=14) and branch retinal vein occlusion(BRVO,n=14).Intravitreal injection of anti-VEGF reagents were administered monthly for three consecutive months,in which 18 patients were injected with ranibizumab and 10 patients were injected with conbercept.All eyes were imaged with optical coherence tomography angiography(OCTA) at baseline and 1wk after monthly intravitreal anti-VEGF injection.The visual acuity(VA),central macular thickness(CMT),the number of hyperreflective foci(HRF) recognized as an inflammatory sign in OCT images,and non-perfusion area(NPA),were compared before and after anti-VEGF treatments.RESULTS: The mean interval between baseline and follow-up was 29.4±0.79(range,27-48)d.Compared with the baseline,the VA improved(log MAR 1.5±0.1 vs 0.8±0.1,P<0.05) and CMT decreased(460±34.0 μm vs 268.8±12.0 μm,P<0.05),significantly,after antiVEGF treatment.The number of HRF was decreased significantly(76.5±4.8 vs 47.8±4.3,P<0.05) after antiVEGF treatment.CONCLUSION: Anti-VEGF therapy is effective in treating RVO-ME.The mechanisms for the decreased HRF and the reduction of NPA by anti-VEGF therapy merits further exploration.

Comparison of intravitreal injection of conbercept and triamcinolone acetonide for macular edema secondary to branch retinal vein occlusion

AIM:To compare the safety and efficacy of the intravitreal injection of conbercept(IVC)and triamcinolone acetonide(IVTA)for macular edema(ME)secondary to branch retinal vein occlusion(BRVO).METHODS:A prospective,randomized clinical study.Patients with ME secondary to BRVO were randomly assigned to either IVC group or IVTA group at a ratio of 2:1 and a 12-month follow-up was performed.The efficacy outcome measures included the mean changes and differences in best corrected visual acuity(BCVA)and the central retinal thickness(CRT).The safety profiles and the mean retreatment intervals were also compared.RESULTS:There was no statistically significant difference of baseline between the two groups(IVC group,n=36;IVTA group,n=17).At 12mof the BCVA letters improved by 27.31±18.36 in the IVC group,and 13.53±11.37 in the IVTA group(P=0.0004).CRT reduction was 253.33±163.69 and 150.24±134.32 pm,respectively(P=0.0034).The mean BCVA in the IVC group was superior to that of the IVTA group for months 6-12(P<0.01).The mean CRT at 9 and 12mo were thinner in the IVC group compared to the IVTA group(P<0.01).The mean retreatment interval in the IVC group was longer than that in the IVTA group(97.40±36.27d vs 68.71±36.38d,P=0.0030).One eye in the IVC group and seven eyes in the IVTA group developed elevated intraocular pressure(IOP;P=0.0012).The proportion of eyes with cataract new-onset or progression were 19.44%in the IVC group and 64.71%in the IVTA group(P=0.0012).CONCLUSION:IVC could maintain or improve BCVA and reduce CRT for a longer time and have longer retreatment interval than IVTA.In addition,patients treated with IVTA are more susceptible to IOP elevation and cataract progression.

Aqueous levels of erythropoietin in acute retinal vein occlusion with macular edema

AIM:To investigate the aqueous erythropoietin(EPO)levels and associated factors in patients with acute retinal vein occlusion(RVO).METHODS:The aqueous EPO level was measured in patients with macular edema(ME)secondary to acute branched retinal vein occlusion(BRVO)or central retinal vein occlusion(CRVO).Aqueous fluid from cataract patients served as the control.We also evaluated whether aqueous level of EPO was associated with factors such as serum EPO level,non-perfusion area,central macular thickness(CMT),and arterio-venous(AV)transit timeRESULTS:Twenty-seven RVO patients(16 BRVO,11CRVO)and 9 control subjects were enrolled in the study.The aqueous EPO level(mU/mL)was higher in RVO(68.2±54.3)than that in the control subjects(12.9±5.9).More specifically,the aqueous EPO level was higher in CRVO(118.9±52.1)than that in BRVO(33.3±10.8).However,no differences were found in serum EPO levels among three groups.CMT in RVO patients had a positive correlation with the aqueous EPO level(r=0.66).Also,in terms of non-perfusion area,the aqueous EPO levels were more elevated in the ischemic subgroup than in the non-ischemic subgroup in both BRVO and CRVO.CONCLUSION:Aqueous EPO levels are elevated in patients with macular edema secondary to recent onset RVO.Patients with CRVO have higher EPO levels than those with BRVO.The aqueous EPO level in RVO has a positive correlation with CMT and is associated with non-perfusion area.These results suggest that the aqueous EPO level could be associated with retinal ischemia and may be involved in the pathogenesis of macular edema secondary to RVO.

Short-term effects of intravitreal Conbercept injection combined with laser photocoagulation on macular edema secondary to ischemic retinal vein occlusion

AIM:To observe changes in the best-corrected visual acuity(BCVA),central macular thickness(CMT),and central choroidal thickness(CCT)of patients with macular edema(ME)secondary to ischemic retinal vein occlusion(i RVO)following intravitreal Conbercept injection.METHODS:This retrospective study included 33 eyes from 33 patients who received intravitreal injections of Conbercept for ME secondary to i RVO.Treatments were performed on a 3+pro re nata(3+PRN)basis.All of the patients were examined by fundus fluorescein angiography and spectral domain optical coherence tomography at the first visit.Laser photocoagulation was performed in the nonperfusion area of the retina of all eyes after the first injection.BCVA,CMT,and CCT were observed before and after 6 mo of treatment.The number of injections necessary to achieve improved vision was also noted.RESULTS:Following Conbercept treatment,the mean BCVA significantly improved from 0.81±0.39 at baseline to 0.41±0.25 and 0.43±0.29 log MAR in the third and sixth months,respectively(both P=0.000).The CMT of the patients at baseline was 556.75±98.57μm;304.78±68.53 and 306.85±76.77μm 3 and 6 mo after treatment,respectively(both P=0.000 vs baseline).The CCTs of the patients at baseline,3 and 6 mo after treatment were 304.63±57.83,271.31±45.53,and 272.29±39.93μm,respectively(P=0.026 and 0.035 vs baseline).No severe adverse event relevant to the therapy was noted,and the average number of injections delivered was 3.35.CONCLUSION:Intravitreal Conbercept injection combined with laser photocoagulation appears to be a safe and effective treatment for ME secondary to i RVO in the short-term.

Different Dosages of Intravitreal Triamcinolone Acetonide Injections for Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose:.To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion.(CRVO).in a sample of Chinese patients from Shaanxi province. Methods:.The 50 eyes from 50 patients were separated into three TA treatment groups:.17 patients were given 4 mg/0.1 ml,.19 patients were given 8 mg/0.2 ml,.and 14 patients were given 16 mg/0.4 ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Results:.Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection,.macular edema recurred at 2-4 months in the low-dose group.(4 mg),.at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg)..No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16 mg TA,.if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. Conclusion: A low dosage of TA (4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO..A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.

Visual acuity after intravitreal ranibizumab with and without laser therapy in the treatment of macular edema due to branch retinal vein occlusion:a 12-month retrospective analysis

AIM:To identify factors contributing to visual improvement after treatment of macular edema(ME)secondary to branch retinal vein occlusion(BRVO),and to assess the interaction between laser therapy and intravitreal ranibizumab(IVR).METHODS:We retrospectively reviewed the medical records of patients who had been treated for BRVO-related ME at our hospital.Records were traceable for at least 12 mo,and evaluated factors included age,sex,medical history,smoking history,treatment methods,foveal hemorrhage,and change in visual acuity.Treatments included laser therapy,IVR,sub-Tenon’s capsule injection of triamcinolone(STTA),a combination,or no intervention.Multivariate logistic regression analysis and interaction terms were used to assess the clinical efficacy of the treatments,and odds ratios(OR)and 95%confidence intervals(CI)were calculated.RESULTS:Seventy-three patients(34 men,39 women;73 eyes)with a mean age of 69.4±12.1 y were included.Patients who underwent IVR monotherapy,laser monotherapy,and STTA+laser had significantly higher best corrected visual acuity at 12 mo compared to baseline(P<0.001,<0.001,and 0.019,respectively).Logistic regression analysis without interaction terms found that IVR was a significant visual acuity recovery factor(adjusted OR:3.89,95%CI:1.25-12.1,P=0.019).Adjusted OR using an interaction model by logistic regression was 16.6(95%CI:2.54-108.47,P=0.003)with IVR treatment,and 8.25(95%CI:1.34-50.57,P=0.023)with laser treatment.No interaction was observed(adjusted OR:0.07,95%CI:0.01-0.75,P=0.029).CONCLUSION:IVR contributes to improvements in visual acuity at 12 mo in ME secondary to BRVO.No interaction is observed between laser therapy and IVR treatments.

Treatment Options of Macular Edema Secondary to Retinal Vein Occlusion (RVO): A Review

Retinal Vein Occlusion (RVO) is a common retinal vascular disease secondary to diabetic retinopathy resulting in permanent loss of vision despite available treatment options. Main vision impending complication of retinal vein occlusion is macular edema. Laser photocoagulation has been an established method for treating macular edema for many years but nowadays intravitreal injection of Anti-Vascular endothelial growth factors (Ranibizumab, Aflibercept Bevacizumab and Pegaptanib sodium) is the treatment of choice for macular edema from retinal vein occlusion. Intra-vitreal corticosteroids Triamcinolone Acetonide and Dexamethasone implant, are also being used to treat in some macular edema cases but with higher rates of side effects. Numerous surgical methods have been attempted for treating RVO and preventing macular edema;they include pars plana vitrectomy, radial optic neurotomy, laser induced chorioretinal anastomosis, and arteriovenous sheathotomy. Surgical methods supposedly relieve compression of the central retinal vein, altering the pathophysiology of vein occlusion at the level of the lamina cribrosa thus improving blood flow and oxygenation. But limitations result from its complications.

Efficacy of intravitreal conbercept injection on short-and long-term macular edema in branch retinal vein occlusion

AIM: To observe the best-corrected visual acuity(BCVA) and central foveal thickness(CFT) repeatedly after the intravitreal injection of conbercept(IVC) for treating cystoid macular edema(CME) in branch retinal vein occlusion(BRVO) and explore the relationship between the duration of CME and visual outcome.METHODS: Subgroup analysis was performed to compare short-term(within 90 d of CME onset) and longterm(over 90 d of CME onset) macular edema in BRVO.After an initial IVC, a pro re nata(PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA.Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6 mo after IVC.RESULTS: Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME.There were statistical significances between and within groups of the BCVAs at different time points(P<0.001).The interaction was found between group and time(P=0.006), indicating the difference in the speed of BCVA improvement between groups.In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group.There were significant differences between and with groups of the CFT at different time points(P<0.001).However, the interaction between group and time in relation to CFT had no significant differences(P=0.59).CONCLUSION: IVC treatment for CME following BRVO is effective and safe.The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO.The improvement of vision might be faster with early IVC treatment than with delayed treatment.

Retinal Functional Changes Measured by Microperimetry after Intravitreal Ranibizumab Injection and Sulfotanshinone Sodium Injection for Macular Edema Secondary to Retinal Vein Occlusion

Objectives: To study the visual field changes after intravitreal ranibizumab (IVR) injection and sulfotanshinone sodium (SS) injection for macular edema (ME) secondary to retinal vein occlusion (RVO), and discuss the value of microperimetry as a routine diagnostic test in the follow-up of RVO patients. Methods: This was a retrospective, interventional, case-series study. Twelve eyes of 12 RVO patients, including 6 eyes with central RVO (CRVO) and 6 eyes with branch RVO (BRVO) were included. The eyes were treated with IVR (0.5 mg) injections and SS injections (20 mg per day, one week consecutively in one month). The outcomes measured included best corrected visual acuity (BCVA), central retinal thickness (CRT), mean defect (MD), pattern standard deviation (PSD), macular light sensitivity of the central 16 points in CRVO group and the central 8 points in BRVO group before and after the treatment. Statistical analyses were then performed on the main outcome measures. Results: An improvement of BCVA was found in all patients after treatment with significant difference (t = 7.74, p p p p > 0.05). All RVO patients had their macular light sensitivity of the involved part improved significantly (t = 5.03, p p p < 0.01). The Pearson’s correlation was calculated among BCVA, MD, macular light sensitivity and CRT. No obvious significance was found between CRT and BCVA outcomes, whereas MD and mean macular light sensitivity outcomes were closely related to BCVA results in the BRVO group and the latter showed a more intimate correlation. No similar correlation was found in RVO and CRVO group. Conclusion: IVR injection and SS injection together could effectively improve the therapeutic effect in RVO patients with ME. Microperimetry could be used as a routine diagnostic test and a possible valuable tool in the follow-up of patients with RVO, especially in BRVO.

Intravitreal Aflibercept for Macular Edema Secondary to Branch Retinal Vein Occlusion in Chinese Patients

Purpose: To investigate the short-term efficacy and safety of intravitreal aflibercept in a case series of patients from Taiwan, China, with macular edema secondary to branch retinal vein occlusion(BRVO).Methods: A total of 32 patients with macular edema associated with BRVO,.without prior macular laser or other intervention, were enrolled consecutively from September 2013 to February 2015..The cases received single 2 mg injections of intravitreal aflibercept..Primary outcome measures included changes in central foveal thickness.(CFT;.1 mm increments by spectral-domain optic coherence tomography).and best corrected visual acuity.(BCVA),.determined at 1,.2,.and 3months after the injection. Complications after injections were recorded. The changes in CFT and BCVA were compared with Wilcoxon sign-rank tests.Results:.The CFT was significantly reduced and the BCVA was significantly improved at 1, 2, and 3 months after injection(all P < 0.05). Tomography findings revealed no recurrence within 3 months. No systemic thromboembolic events,elevated intraocular pressure, retinal detachment, or infectious endophthalmitis occurred following injection.Conclusion:.Single intravitreal aflibercept may be useful in treating macular edema associated with BRVO within 3months. No adverse systemic or ocular effects were found in this case series.

Efficacy of intravitreal injection of ranibizumab in the treatment of macular edema secondary to non-ischemic branch retinal vein occlusion

Objective: To observe the efficacy of intravitreal injection of ranibizumab in the treatment of macular edema(ME) secondary to non-ischemic branch retinal vein occlusion (BRVO). Methods: The clinical data of 27 patients (27 eyes) with macular edema secondary to non-ischemic BRVO were diagnosed by ophthalmology in Chongqing University Center Hospital from May 2018 to April 2019, selected as the experimental group, and 20 cases (20 eyes) of normal people as the control group. For the experimental group, before and after treatment, 1wk, 1mo, 2mo, 3mo and 6mo were used to observe the uncorrected visual acuity(UCVA),best corrected visual acuity (BCVA), intraocular pressure (IOP), central retinal thickness (CRT) macular center volume (MCV) and EN FACE images. Subjects in the normal control group were examined by optical coherence tomography (OCT) for CRT and CMV at 1wk, 1mo, 2mo, 3mo and 6mo on the day of and after enrollment. Results: The mean age of patients in the experimental group was (67.37±8.63) years old and the times of Intravitreal injection was (3.26 ±0.59) times. The successful rate of treatment was 85.19%. There was no significant difference in IOP between pre-treatment and 1wk, 1mo, 2mo, 3mo and 6mo (P > 0.05). 1wk, 1mo, 2mo, 3mo and 6mo BCVA were significantly higher than those before treatment (P < 0.0001). The levels of CRT and CMV at 1wk, 1mo, 2mo, 3mo and 6mo after treatment were significantly lower than those before treatment (P <0.01). Compared with the normal control group, the CRT and CMV of the experimental group before and after treatment showed statistically significant differences in 1wk, 1mo, 2mo and 3mo (P <0.05). There was no statistically significant difference in 6mo CRT and CMV after treatment (P>0.05). EN FACE showed that 1wk, 1mo, 2mo, 3mo and 6mo macular thickness decreased gradually, retinal edema subsided, cystoid changes disappeared, and the interlamellar structure of the ellipsoid zone gradually recovered after intravitreal injection of ranibizumab. Conclusion: Intravitreal injection of ranibizumab in the treatment of non-ischemic BRVO secondary ME has significant efficacy, EN FACE is an effective means to assess the severity, treatment and prognosis of patients.