A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion

Ang, Juan Lyn; Ah-Moye, Sarah; Kim, Leah; Nguyen, Vuong; Hunt, Adrian; Barthelmes, Daniel; Gillies, Mark C; Mehta, Hemal

doi:10.1038/s41433-020-0861-9

Cited by 34 publications

(32 citation statements)

References 100 publications

(167 reference statements)

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“…Thus, a major treatment goal in DR and other ischemic retinopathies is the reduction of vascular permeability by restoration of the iBRB [1]. The effectiveness of intra-ocular treatments targeting vascular endothelial growth factor (VEGF) in many DR patients with diabetic macular edema and RVO patients suggests that vascular permeability in ischemic retinal diseases is often driven by VEGF accumulation [6][7][8]. Clinical studies have also documented increased levels of inflammatory cytokines in the vitreous of DR, ROP and RVO patients [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory Resolution and Vascular Barrier Restoration after Retinal Ischemia Reperfusion Injury

Abcouwer

Shanmugam

Muthusamy³

et al. 2021

Preprint

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Several retinal pathologies exhibit both inflammation and breakdown of the inner blood-retinal barrier (iBRB) resulting in vascular permeability, suggesting that treatments that trigger resolution of inflammation may also promote iBRB restoration. Using the mouse retinal ischemia-reperfusion (IR) injury model we followed the time course of neurodegeneration, inflammation and iBRB disruption and repair to examine the relationship between resolution of inflammation and iBRB restoration and to determine if minocycline, a tetracycline derivative shown to reverse microglial activation, can hasten these processes. A 90 min ischemic insult followed by reperfusion in the retina induced cell apoptosis and inner retina thinning that progressed for approximately 2 weeks. IR increased vascular permeability within hours, which lasted for at least 2 weeks and resolved between 3 and 4 weeks after injury. Increased vascular permeability coincided with alteration and loss of endothelial cell tight junction (TJ) protein content and disorganization of TJ protein complexes. Whereas repletion of TJ protein content occurred within days, restoration of the iBRB coincided with eventual re-organization of TJ complexes at the cell border. A robust inflammatory response was evident a 1 day after IR and progressed to resolution over the 4-week time course. The inflammatory response included a rapid and transient infiltration of granulocytes and Ly6C + classical inflammatory monocytes, a slow accumulation of Ly6C neg monocyte/macrophages, and activation, proliferation and mobilization of resident microglia. The presence of monocyte/macrophages and increased numbers of microglia were sustained until the iBRB was eventually restored. Intervention with minocycline to reverse microglial activation promoted early restoration of the iBRB. These results suggest that resolution of inflammation and restoration of the iBRB following retinal IR injury are functionally linked.

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Section: Introductionmentioning

confidence: 99%

Inflammatory Resolution and Vascular Barrier Restoration after Retinal Ischemia Reperfusion Injury

Abcouwer

Shanmugam

Muthusamy³

et al. 2021

Preprint

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“…Studies have found that the visual outcomes of eyes receiving VEGF inhibitors for retinal diseases in routine clinical practice are inferior to those of clinical trials. [18][19][20][21] The mean VA of patients at baseline in the present study was worse than those in the pivotal clinical trials of VEGF inhibitors for BRVO, The those of BRAVO and VIBRANT as was those that gained ≥ 3 lines of vision. [6,7] Patients with CRVO that gained ≥ 3 lines of vision in the present study however, were fewer than those in CRUISE, COPERNICUS and GALILEO.…”

Section: Discussionmentioning

confidence: 91%

“…[6][7][8][9][10] The mean change in VA in BRVO at 12 months we observed was similar to a meta-analysis that reported outcomes of VEGF inhibitor treatments for BRVO in routine clinical practice. [21] The mean drop in CST at…”

Section: Discussionmentioning

confidence: 99%

“…12 months in the present study was inferior and intravitreal treatments fewer than those reported in the meta-analysis. [21] The deterioration of macular anatomy precedes functional impairment when VEGF inhibitor treatments are withheld in RVO. [22] Treatments in the present study were withheld when the VA was better that could have led the fewer treatments in our cohort and the thickened maculae.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Outcomes of Retinal Vein Occlusion in Clinical Practice in Nepal

Bhandari

Poudel

Paudyal

et al. 2020

Preprint

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Background: This study evaluated the treatment outcomes of retinal vein occlusion (RVO) in a routine clinical practice in Nepal. Methods: This was a retrospective analysis of observational data of patients with RVO who attended the retina clinic of the Tilganga Institute of Ophthalmology from 1 November 2017 to 31 October 2018. The main outcome was the mean change in visual acuity (VA) at 12 months from the start of treatment. Other outcomes of interest were the mean change in central subfield thickness (CST) and the number of treatments over 12 months. Results: A total of 99 eyes (of 99 patients) with RVO (60 - branch RVO [BRVO] and 39 - central RVO [CRVO] were available for the analysis. Eyes with CRVO had worse VA and CST at baseline. Eyes in both groups were similar for age, associated factors for RVO, duration of vision loss and the presence of ischemia at baseline. The mean (95% Confidence Interval [CI]) VA change at 12 months for BRVO was -0.35 (-0.46, -0.23) logMAR (p < 0.001) from a mean (SD) of 0.75 (0.42) logMAR at baseline with 63% achieving VA < 0.3 logMAR while for CRVO it was -0.35 (-0.46, -0.23) logMAR (p = 0.19) from 1.13 (0.61) logMAR at baseline and VA < 0.3 logMAR in 36%. The mean (95% CI) change in CST over 12 months was -114 (-189, -40) µm (p = 0.003) from a mean (SD) of 423 (151) µm at baseline for BRVO and -184(-276, -91) µm (p < 0.001) from 519 (213) µm for CRVO. Patients in both groups received a median of 2 bevacizumab injections over 12 months. Around 37% eyes were lost before 12 months’ observation. The mean VA and CST trajectory in these eyes at their last visit was similar to those that completed 12 months. Conclusion: The outcomes of RVO are inferior and the number of treatments over the 12 months fewer than those of clinical trials and other reports from routine clinical practice. Future studies to identify the barriers for undertreatment in our practice are warranted to improve the treatment outcomes.

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“…Macular edema is a pathology that occurs secondary to various vitreoretinal disorders such as RVO and DR 4 . Conventional therapies such as intravitreal anti-vascular endothelial growth factor (VEGF) injection, intravitreal or sub-tenon triamcinolone acetonide injection, retinal photocoagulation, and pars plana vitrectomy (PPV) or combinations of such therapies have increased the proportion of successful anatomical and functional outcomes 5 . However, treatment-resistant refractory foveal cystoid macular edema (rfCME) still exists.…”

Section: Introductionmentioning

confidence: 99%

Cystotomy with or without fibrinogen clot removal for refractory cystoid macular edema secondary to branch retinal vein occlusion

Yamada

Imai

Tetsumoto

et al. 2021

Sci Rep

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To demonstrate the long-term effect of cystotomy with or without fibrinogen clot removal for treatment-resistant cystoid macular edema (CME) secondary to branch retinal vein occlusion (BRVO). Retrospective clinical study. We retrospectively analyzed medical records of 22 eyes of 22 patients with treatment-resistant CME secondary to BRVO with 12 months observation after cystotomy with or without fibrinogen clot removal. Patients included 11 women and 11 men. The mean ± SD age was 72.7 ± 10.2 years. LogMAR-converted best corrected visual acuity (BCVA) was statistically better at 12 months after surgery (0.30 ± 0.30) than preoperative BCVA (0.39 ± 0.27) (p = 0.01). The central sensitivity of microperimetry (dB) was maintained during follow-up (preoperative sensitivity: 25.4 ± 4.1, postoperative sensitivity at 12 months after the surgery: 25.9 ± 4.2, p = 0.69). Twelve months after surgery, there was a significant improvement in the central retinal thickness (CRT) on optical coherence tomography (OCT) (303.7 ± 80.1) (μm) compared with the preoperative CRT (524.2 ± 114.8) (p < 0.01). In 12 months, CME recurred in 3 of 22 eyes. The preoperative reflectivity in cystoid cavity on OCT was significantly higher in patients with fibrinogen clot removal (n = 5) than in patients without fibrinogen clot removal (n = 17) (p < 0.01). For treatment-resistant CME secondary to BRVO, Cystotomy with or without fibrinogen clot removal may be one of the treatment options.

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A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion

Cited by 34 publications

References 100 publications

Inflammatory Resolution and Vascular Barrier Restoration after Retinal Ischemia Reperfusion Injury

Inflammatory Resolution and Vascular Barrier Restoration after Retinal Ischemia Reperfusion Injury

Treatment Outcomes of Retinal Vein Occlusion in Clinical Practice in Nepal

Cystotomy with or without fibrinogen clot removal for refractory cystoid macular edema secondary to branch retinal vein occlusion

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