Combination of Ranibizumab with macular laser for macular edema secondary to branch retinal vein occlusion: one-year results from a randomized controlled double-blind trial

Abstract

Background: It is not clear whether macular laser combined with anti-vascular endothelial growth factor (VEGF) can reduce the number of anti-VEGF injections in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Our study aimed to investigate the effects of intravitreal ranibizumab with or without macular laser for ME secondary to BRVO and its associated number of anti-VEGF injections. Methods: This is a prospective, randomized, double-blind, monocentric trial.80 patients were enrolled and 64 patients fulfilled the study requirements. All patients received a minimum of 3 initial monthly ranibizumab injections, pro re nata (PRN) dosing thereafter VA and CRT stabilization criteria-driven PRN treatment. Laser was given 7 days after third ranibizumab injection in ranibizumab with laser group. The follow-up time of this study was 1 year. Best corrected visual acuity (BCVA) improvement, central retinal thickness (CRT) reduction and number of injections of patients were compared between two groups. T-test, non-parametric Wilcoxon test and chis-square tests were adopted for between-group comparisons. Results: Thirty patients received intravitreal ranibizumab 0.5 mg alone and 34 patients received intravitreal ranibizumab 0.5 mg with macular laser. At 52 week, BCVA increased significantly and CRT decreased significantly in both groups (P < 0.001). However, there was no significant difference in BCVA improvement with baseline BCVA adjusted (p = 0.5226), and in the CRT reduction (P = 0.4552) between two groups after 52 weeks. There was also no significant difference in the number of injections between the two groups. (P = 0.0756). There was also no significant difference between ischemic and non-ischemic groups in BCVA improvement, CRT reduction and number of injections (P > 0.05).

Changes in Macular Microvascular Structure in Macular Edema Secondary to Branch Retinal Vein Occlusion Treated with Antivascular Endothelial Growth Factor for One Year

“…All participants signed a standard informed consent form which included information on the potential risks and benefits of the procedure and subsequent management; they could not be identified through this document. We followed the methods of Song et al [ 12 ].…”

Comparison of the efficiency of anti-VEGF drugs intravitreal injections treatment with or without retinal laser photocoagulation for macular edema secondary to retinal vein occlusion: A systematic review and meta-analysis

“…BCVA was reported in 16studies with a total of 1205 RVO patients before and after treatment, including 941 BRVO patients and 264 CRVO patients (Hayashi et al, 2011;Donati et al, 2012;Farese et al, 2014;Rehak et al, 2014;Pielen et al, 2015;Clark et al, 2016;Tadayoni et al, 2016;Tultseva et al, 2017;Callizo et al, 2019;Cao et al, 2019;Goel et al, 2019;Kumar et al, 2019;Terashima et al, 2019;An and Jeong, 2020;Nourinia et al, 2020;Song et al, 2020).The results of random effect model analysis(p < 0.00001,I 2 = 86%) showed that IVI is not inferior to IVI + LPC(WMD = 0.12,95%CI = -3.54-3.78,p = 0.95),neither in BRVO patients (WMD = -2.01,95%CI = -4.37-0.34,p = 0.09),nor in CRVO patients(WMD = 5.82,95%CI = -3.65-15.29,p = 0.23)(Figure 3). The CMT was described in 17 studies with 1101 RVO patients including 989 BRVO patients and 287 CRVO patients (Hayashi et al, 2011;Donati et al, 2012;Farese et al, 2014;Rehak et al, 2014;Pielen et al, 2015;Chhablani et al, 2016;Clark et al, 2016;Tadayoni et al, 2016;Tultseva et al, 2017;Callizo et al, 2019;Cao et al, 2019;Goel et al, 2019;Kumar et al, 2019;Terashima et al, 2019;Nourinia et al, 2020;Song et al, 2020;Thomley et al, 2021).The fixed effect model analysis(p = 0.27,I 2 = 16%)demonstrated that there was no significant difference in CMT between IVI + LPC group and IVI group(WMD = -4.40,95%CI = -21.33-12.53,p = 0.61),whether in BRVO patients p = 0.84) or in CRVO patients(WMD = -21.72,95%CI = -68.89-25.45,p = 0.37)(Figure <...…”

“…Recently, some studies (Donati et al, 2012;Farese et al, 2014;Rehak et al, 2014;Tomomatsu et al, 2016;Tultseva et al, 2017;Goel et al, 2019;Terashima et al, 2019;An and Jeong, 2020;Nourinia et al, 2020) have found that, compared with single IVI, the combination of IVI and LPC could improve the prognosis in RVO patients with ME and decrease the number of injections. However, other studies (Hayashi et al, Frontiers in Pharmacology frontiersin.org 2011; Pielen et al, 2015;Chhablani et al, 2016;Tadayoni et al, 2016;Callizo et al, 2019;Cao et al, 2019;Kumar et al, 2019;Song et al, 2020;Thomley et al, 2021) suggested that combination treatment could neither improve the prognosis of patients nor reduce the frequency of IVI, and on the contrary, it has increased the medical burden of RVO patients.…”

Structural and Visual Changes in Branch Retinal Vein Occlusion Patients with Retinal Atrophy

“…Forty-six patients with BRVO enrolled in Song's study were included. Song's study was a 12-month randomized controlled study assessing the efficacy of intravitreal ranibizumab in patients with ME secondary to BRVO [ 21 ]. This trial conformed to the principles of the Declaration of Helsinki.…”

“…During the follow-up, 3 initial IVR (Lucentis 0.5 mg) injections must be conducted monthly in all affected eyes, and additional injections would be repeated if VA suffered more than 5 letters loss due to disease activity or CRT increased more than 100 μ m compared to the previous visit. All patients had blood pressure (BP) measurement at each visit, and the BP was normal in hypertension patients during the follow-up time [ 21 ].…”