Cotton Wool Spots after Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Associated with Central Retinal Vein Occlusion

Tsujikawa, Akitaka; Muraoka, Yuki; Harino, Seiyo; Osaka, Rie; Murakami, Tomoaki; Ooto, Sotaro; Suzuma, Kiyoshi; Morishita, Seita; Fukumoto, Manabu; Suzuki, Hiroyuki; Ikeda, Tsunehiko

doi:10.1159/000443622

Cited by 12 publications

(8 citation statements)

References 32 publications

(41 reference statements)

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“…Campochiaro et al found the mean time from diagnosis of BRVO to screening was 3.5 months with duration ≤3 months in 65% of patients. 8 In our study 76.2% cases presented within 6 months of onset of symptoms. Mean study eye baseline BCVA was 6/18 and mean baseline CMT was 520.5 µ in a study by Campochiaroet al [9].…”

Section: Original Research Articlesupporting

confidence: 47%

Outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion patients: a single centre experience

Meherda¹,

Parida

Choudhury

et al. 2019

Trop J Ophthalmol Otolaryngol

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Objective: To find out outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion (BRVO) patients in a government hospital in the capital of Odisha. Methods: This study was a prospective interventional study of 18 months duration, done from August 2017 to February 2019 which included 21 cases of BRVO. Thorough history was taken and detail ophthalmological evaluation was done. Best corrected visual acuity (BCVA) was examined with Snellen's chart and central macular thickness (CMT) was measured using optical coherence tomography (OCT). Routine blood tests were done. Intravitreal injection of ranibizumab 0.5 mg in 0.05 ml was given. BCVA and CMT was measured at 1 day, 1 week, 1 month and 3 months follow up visit. Results: Mean age was 55.29 ± 16.86 yrs. Male: female ratio was 3.2:1. 33. About 3% patients presented within 1 month of onset of symptoms. Diastolic blood pressure of ≥ 90 was found in 81% patients. 90.5% showed improvement at 1 week post-operatively.At post-operative day 1 CMT was significantly decreased (p= 0.0011). Reduction in mean CMT at post-operative day 7 was >270 µ. Conclusion: Single intravitreal injection of ranibizumab 0.5 mg in 0.05 mlcauses significant increase in vision and significant reduction of central macular thickness in patients with branch retinal vein occlusion.

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Section: Original Research Articlesupporting

confidence: 47%

Outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion patients: a single centre experience

Meherda¹,

Parida

Choudhury

et al. 2019

Trop J Ophthalmol Otolaryngol

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“…After these phase III studies, 9 initial monthly injections of ranibizumab were performed in the RAVE trial [16] and 7 initial monthly injections in the SHORE study [17] . Multiple intravitreal injections of anti-VEGF agents can increase the risk of systemic or ocular complications and may be associated with economic burden despite favorable treatment outcomes [18] . Further, it remains unclear whether such large numbers of injections are necessary for the initial treatment of ME after CRVO.…”

Section: Introductionmentioning

confidence: 99%

Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema following Central Retinal Vein Occlusion: 1 Initial Injection versus 3 Monthly Injections

Osaka

Muraoka²,

Miwa³

et al. 2017

Ophthalmologica

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Purpose: To compare the 12-month efficacy of 1 initial intravitreal injection of an anti-vascular endothelial growth factor (VEGF) agent followed by pro re nata (PRN) dosing with that of 3 initial monthly injections followed by PRN dosing in patients with macular edema (ME) after central retinal vein occlusion (CRVO). Methods: Twenty-nine eyes received 1 initial injection (1+PRN group) and 20 received 3 monthly injections (3+PRN group). Results: At month 12, changes in logMAR visual acuity from baseline were -0.172 ± 0.372 and -0.142 ± 0.317 in the 1+PRN and 3+PRN groups, respectively; the difference was not significant (p = 0.769). The number of anti-VEGF injections administered in the 3+PRN group (5.9 ± 2.1) was significantly greater than that in the 1+PRN group (4.1 ± 2.8; p = 0.022). Conclusion: When used for ME after CRVO, a 1+PRN regimen achieved 12-month outcomes similar to those of a 3+PRN regimen with fewer injections.

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“…However, there were no FA images in this publication. A retrospective study estimated that 22.8% of eyes with central retinal vein occlusion (CRVO) developed cottonwool spots after an initial aflibercept injection and indicated that cotton-wool spots were reversible once the circulatory disturbance of the capillary bed was resolved (23).…”

Section: Discussionmentioning

confidence: 99%

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

Liang

Yang

et al. 2021

Front. Med.

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Introduction: Incontinentia pigmenti (IP) is a rare X-linked neuroectodermal dysplasia affecting multiple organs. One of its most significant ophthalmic manifestations is retinal neovascularization due to retinal ischemia, which has been traditionally treated with laser photocoagulation or cryotherapy. The application of anti-vascular endothelial growth factor (VEGF) has been reported for the treatment of retinopathy of IP with beneficial results. However, clinicians should be aware of the possible ocular and systemic side effects of the intravitreal injection of anti-VEGF agents.Case Report: A 4-month-old female infant with IP was treated with intravitreal injection of conbercept in both eyes. However, cotton-wool spots were noticed in the left eye 1 week after the injection. Laser photocoagulation was performed as an adjunct treatment. The cotton-wool spots were absorbed 1 month after the first intravitreal injection and have eventually disappeared.Discussion: The cotton-wool spots, after intravitreal injection of conbercept for the treatment of IP, indicated severe retinal ischemia resulting from the neutralization of excessive VEGF, which was shown on fundus photograph and fluorescent angiography. Anti-VEGF agents could cause retinal arteriolar vasoconstriction and artery occlusion on rare occasions. The administration of anti-VEGF agents in pediatric cases with severe neovascularization and retinal ischemia should be carefully considered.

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Cotton Wool Spots after Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Associated with Central Retinal Vein Occlusion

Cited by 12 publications

References 32 publications

Outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion patients: a single centre experience

Outcome following single intravitreal injection of ranibizumab in branch retinal vein occlusion patients: a single centre experience

Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema following Central Retinal Vein Occlusion: 1 Initial Injection versus 3 Monthly Injections

Case Report: A Case of Cotton-Wool Spots After Intravitreal Injection of Conbercept in an Infant With Incontinentia Pigmenti

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