Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion: a Systematic Review

Pielen, Amelie; Feltgen, Nicolas; Isserstedt, Christin; Callizo, Josep; Junker, Bernd; Schmucker, Christine

doi:10.1371/journal.pone.0078538

Cited by 101 publications

(105 citation statements)

References 38 publications

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“…Pielen et al conducted a systematic review regarding "Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion" [1] . For both, intravitreal steroids and anti-VEGF agents, efficacy could be shown in randomized controlled trials.…”

Section: Efficacymentioning

confidence: 99%

“…Intravitreal anti-VEGF agents target the macular edema and resolution may lead to visual improvement. The sooner the macular edema is treated, the better is the response and prognosis for the patient [1,2] . Morphological changes (macular edema) occur before functional impairment (visual acuity), so close monitoring of patients is warranted after initial anti-VEGF therapy to treat as soon macular edema reoccurs [1,3] .…”

Section: Introductionmentioning

confidence: 99%

“…The sooner the macular edema is treated, the better is the response and prognosis for the patient [1,2] . Morphological changes (macular edema) occur before functional impairment (visual acuity), so close monitoring of patients is warranted after initial anti-VEGF therapy to treat as soon macular edema reoccurs [1,3] . Longstanding macular edema leads to structural changes like atrophy of retinal pigment epithelium and loss of photoreceptors which prevent visual improvement [4] .…”

Section: Introductionmentioning

confidence: 99%

“…On average, patients need 7-8 injections in the first year [1] . Therefore, it seems reasonable to re-treat with 3 monthly injections and re-evaluate again after the whole set.…”

Section: Introductionmentioning

confidence: 99%

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Anti-VEGF Therapy for Retinal Vein Occlusion

Danzmann¹,

Pielen²,

Bajor³

2016

International Journal of Ophthalmic Research

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Current recommendations for treatment of macular edema secondary to BRVO or CRVO favour intravitreal anti-VEGF agents compared to intravitreal steroids. An upload of 3 injections is reasonable to address intravitreal VEGF levels. Prognosis for visual improvement is good and time to treatment is crucial. There is evidence that an early targeted laser photocoagulation of ischemic areas may lead to additional treatment effects, less injections and improved prognosis if administered early after RVO. In the course of the disease patients must be frequently monitored for recurrence of edema to initiate re-treatment and for conversion to ischemic RVO. Ischemia, proliferations and rubeosisiridis must not be treated with intravitreal anti-VEGF alone. Laser treatment of peripheral retina remains the standard-of-care to treat ischemia. In this article we review up-to-date information on intravitreal anti-VEGF therapy in RVO, international guidelines, safety and efficacy of treatment. We discuss new insights on factors that may improve prognosis or burden of intravitreal treatment. And we discuss the role of ischemia in RVO.

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Section: Efficacymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…On average, patients need 7-8 injections in the first year [1] . Therefore, it seems reasonable to re-treat with 3 monthly injections and re-evaluate again after the whole set.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Anti-VEGF Therapy for Retinal Vein Occlusion

Danzmann¹,

Pielen²,

Bajor³

2016

International Journal of Ophthalmic Research

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“…[1][2][3][4] Dexamethasone is one of the most potent corticosteroids, with an anti-inflammatory activity that is sixfold greater than that of triamcinolone and 30-fold greater than cortisol. 5,6 In the dexamethasone implant, the active drug is dispersed through a biodegradable copolymer of lactic acid and glycolic acid (PLGA), forming a matrix structure (Novadur, Allergan Inc). 7 Dexamethasone intravitreal implants (DEX implants) can both reduce the risk of further vision loss and increase the chances of improving visual acuity in eyes with macular edema after BRVO or CRVO.…”

Section: Introductionmentioning

confidence: 99%

Anatomical and functional recurrence after dexamethasone intravitreal implants: a 6-month prospective study

Fortoul

Denis

Kodjikian

2015

Eye

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Purpose To evaluate the efficacy, safety, and delay of anatomical and functional recurrence after a first intravitreal injection of dexamethasone implant in eyes with cystoid macular edema (CME) secondary to retinal vein occlusion (RVO). Methods A 6-month prospective, monocentric and noncomparative case-series of 26 eyes of 26 patients. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were measured at baseline and each visit at 1 week, and months 1, 2, 3, 4, 5, and 6 after a first treatment. Primary efficacy outcome was the proportion of eyes with a minimum three-line improvement from baseline BCVA at each visit and at 6 months. We also defined different patterns of recurrence: qualitative anatomical recurrence, quantitative anatomical recurrence and functional recurrence. A P-value o5% was considered statistically significant. Results Mean population age was 69.3 years (SD = 12.2; range = 42-94 years). Mean ME duration before treatment was~9.2 months (SD = 11.43; range = 0.4-40 months). Eighty eight percent of eyes achieved a three-line improvement from baseline at 2 months (P = 0.02). The mean delay from baseline until qualitative anatomical, functional, or quantitative anatomical recurrence was 4.11 months (±0.86), 4.31 months (±1.33), and 4.40 months (±1.14), respectively. Qualitative anatomical recurrence occurred on average 14.4 days (SD = 42.18) before a minimum of one-line BCVA impairment (functional recurrence). Conclusion Dexamethasone intravitreal treatment seems to be effective for ME after RVO even with long-duration ME or poor visual acuity before treatment. Other longer studies should assess the delay of recurrence after second and further treatments with DEX implants or combined therapies for ME after RVO.

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Handheld‐automated microsurgical instrumentation for intraocular laser surgery

et al. 2015

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Background and Objective Laser photocoagulation is a mainstay or adjuvant treatment for a variety of common retinal diseases. Automated laser photocoagulation during intraocular surgery has not yet been established. The authors introduce an automated laser photocoagulation system for intraocular surgery, based on a novel handheld instrument. The goals of the system are to enhance accuracy and efficiency and improve safety. Materials and Methods Triple-ring patterns are introduced as a typical arrangement for the treatment of proliferative retinopathy and registered to a preoperative fundus image. In total, 32 target locations are specified along the circumferences of three rings having diameters of 1, 2, and 3 mm, with a burn spacing of 600 μm. Given the initial system calibration, the retinal surface is reconstructed using stereo vision, and the targets specified on the preoperative image are registered with the control system. During automated operation, the laser probe attached to the manipulator of the active handheld instrument is deflected as needed via visual servoing in order to correct the error between the aiming beam and a specified target, regardless of any erroneous handle motion by the surgeon. A constant distance of the laser probe from the retinal surface is maintained in order to yield consistent size of burns and ensure safety during operation. Real-time tracking of anatomical features enables compensation for any movement of the eye. A graphical overlay system within operating microscope provides the surgeon with guidance cues for automated operation. Two retinal surgeons performed automated and manual trials in an artificial model of the eye, with each trial repeated three times. For the automated trials, various targeting thresholds (50–200 μm) were used to automatically trigger laser firing. In manual operation, fixed repetition rates were used, with frequencies of 1.0–2.5 Hz. The power of the 532 nm laser was set at 3.0 W with a duration of 20 ms. After completion of each trial, the speed of operation and placement error of burns were measured. The performance of the automated laser photocoagulation was compared with manual operation, using interpolated data for equivalent firing rates from 1.0 to 1.75 Hz. Results In automated trials, average error increased from 45 ± 27 to 60 ± 37 μm as the targeting threshold varied from 50 to 200 μm, while average firing rate significantly increased from 0.69 to 1.71 Hz. The average error in the manual trials increased from 102 ± 67 to 174 ± 98 μm as firing rate increased from 1.0 to 2.5 Hz. Compared to the manual trials, the average error in the automated trials was reduced by 53.0–56.4%, resulting in statistically significant differences (P ≤ 10−20) for all equivalent frequencies (1.0–1.75 Hz). The depth of the laser tip in the automated trials was consistently maintained within 18 ± 2 μm root-mean-square (RMS) of its initial position, whereas it significantly varied in the manual trials, yielding an error of 296 ± 30 μm RMS. At high firing rates...

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Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion: a Systematic Review

Cited by 101 publications

References 38 publications

Anti-VEGF Therapy for Retinal Vein Occlusion

Anti-VEGF Therapy for Retinal Vein Occlusion

Anatomical and functional recurrence after dexamethasone intravitreal implants: a 6-month prospective study

Handheld‐automated microsurgical instrumentation for intraocular laser surgery

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