Efficacy and Safety of Pro Re Nata Regimen without Loading Dose Ranibizumab Injections in Retinal Vein Occlusion

Abstract

Objectives:To evaluate the effects and safety of intravitreal ranibizumab on visual acuity and anatomic results in the treatment of macular edema due to retinal vein occlusion (RVO).Methods:Forty Six eyes of 45 patients who were administered intravitreal ranibizumab because of macular edema due to Retinal Vein Occlusion (RVO) were included in this retrospective clinical study. During monthly follow-up, the best corrected visual acuity values in terms of LogMAR with The Early Treatment Diabetic Retinopathy Study (ETDRS) chart, central macular thickness (CMT), and complications were examined. Cases were classified as central retinal vein occlusion (CRVO), superotemporal branch retinal vein occlusion (BRVO), and inferotemporal BRVO. We only included RVO patients but using ETDRS chart for the vision measurement.Results:In all follow-up months, there was a significant increase in BCVA in all RVO cases and in superotemporal BRVO cases after the first injection of ranibizumab. Although there was no significant increase in the 1st month of follow-up period compared to pre-treatment, there was significant increase in 2-6 months in inferotemporal BRVO patients. There was no statistically significant increase in 1st and 2nd month follow-up periods compared to pre-treatment; however there was a significant increase in 3-6 months in the CRVO patients. There was a significant decrease in average CMT measurements in all follow-up months compared to pre-treatment in all RVO cases, in superotemporal and inferotemporal BRVO cases. There was no significant decrease in average CMT measurements in the 1st, 2nd, and 3rd months compared to pre-treatment although there was a significant decrease in 4-6 months in cases included in the CRVO patients.Conclusions:Intraocular ranibizumab injections provided rapid, effective treatment for macular edema due to RVO with low rates of ocular and nonocular safety events. However, repeated injections and frequent follow-up intervals may be required.

Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion

“…Confirming that remark, mean letter gain was found to be 18.8 in patients who received three RNB injections in our study. Likewise, Unsal et al reported a VA better than 6/12 in 31.0 per cent of eyes with mean 2.1 RNB injections. That rate was 35.7 per cent in our study.…”

“…No eyes received laser treatment in the injection groups. It offers a real‐world comparison of DEX and RNB in BRVO‐related macular oedema and the sample size is relatively sufficient compared with previous studies . Although frequent injections with regular intervals could not be given, our patients were followed closely.…”

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

“…The recommended dosage is 0.5 mg, 2.0 mg, and 1.25 mg for ranibizumab, aflibercept, and bevacizumab, respectively [115, 116]. Some specialists preferred a monthly injection, while others employ a treat and extend (TREX) or an as needed (pro re nata) regimen [93, 106, 117–120]. A recent study reported that BRVO patients can receive good VA and central macular thickness (CMT) outcomes with a lower frequency of intravitreal ranibizumab.…”

Vitreoretinal Society of India practice pattern survey 2020: Medical retina

“…[ 22 ] Intravitreal anti-VEGF injections are a standard of care in such cases, which can be performed PRN with or without a loading dose. [ 23 24 ] Almost equal proportion of VRSI survey respondents elected to start PRN regimen from baseline (43.2%) and loading doses of three monthly injections, followed by PRN (40.2%), respectively, in the management of a fresh BRVO with CME. In a scenario when there is no response after three anti-VEGF injections and with significant capillary dropout on FA, more than half of the participants (53.3%) preferred to perform additional sectoral PRP.…”