Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes

Abstract

Purpose. To report the long-term visual and anatomic outcomes of intravitreal injections for macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-life clinical setting. Design. Retrospective interventional case series. Methods. A total of 223 consecutive eyes with ME secondary to RVO, treated with the first three intravitreal Ranibizumab or dexamethasone injections between August 2008 and September 2018, were enrolled in the study. Subsequent retreatment was guided by best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurements, aimed at achieving macular fluid regression and BCVA stability. BCVA and CMT were recorded at baseline and at subsequent annual time points. The mean number of injections administered each year and the incidence of adverse events were recorded. Results. The mean BCVA and CMT at baseline were 0.79 logMar (SD 0.71) and 615.7 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p<0.0001) and 401.04 μm (SD 183.8; p<0.0001). Improvements remained significant at the final FU visit. Eyes with BRVO and nonischemic RVO showed significantly better visual outcomes when compared to eyes with CRVO and ischemic RVO, over the entire FU period. An average of 4.08 (SD 2.1) Ranibizumab and 1.5 (SD 0.6) Ozurdex injections were administered over the first 12 months. The number of injections decreased thereafter progressively. One eye with CRVO developed endophthalmitis and one with BRVO developed an intraocular pressure increase that was refractory to topical medications and ultimately treated with trabeculectomy. Conclusion. Intravitreal Ranibizumab and/or dexamethasone injections were found to be effective at inducing a long-lasting improvement of BCVA and CMT in a real-life clinical setting. A safety profile similar to that already well-established in Ranibizumab and dexamethasone treatment was observed, as well as a steady decrease in the number of intraocular injections required. The results support intravitreal treatments for BRVO and CRVO in patient populations with similar characteristics in similar settings.

Efficacy of intravitreal ziv-aflibercept in patients with macular edema following retinal vein occlusion in Korle-Bu Teaching Hospital, Ghana: a retrospective case series

“…The visual gain of at least 3 lines in 62% of eyes at 1 year in our series is also similar to other studies on RVO [11,12] but superior to those reported by Spooner et al using bevacizumab, ranibizumab, or aflibercept in a Caucasian population [21]. Long-term visual outcomes following intravitreal anti-VEGF therapy have been reported by Spooner et al and Maggio et al [21,22]. The retrospective study of Spooner et al [21] included 68 eyes with RVO; observed visual gains at 1 year were maintained at [22] also found significant visual gain at 4 years following flexible dosing regimen of ranibizumab and dexamethasone in eyes with ME associated with RVO.…”

“…Significant reduction in CSFT in eyes with RVO following administration of IVZ on prn bases has been reported similar to this series [15][16][17]. These observations are further supported by other studies on outcome of ME associated with RVO-treated other anti-VEGFS [9][10][11][12][13][21][22][23]. In our study, baseline CSFT and mean reduction in reduction in CFST were not significantly different between BRVO and CRVO, although VA was significantly better in the BRVO compared to CRVO group in all visits.…”

“…In the retrospective study by Spooner et al [ 21 ], the mean CMT at baseline was significantly worse in the CRVO compared to BRVO group although no difference was noticed at 1 year. In a study by Maggio et al [ 22 ], the mean CMT was significantly lower in BRVO eyes at baseline and at year 1 although no such differences were found in subsequent years up until year 5. Such differences may be related to the different parameters used (CSFT vs. CMT), or the duration of ME.…”

“…The retrospective study of Spooner et al [ 21 ] included 68 eyes with RVO; observed visual gains at 1 year were maintained at 5 years. Maggio et al [ 22 ] also found significant visual gain at 4 years following flexible dosing regimen of ranibizumab and dexamethasone in eyes with ME associated with RVO. Our finding of significantly better BCVA in the BRVO group compared to the CRVO/HRVO group in all visits is supported by other retrospective studies in real-world clinical settings [ 21 , 22 ].…”

“…Eldeeb et al and Chan et al did not observe ocular or systemic adverse events following IVZ in eyes with RVO [ 16 , 17 ]. The ocular adverse events noted in this series can be attributed to recognized complications of retinal vein occlusions and/or associated ME [ 21 , 22 , 26 ].…”