Pars Plana Vitrectomy Combined with Internal Limiting Membrane Peeling to Treat Persistent Macular Edema after Anti-Vascular Endothelial Growth Factor Treatment in Cases of Ischemic Central Retinal Vein Occlusion

Abstract

Objective: To evaluate the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling in cases of ischemic central retinal vein occlusion (CRVO) where macular edema (ME) persisted after anti-vascular endothelial growth factor (anti-VEGF) treatment. Methods: Fifteen eyes with ischemic CRVO-related ME were included in the study. Nine were treated with panretinal photocoagulation after initial examination. Anti-VEGF agents were injected intravitreally. Persistent ME was treated with PPV combined with ILM peeling. During surgery, laser photocoagulation was further applied to the non-perfused area. Results: Mean retinal thickness gradually decreased after surgery (p = 0.024 at 6 months), although visual acuity did not improve significantly during the follow-up period (14.7 ± 11.6 months). Neovascular glaucoma subsequently developed in three cases and a trabeculectomy was performed in one case. Conclusion: In eyes with ischemic CRVO, PPV combined with ILM peeling contributed to a reduction in persistent ME. However, there was no significant improvement in visual acuity.

Vitrectomy with Internal Limiting Membrane Peeling with Intravitreal Ranibizumab Injection for Patients with Central retinal Vein Occlusion with Combined Epiretinal Membrane

“…Another study by Shirakata et al 14 revealed that central retinal thickness decreased significantly postvitrectomy for ischaemic vein occlusion after 6 months (p = 0.024) without significant improvement in VA in postoperative period (14.7 ± 11.6 months).…”

Ranibizumab versus Dexamethasone Implant in Macular Edema Secondary to Ischemic Retinal Vein Occlusion in a Real-Life Practice: A Retrospective Case Control Study

“…[14,15]. Soon after these studies, some authors evaluated the efficacy of intravitreal treatment in the ischemic subgroup of RVO patients [2,5,[7][8][9][10][11][12][13]. In this case control study, we aimed to compare the real-life outcomes of Intravitreal Ranibizumab (IVR) and Intravitreal Dexamethasone Implant (IDI) treatments in patients with ME secondary to RVO.…”

“…However, the treatment options for ME edema secondary to ischemic RVO are still a debate. Focal laser photocoagulation, some surgical approaches, and intravitreal injections of steroids and anti-Vascular Endothelial Growth Factors (anti-VEGF) are the treatments evaluated for ME secondary to RVO [4][5][6][7][8][9][10][11][12][13][14][15]. However, pivotal multicenter studies regarding about the efficacy of intravitreal injections of steroids and anti-VEGF agents in ME tis; Novartis, Basel, Switzerland) with a 30 -gauge needle, or IDI (700 μg) was injected through the pars plana 3.5 mm posterior to the limbus with 22-gauge preloaded injection system.…”

Sequence effect in the treatment of proliferative diabetic retinopathy with intravitreal ranibizumab and panretinal photocoagulation

“…Central macular thickness (CMT) was measured using OCT as the average macular thickness in a circle of 1 mm diameter centered on the fovea before the treatment (baseline) and 1 month after final IVR. Every eye included in this report had an initial CMT more than 300 µm, 20 which also needed combined procedures of treatment. The treatment was considered effective if CMT reduction was more than 20%.…”