Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion

Chung, Eun Jee; Hong, Young Taik; Lee, Sung Chul; Kwon, Oh Woong; Koh, Hyoung Jun

doi:10.1007/s00417-008-0866-8

Cited by 98 publications

(69 citation statements)

References 24 publications

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“…They are also useful to reduce ischemic progression and to manage complications, such as neovascular glaucoma [61]. There are some prognostic factors for better outcome, such as better initial VA, no foveal hemorrhages, no macular ischemia, detection of VA gain after first injection, young age and final central retinal thickness [45,48,62,63]. But there are limits in efficacy, need for multiple injections, rebound effect of macular edema and nonresponders.…”

Section: Treatmentmentioning

confidence: 99%

“…The dosage varies between 1 and 2.5 mg, there are no different outcomes [39,40,41,42,43,44,45,46,47,48]. The Pan-American Collaborative Retina Study group concluded that intravitreal injections of bevacizumab at doses up to 2.5 mg were more effective in improving VA and reducing macular edema at 6 months (compared to 1.25 mg), but the study had no control group [44].…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Retinal Vein Occlusion: Current Treatment

Lattanzio¹,

Gimeno

Parodi³

et al. 2010

Ophthalmologica

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Retinal vein occlusion (RVO) is a pathology noted for more than 150 years. Although a lot has been written on the matter, it is still a frequent condition with multifactorial etiopathogenesis with many unclear aspects. The RVO pathogenesis has varied systemic and local implications that make it difficult to elaborate treatment guidelines. The management of the patient with RVO is very complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. Laser therapy remains the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Multicenter studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are the future weapons to stop disease progression and get a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow a better patient management.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Retinal Vein Occlusion: Current Treatment

Lattanzio¹,

Gimeno

Parodi³

et al. 2010

Ophthalmologica

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“…10,13,28 poor visual outcome correlates with increased foveal avascular zone (FaZ) 29 or disruption of perifoveal capillaries seen in fluorescein angiograms. [30][31][32] Similarly in BRvO patients treated with grid laser, those with intact perifoveal capillaries have a better visual prognosis than those with perifoveal capillary disruption. 31 Nonperfusion is a significant baseline factor for development of disc or retinal neovascularization in patients with BRvO with the highest risk at ≥5.5 disc areas.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Treatment of Macular Edema following Branch Retinal Vein Occlusion

Sophie¹,

Campochiaro²

2013

US Ophthalmic Review

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1 Worldwide, it is estimated that 16.4 million people have had an RVo (5.2 per 1,000 persons), 13.9 million with BRVo (4.42 per 1,000 persons), and 2.5 million with cRVo (0.80 per 1,000 persons).There is a higher prevalence of BRVo in asians and hispanics than in other ethnic groups. 2 RVo typically occurs in the middle aged to elderly group (more than 50 years), with an equal gender distribution. While there are many similarities between BRVo and cRVo, there are also important differences. This review focuses on BRVo. Risk Factorshypertension is a major risk factor for BRVo. AbstractBranch retinal vein occlusion (BRVo) is a relatively prevalent cause of reduced vision primarily due to macular edema. Vascular endothelial growth factor (VEGF) is the major stimulator of excessive vascular leakage and also contributes to retinal hemorrhages and progressive retinal nonperfusion (RNP). Progressive RNP results in worsening of retinal ischemia further increasing levels of VEGF, resulting in a positive feedback loop for disease worsening over time. aggressive early treatment with a specific antagonist of VEGF causes rapid improvement in edema and visual acuity, speeds resolution of hemorrhages, and stabilizes or improves RNP. Therefore, first-line treatment of acute BRVos is monthly injections of an anti-VEGF agent for at least 6 months. after that, a period of monthly follow up with anti-VEGF treatment, only if there is recurrent edema, can be used to gauge persistent disease activity and the need for grid laser photocoagulation to diffuse leakage in the macula outside the foveal avascular zone. Following grid laser, another period of monthly follow up with anti-VEGF treatment only if there is recurrent edema provides a measure of persistent disease activity, and if frequent injections are still needed to control edema, the benefits and risks for switching to dexamethasone implants should be discussed with the patient. Keywords hypoxia, retinal ischemia, vascular leakage, vascular endothelial growth factorDisclosure: Raafay Sophie, Md, has no conflicts of interest to declare. Peter a campochiaro, Md, is a consultant for Kala Pharmaceuticals and applied Genetic Technologies corporation and served as a consultant for allergan within the past 2 years. he has equity in GrayBug, inc. Johns hopkins university receives payment for his consultation with Genentech, Regeneron, and aerpio. he receives research support from Genentech, Regeneron, allergan, aerpio, Genzyme, and oxford BioMedica. These activities are being managed by the conflict of interest committee of the Johns hopkins university School of Medicine.

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“…Most of the investigations have employed the administration of bevacizumab for the treatment of ME [98,99,100,101,102,103,104,105]. In particular, it has been demonstrated that its intravitreal administration brings about a reduction in VEGF levels that occurs in parallel with a decrease in the central retinal thickness and improvement in VA of patients affected by BRVO [102].…”

Section: Treatmentmentioning

confidence: 99%

“…Two prospective case series revealed that a VA improvement similar or even better than that achievable by grid laser photocoagulation can be maintained up to 1 year of follow-up through repeated injections [103, 104]. Important prognostic factors for the functional outcome are the existence of macular ischemia and the detection of an initial gain in VA after the first bevacizumab injection [105]. …”

Section: Treatmentmentioning

confidence: 99%

Branch Retinal Vein Occlusion: Classification and Treatment

Parodi

Bandello²

2009

Ophthalmologica

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Branch retinal vein occlusion (BRVO) refers to a heterogeneous group of disorders with different clinical aspects, courses, and probably therapy. Depending on the site of the arteriovenous crossing, we can roughly divide BRVO into 3 main groups: major BRVO, hemispheric retinal vein occlusion, and macular BRVO. Main treatment options include laser treatment, corticosteroid administration, anti-VEGF drugs, and sheathotomy with or without vitrectomy. Laser photocoagulation, as demonstrated by the Branch Vein Occlusion Study, represents the gold standard for the treatment of macular edema and ocular neovascularization following BRVO. The limited functional outcomes achievable by means of laser treatment have prompted researchers to try alternative options, with varying results. The recent introduction of combined therapies for macular edema may provide a superior approach in an attempt to improve and stabilize visual acuity over a long-term follow-up.

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Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion

Cited by 98 publications

References 24 publications

Retinal Vein Occlusion: Current Treatment

Retinal Vein Occlusion: Current Treatment

Treatment of Macular Edema following Branch Retinal Vein Occlusion

Branch Retinal Vein Occlusion: Classification and Treatment

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