Ranibizumab as an adjunct to laser for macular edema secondary to branch retinal vein occlusion

Abstract

Purpose:To compare the safety, efficacy, and dosing regimen of intravitreal ranibizumab as an adjunct to laser therapy for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO).Materials and Methods:Thirty eyes of 30 patients of BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received grid laser treatment alone, Group 2 received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment on 7th day following injection, while Group 3 received three loading doses of intravitreal ranibizumab at monthly interval (i.e. 0, 1, & 2 months) + standard laser treatment 7 days after the 1st injection. Outcome measure noted at 6 months follow-up were the improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT).Results:At 6 months follow-up, there was an average gain of 12 letters (P=0.05), 17.5 letters (P=0.05) and 19 letters (P=0.05) in groups 1, 2, and 3, respectively, with the decrease in CMT being 208.7 μm (P=0.05), 312.9 μm (P= 0.05) and 326.8 μm (P=0.05), respectively, in these groups. Gain in BCVA of more than 3 lines was noted in 1/10 patients in Group 1(10%) as compared to 3/10 (30%) and 4/10 (40%) patients in groups 2 and 3, respectively.Conclusion:The gain in BCVA and reduction in CMT were better with combination therapy (single- and triple- dose regimen) compared to grid laser alone. Single dose of intravitreal ranibizumab with grid laser seems to be an effective therapy.

Comparative efficacy and safety of approved treatments for macular oedema secondary to branch retinal vein occlusion: a network meta-analysis

“…Three trials were excluded because these were extension studies 15 28 29 and three trials were excluded because they evaluated only one treatment of interest. 24 30 31 Manual searching identified three further trials (BRIGHTER, 32 COMRADE-B 33 and VIBRANT 12 ).…”

Optimal Treatment of Retinal Vein Occlusion: Canadian Expert Consensus

“…Thus, the group recommended careful observation with frequent follow-up examinations and prompt PRP of eyes in which neovascularization develops [33]. Recently, there have been several reports of the beneficial effects of combination therapy with laser and intravitreal anti-VEGF injections on improving VA [92,93]. This combination also provides durable response with less therapeutic interventions.…”

“…Pars plana vitrectomy with internal limiting membrane peeling has also been investigated for treatment of RVO-associated macular edema with variable outcomes [50,74,91,92,93,94,95,96,97,98,99,100,101,102,103,104]. There is a need for further documentation of the effectiveness and safety of these therapies via randomized, controlled clinical trials, particularly in the era of effective and less invasive intravitreal pharmacotherapies.…”

Strategy for the Management of Macular Edema in Retinal Vein Occlusion: The European VitreoRetinal Society Macular Edema Study

“…While focal and grid laser photocoagulation is routinely used to supplement anti-VEGF injections, the possible benefit of this combined treatment has not been thoroughly studied. It has been suggested that the addition of grid laser photocoagulation to anti-VEGF therapy to treat edema in BRVO can lead to a better visual outcome and decrease the number of injections needed than if laser was not utilized [ 19 , 20 ]. A separate prospective investigation found that the addition of a dexamethasone intravitreal implant to anti-VEGF injections also leads to a decrease in the number of injections needed and better vision in the combination group compared to monotherapy [ 21 ].…”