Six-month results of intravitreal ranibizumab for macular edema after branch retinal vein occlusion in a single-center prospective study: visual outcomes and microaneurysm formation

Kawamura, Mihoko; Hirano, Yoshio; Yoshida, Masahito; Mizutani, Takeshi; Sugitani, Kazuhiko; Yasukawa, Tsutomu; Ogura, Yuichiro

doi:10.2147/opth.s170698

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…The mean number of injections and clinic visits was 4.26 (0.71) and 6.71 (1.41), respectively. The BCVA and CST values were consistent with those in previous reports [ 7 , 8 , 10 , 11 , 18 , 19 ], and the mean number of injections was similar to that of the one injection plus PRN regimen [ 10 , 11 ]. The mean number of clinic visits was similar to that in the TAE regimen [ 18 , 19 ].…”

Section: Discussionsupporting

confidence: 89%

“…The mean number of clinic visits was similar to that in the TAE regimen [ 18 , 19 ]. Many previous studies investigated PRN and TAE regimens for BRVO [ 7 , 8 , 10 , 11 , 18 , 19 , 22 ], but this mTAE regimen is the first to combine the best features of PRN and TAE regimens.…”

Section: Discussionmentioning

confidence: 99%

“…Miwa et al [10] reported that changes in VA and central foveal thickness from the baseline in a group that received one initial IVR injection were not significantly different from those in a group that received three monthly IVR injections. Kawamura et al [11] reported a mean Early Treatment Diabetic Retinopathy Study (ETDRS) letters score gain of 15.2 letters and central retinal thickness reduction of 230 µm, with 90% of patients having a Snellen equivalent BCVA of 20/40 or better and 15% having a Snellen equivalent BCVA of 20/20. However, such reactive treatment has a potential risk of undertreatment, as has been demonstrated in studies for exudative age-related macular degeneration (AMD).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study

Arai

Takahashi

Inoda

et al. 2020

JCM

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Purpose: To assess the efficacy and safety of a modified treat-and-extend (mTAE) regimen of aflibercept for macular edema (ME) due to branch retinal vein occlusion (BRVO). Methods: This prospective multicentre intervention study evaluated 50 eyes of 50 patients enrolled from October 2016 to September 2017. The patients received intravitreal aflibercept (IVA) injections on an mTAE regimen for a total of 12 months. The main outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 12 months. Results: The baseline BCVA and CST were 0.33 (0.27) and 488 (171) µm (mean (standard deviation)), respectively. The BCVA and CST were significantly improved at month 12 (0.067 (0.19) LogMAR and 295 (110) µm; both p < 0.0001, paired t-test). The mean number of clinic visits and IVA injections was 6.71 (1.41) and 4.26 (0.71), respectively. The time to first recurrence from the first injection was most frequently 3 months. Conclusion: The mTAE regimen of IVA injections for ME due to BRVO effectively improved BCVA and reduced CST, and thus might be an effective therapy to reduce the number of injections and visits.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study

Arai

Takahashi

Inoda

et al. 2020

JCM

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“…In addition, prompt administration (within 3 months after disease onset) of anti-VEGF agents was more effective than delayed administration (over 3 months after disease onset) [44], which supports the association between excessive VEGF expression and microaneurysm formation. Moreover, we reported the same effect in a prospective study with IV injection of ranibizumab in eyes with BRVO [109]. Furthermore, microaneurysms are seen frequently at the edge of the NPAs, which also indicates the association of VEGF with microaneurysm formation, because VEGF proteins are produced from the ischemic area.…”

Section: Microaneurysm and Macroaneurysmsupporting

confidence: 66%

Multimodal Imaging of Microvascular Abnormalities in Retinal Vein Occlusion

Hirano

Suzuki

Tomiyasu

et al. 2021

JCM

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The technologies of ocular imaging modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have progressed remarkably. Of these in vivo imaging modalities, recently advanced OCT technology provides high-resolution images, e.g., histologic imaging, enabling anatomical analysis of each retinal layer, including the photoreceptor layers. Recently developed OCTA also visualizes the vascular networks three-dimensionally, which provides better understanding of the retinal deep capillary layer. In addition, ex vivo analysis using autologous aqueous or vitreous humor shows that inflammatory cytokine levels including vascular endothelial growth factor (VEGF) are elevated and correlated with the severity of macular edema (ME) in eyes with retinal vein occlusion (RVO). Furthermore, a combination of multiple modalities enables deeper understanding of the pathology. Regarding therapy, intravitreal injection of anti-VEGF drugs provides rapid resolution of ME and much better visual improvements than conventional treatments in eyes with RVO. Thus, the technologies of examination and treatment for managing eyes with RVO have progressed rapidly. In this paper, we review the multimodal imaging and therapeutic strategies for eyes with RVO with the hope that it provides better understanding of the pathology and leads to the development of new therapies.

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“…One hypothesis to explain SSPiM are that these are particles remaining after resolution of a retinal hemorrhage plus fluid leakage from the broken BRB following venous obstruction. Another hypothesis is that SSPiM are related to microaneurysms because microaneurysms in BRVO are related to chronic disease and are known to be factors for ME relapse 2 , 21 , 22 . Microaneurysms in BRVO can occur at the junction of the nonperfused and perfused retina 23 , and one study suggested that microaneurysms are a secondary change caused by local hypoxia and increased VEGF concentration 9 .…”

Section: Discussionmentioning

confidence: 99%

Suspended scattering particles in motion using OCT angiography in branch retinal vein occlusion disease cases with cystoid macular edema

Choi

Han

Yun

et al. 2020

Sci Rep

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We aimed to investigate the clinical implication of suspended scattering particles in motion (SSpiM) using optical coherence tomography angiography (octA) among branch retinal vein occlusion disease (BRVo) cases with macular edema (Me). Medical records of BRVo patients were reviewed. central retinal thickness (cRt), Me type, and cyst size on optical coherence tomography images were evaluated before and after intravitreal bevacizumab injection. nonperfusion area, SSpiM, and microvascular abnormalities in octA images were evaluated using a Heidelberg machine. SSpiM was identified in 24 of 56 cases. There were no differences in baseline characteristics between groups with and without SSpiM. Disease duration, disease-free duration, previous injection number, microaneurysms in the superficial vascular complex, and microaneurysms in the deep vascular complex (DVC) (p = 0.003, 0.013, 0.028, 0.003, < 0.001, respectively) differed significantly between the two groups. After multivariate logistic analysis, microaneurysms in the DVC were the only different factor between the two groups (odds ratio [OR]: 0.091; p = 0.001). Furthermore, SSPiM in the DVC (OR 10.908; p = 0.002) and nonperfusion grade (OR 0.039; p < 0.001) were significantly associated with cyst response after intravitreal injection. SSpiM may be correlated with microaneurysms in the DVc and a poor anatomical response after intravitreal injection. Branch retinal vein occlusion (BRVO) is a major vasculopathy among retinal diseases, and when it occurs, macular edema (ME) is also usually present and well-developed 1,2. Optical coherence tomography (OCT) and fluorescein angiography are widely used to assess various ocular diseases 3-5. However, OCT angiography (OCTA), which is a more recent technology, has greatly helped to elucidate differences in structural anomalies and identify anatomical vascular patterns not previously seen before 6-12. OCTA images are acquired by analyzing differences in reflectivity from repeated OCT B-scan images 13,14. Microvascular abnormalities such as microaneurysms, telangiectasia, and neovascularization can be assessed in OCTA images in addition to areas of nonperfusion as well as areas of vascular density. In most cases, distinction between areas of nonperfusion and vascular density is possible, but nonvascular decorrelation signals or artifacts may prevent such a distinction 15-17. In one study of nonvascular decorrelation signals, Kashani et al. proposed the concept of suspended scattering particles in motion (SSPiM) 18. They suggested that severe breakdown of the blood-retinal barrier (BRB) induces an increase in particle efflux and that SSPiM appear due to a decorrelation signal caused by Brownian motion of particles in intraretinal cysts. They also demonstrated experimentally that an intralipid solution generated SSPiM-like signals 18. In a previous study, we focused on and evaluated decorrelation signals like SSPiM in diabetic ME (DME) patients using OCTA images, and found that both steroid and anti-vascular endothelial growth ...

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Six-month results of intravitreal ranibizumab for macular edema after branch retinal vein occlusion in a single-center prospective study: visual outcomes and microaneurysm formation

Cited by 6 publications

References 17 publications

Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study

Efficacy of Modified Treat-and-Extend Aflibercept Regimen for Macular Edema Due to Branch Retinal Vein Occlusion: 1-Year Prospective Study

Multimodal Imaging of Microvascular Abnormalities in Retinal Vein Occlusion

Suspended scattering particles in motion using OCT angiography in branch retinal vein occlusion disease cases with cystoid macular edema

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