Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion

Bradshaw, S.; Gala, Smeet; Nanavaty, M; Shah, Anshul; Mwamburi, M; Kefalas, Panos

doi:10.1186/s12886-016-0282-5

Cited by 24 publications

(20 citation statements)

References 41 publications

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“…Currently, there is no effective treatment for patients with iRVO. The present therapeutic options are aimed at treating the complications of iRVO, namely macular edema and neovascularization and its results, rather than at re-vascularizing the ischemic retina (33,86,87) . Local treatments include laser photocoagulation, intravitreal anti-VEGF, corticosteroids and vitrectomy, or combination of these therapies.…”

Section: A Current Treatments Of Ischemic Rvomentioning

confidence: 99%

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Khayat

Williams

Lois

2018

Survey of Ophthalmology

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Retinal vein occlusion (RVO)-including central RVO, branch RVO, and hemicentral and hemispheric RVO-is the second most common vascular cause of visual loss, surpassed only by diabetic retinopathy. The presence and extent of retinal ischemia in RVO is associated with a worse prognosis. On this basis, most previously conducted studies considered ischemic retinal vein occlusion (iRVO) and non-iRVO as separate entities based on set thresholds of existing retinal ischemia as determined by fundus fluorescein angiography. Other diagnostic technologies have been used specifically in the differentiation of ischemic central retinal vein occlusion and nonischemic central retinal vein occlusion. To date, there is no fully accepted definition for iRVO. Some clinicians and researchers may favor establishing a clear differentiation between these forms of RVO; others may prefer not to consider iRVO as a separate entity. Whatever the case, retinal ischemia in RVO confers a higher risk of visual loss and neovascular complications; thus, it should be determined as accurately as possible in patients with this disease and be considered in clinical and experimental studies. Most recently conducted clinical trials evaluating new treatments for macular edema secondary to RVO included none or only few patients with iRVO based on previous definitions (i.e., few patients with sizeable areas of retinal ischemia were recruited in these trials), and thus it is unclear whether the results observed in recruited patients could be extrapolated to those with retinal ischemia. There has been scant research aiming at developing and/or testing treatments for retinal ischemia, as well as to prevent new vessel formation as a result of RVO. We provide a detailed review of the knowledge gathered over the years on iRVO, from controversies on its definition and diagnosis to the understanding of its epidemiology, risk factors and pathogenesis, the structural and functional effects of this disease in the eye and its complications, natural history, and outcomes after treatment. In each section, the definition of iRVO used is given so, independently of whether iRVO is considered a separate clinical entity or a more severe end of the spectrum of RVO, the information will be useful to clinicians to determine patient's risk, guide therapeutic decisions, and counsel patients and for researchers to design future studies.

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Section: A Current Treatments Of Ischemic Rvomentioning

confidence: 99%

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Khayat

Williams

Lois

2018

Survey of Ophthalmology

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“…CRVO may be classified as ischemic and nonischemic based on the area of capillary nonperfusion of the retina as a consequence of the occlusion [3,8] . Nonischemic CRVO is the milder form, which may resolve on its own or may progress to the ischemic form.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Anatomical and Functional Outcomes in Patients with Ischemic Central Retinal Vein Occlusion Treated with Anti-Vascular Endothelial Growth Factor Agents

Chatziralli¹,

Theodossiadis²,

Parikakis³

et al. 2017

Ophthalmic Res

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Purpose: To evaluate the anatomical and functional outcomes in patients with ischemic central retinal vein occlusion (CRVO) treated with intravitreal anti-vascular endothelial growth factor (VEGF) agents. Methods: This retrospective study included 15 treatment-naive patients with ischemic CRVO and macular edema who were treated with intravitreal ranibizumab or aflibercept. The main outcomes were the evolution of retinal ischemia over time, as well as the change in best corrected visual acuity (BCVA) and in central subfield thickness (CST) at month 24. Results: At month 24, patients with ischemic CRVO gained +7.8 letters compared to baseline, while there was a significant decrease in CST by 243.7 μm. At baseline, ischemia was located mainly at the peripheral retina, while 6.6% of patients presented macular ischemia. At month 24, 20% of patients had macular ischemia, which was found to be negatively correlated with BCVA. The patients with macular ischemia had very poor final visual outcome and were advised to discontinue treatment. Conclusions: Our study showed that anti-VEGF treatment was effective in patients with ischemic CRVO, since it reduces macular edema and maintains or improves VA in the long term (24-month follow-up). It is worthy of note that in a small proportion of patients (13.3%) peripheral ischemia progressed to macular ischemia over time. In cases where macular ischemia is present, anti-VEGF treatment does not seem to offer any improvement in VA.

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“…[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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Özkaya¹,

Nur²,

Ipek³

et al. 2017

Int J Ophthalmol Clin Res

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The aim of this study was to compare the real-life outcomes of Intravitreal Ranibizumab (IVR) and Intravitreal Dexamethasone Implant (IDI) treatments in patients with Macular Edema (ME) secondary to Ischemic Retinal Vein Occlusion (IRVO). Methods: Retrospective, interventional case control study. The treatment naïve IRVO patients with ME who were treated with Intravitreal Ranibizumab (IVR) or Intravitreal Dexamethasone Implant (IDI) and had a minimum follow-up time of 12 months were included. Primary outcome measure was the change in Best Corrected Visual Acuity (BCVA). Secondary outcome measures were change in central retinal thickness and mean number of injections. Results: A total of 41 eyes of 41 patients were included. Nineteen patients (46.3%) were treated with IVR, 22 patients (53.7%) were treated with IDI. Mean BCVA in IVR group at baseline and month 12 was 1.25 ± 0.58 and 0.82 ± 0.54 LogMAR, respectively. Mean BCVA in IDI group at baseline and month 12 was 1.15 ± 0.52 and 1.09 ± 0.54 LogMAR, respectively. The change in mean BCVA was significantly better in IVR group than IDI group at month 12 (p = 0.05 for month 3, p = 0.1 for month 6, p = 0.07 for month 9, and p = 0.03 for month 12, respectively). Mean number of visits during the first year was 5.0 ± 1.0 (range 2-6) in IVR group, and 4.0 ± 0.9 (range 3-6) in IDI group (p = 0.004). Mean number of injections was 3.7 ± 1.2 (range 3-6) in IVR group, and 1.50 ± 0.6 (range 1-3) in IDI group (p < 0.0001). Conclusion: There was a statistically significant difference in regard to change in VA at month 12 between IVR and IDI treatments and the in-group VA changes was statistically better in IVR group which might suggest that IVR might be a better option in ME secondary to IRVO.

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Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion

Cited by 24 publications

References 41 publications

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Long-Term Anatomical and Functional Outcomes in Patients with Ischemic Central Retinal Vein Occlusion Treated with Anti-Vascular Endothelial Growth Factor Agents

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

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