Treatment of Retinal Vein Occlusion with Ranibizumab in Clinical Practice: Longer-Term Results and Predictive Factors of Functional Outcome

Abstract

Purpose: To evaluate long-term results and predictors of efficacy in patients with macular edema due to retinal vein occlusion (RVO) treated with intravitreal ranibizumab in a clinical practice setting. Methods: The clinical records of patients with a minimum follow-up of 3 years were retrospectively analyzed. Sixteen eyes with branch RVO (BRVO) and 16 with central RVO (CRVO) were included. All patients performed cross-sectional evaluation with best-corrected visual acuity (BCVA), spectral domain optical coherence tomography and fluorescein angiography. The foveal avascular zone (FAZ) was assessed and microstructural morphology of the retina was characterized. Results: Follow- up was 42.9 ± 9.0 and 44.8 ± 8.0 months in the CRVO and BRVO groups, respectively. Patients with CRVO received on average 6.9 injections, with a final VA gain of 8.3 ± 15.0 letters (p = 0.05). BRVO eyes had on average 5.9 injections, with a final VA gain of 1.6 ± 21.0 letters (p > 0.05). The FAZ area remained stable in both groups (p > 0.05). Baseline BCVA and disruption of the retinal pigment epithelium (RPE) were predictors of final BCVA (p = 0.001 and 0.011, respectively). Conclusion: Although functional outcomes were inferior to those reported in clinical trials, ranibizumab was satisfactory in the long-term treatment of macular edema secondary to RVO and was not associated with increased macular ischemia. Final BCVA depends on baseline BCVA and RPE integrity.

Baseline choroidal thickness as a short-term predictor of visual acuity improvement following antivascular endothelial growth factor therapy in branch retinal vein occlusion

“…Another study by Farinha and associates assessed predictors of functional outcomes in patients with BRVO treated with ranibizumab. Their study demonstrated that a better initial BCVA correlated with a better final BCVA, while RPE disruption negatively correlated with final BCVA 15. These results appear to be in conflict with the visual acuity findings in our study and the study by Kim and colleagues.…”

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

“…It is worthy to mention that both ischemic and nonischemic CRVO types showed a positive response to anti-VEGF agents based on pivotal trials [12][13][14][15][16][17] . Real-life data also demonstrated significant anatomical and visual improvement in patients with CRVO treated with intravitreal anti-VEGF agents in a variable follow-up period [18][19][20] .…”

“…However, it is worthy of note that there is a lack of standardized definition for ischemia so far, and, therefore, there is controversy in the results of the studies regarding ischemia and its role in the visual outcome. Regarding the effect of retinal ischemia, Farinha et al [18] also demonstrated that ischemic eyes with RVO had larger final FAZ areas and worse functional outcome. This was in accordance with Sophie et al [23] , who stated that in patients with RVO retinal nonperfusion may contribute to restricted visual gain in the long-term follow-up.…”

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

“…The management of macular edema secondary to branch retinal vein occlusion has greatly improved in recent times with the introduction of a therapy based on intravitreal injection of antivascular endothelial growth factor (VEGF) molecules and steroids [69]. Patient outcomes even with identical treatments can be vastly different due to disease, and patient heterogeneity prognostic factors for BRVO include patient age [70], baseline visual acuity and retinal thickness [51, 71, 72], early response to treatment [70], duration of macular edema [73, 74], posterior vitreous detachment [75], OCT characteristic [76–78], cytokine level [34, 79], central retinal sensitivity [80], leaking capillaries and microaneurysms in the perifoveal capillary network [60, 81, 82], retinal pigment epithelium (RPE) integrity [83, 84], serious retinal detachment [85], and subretinal hemorrhage [86]. Some of these prognostic factors are still controversial.…”