Combined intravitreal ranibizumab and grid laser photocoagulation for branch retinal vein occlusion with macular edema

Abstract

Objective To observe the effectiveness of combined therapy of intravitreal injections of ranibizumab and macular grid laser photocoagulation for branch retinal vein occlusion (BRVO) with macular edema (ME).Methods Forty-six patients of BRVO with ME were enrolled in this study.All the patients were examined for corrected visual acuity of Early Treatment Diabetic Retinopathy Study (ETDRS),slit lamp microscope,direct ophthalmoscope,intraocular pressure,fundus color photography,fundus fluorescein angiography and optical coherence tomography.The patients were divided into three groups by different treatments:injection group (18 eyes) received intravitreal injections of ranibizumab only,joint group (17 eyes) received intravitreal injections of ranibizumab combined with grid laser photocoagulation,and laser group (11 eyes) received laser photocoagulation only.The follow-up ranged from three to 15 months,with a mean of (8.0±3.2) months.The same equipment and methods were used to return visit in follow-up period.Repeated injections were adopted in injection group and joint group according to the results of subsequent visits.Then the repeated times of injection in two groups were compared.The visual acuity,macular retinal thickness (CRT) and ocular and systemic adverse reactions about drugs and treatments were followed up.The last follow-up time was considered as the judgment time for the therapeutic effects.Results The mean repeat times of injection in the injection group was 5.4±0.4,which more than that in the joint group 3.2±0.6 (t =12.17,P＜0.05).No ocular or systemic adverse events were observed in follow-up period.ETDRS visual acuity of injection group,joint group and laser group increased by 7.30 ± 8.68,8.50±6.04,1.55±6.85 letters respectively after treatment.The differences were statistically significant before and after treatment in injection group and joint group (t=3.58,5.78; P＜0.05),but there was no significant difference in laser group (t=0.75,P＞0.05).The difference was not statistically significant between injection group and joint group (t=0.45,P＞0.05).The difference was statistically significant between injection group and laser group,but also between joint group and laser group (t=2.13,2.81; P＜0.05).CRT of injection group,joint group and laser group decreased by (110.56±43.08),(125.47±35.19),(50.73 ± 19.68) μm respectively after treatment,with statistically significant differences ( t =-10.89,-14.70,-8.55; P＜ 0.05).Conclusion In the treatment of BRVO with ME,intravitreal injection of ranibizumab combined with macular grid laser photocoagulation can reduce repeat times of injection,improve visual function and relieve ME. Key words: Retinal vein occlusion/therapy; Antibodies, monoclonal/therapeutic use; Laser coagulation