Compression between Combined Anti-VGEF with Steroids Versus Pure Anti-VEGF in Retinal Vein Occlusion

Eman Abo Taleb,Altaf Alsowaidi,Ntodie M

doi:10.14302/issn.2470-0436.jos-20-3400

Abstract

Aim To compare the efficacy of combined anti-VGEF (IVB) with steroids versus pure anti-VEGF for the treatment of macular edema secondary to retinal vein occlusion (RVO). Methods In this prospective study, 51 eyes were randomized into 2 groups according to treatment of clinically identified macular edema secondary to retinal vein occlusion within 4 weeks of onset: Group 1 (19 eyes) was given intravitreal Bevacizumab (IVB) (1.25mg/.05ml) + Triamcinolone (IVTA) (2mg/.05ml); Group 2 (22 eyes) was given pure intravitreal Bevacizumab (IVB) (1.25mg/.05ml) at baseline, at month 1, and at month 2. The outcome of the study represented the EDRTS letters gain, IOP change and (CRT) by using Spectral domain optical coherence tomography (OCT) at month 1, 2, 3 and 6 in each group. Both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) patients with at least 6 months FU were enrolled in the study. Results EDRTS letters gain was (20.37±15.28, 28.05±16.68, 35.16±17.12, 36.47±18.17) in group1 and (14.50±14.56, 18.41±14.56, 20.59±16.13, 21.06±15.72) in group2 at month 2,3 and 6 p value (0.18, .04, 0.004, 0.002). Mean IOP pre-injection (14.00±2.67) in group 1 and (13.5±5.89) in group 2. Group 1 has transient increase in IOP at month 1 and then return to baseline over 6 months. CRT from baseline to final FU decrease by 264.82 (µm) ±147.66 in group 1 and 308.42(µm) ±226.78 in group 2 with no significant difference between two group p value 0.57. There was no significant difference in EDRTS letters gain between CRVO patients and BRVO patients at month 1, 2, 3 and 6 p values (0.83, 0.23, 0.29, 0.13). Conclusion Early treatment macular edema in RVO patients by combined anti-VGEF+ steroid effectively improve functional outcome better than pure anti-VGEF injection.

Highlights

Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and is estimated to affect 16 million adults worldwide, with a reported prevalence of 4.6% in those aged 480 years[1]
In the nearly two decades following the publication of the Branch Retinal Vein Occlusion Study (BVOS) and Central Retinal Vein Occlusion Study (CVOS), pharmacologic therapy for retinal vein occlusion (RVO) was almost nonexistent
In the SCORE trials, 11.6% to 12.0% of patients treated with repeated intravitreal triamcinolone lost at least 15 letters, and more than 20% had central point thicknesses greater than 500 μm at 12-month follow-up. 3, 4 the rate of refractory edema was lower in the BRAVO/ CRUISE trial (0.7% to 3.8% lost at least 15 letters, and 6.7% to 15.9% had central foveal thickness greater than 400 μm at 12 months), frequent ranibizumab monotherapy was not universally successful. 5, 6

Summary

Introduction

Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and is estimated to affect 16 million adults worldwide, with a reported prevalence of 4.6% in those aged 480 years[1]. As evidenced by several large-scale clinical trials, 3-6 intravitreal monotherapy is effective for the vast majority of patients with RVO and has become the predominant therapeutic approach. 7. a small minority of patients display recalcitrant macular edema despite frequent intravitreal monotherapy dosing. In the SCORE trials, 11.6% to 12.0% of patients treated with repeated intravitreal triamcinolone lost at least 15 letters, and more than 20% had central point thicknesses greater than 500 μm at 12-month follow-up. 3, 4 the rate of refractory edema was lower in the BRAVO/ CRUISE trial (0.7% to 3.8% lost at least 15 letters, and 6.7% to 15.9% had central foveal thickness greater than 400 μm at 12 months), frequent ranibizumab monotherapy was not universally successful. In the SCORE trials, 11.6% to 12.0% of patients treated with repeated intravitreal triamcinolone lost at least 15 letters, and more than 20% had central point thicknesses greater than 500 μm at 12-month follow-up. 3, 4 the rate of refractory edema was lower in the BRAVO/ CRUISE trial (0.7% to 3.8% lost at least 15 letters, and 6.7% to 15.9% had central foveal thickness greater than 400 μm at 12 months), frequent ranibizumab monotherapy was not universally successful. 5, 6 Such recalcitrant cases have prompted the search for therapeutic alternatives, most notably combination pharmacologic and pharmaco-laser treatments.

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