Intravitreal Injections for Macular Edema Secondary to Retinal Vein Occlusion: Long-Term Functional and Anatomic Outcomes.

Maurizio Mete,Massimo Guerriero,Marcella Attanasio,Emilia Maggio,Grazia Pertile,Giorgia Maraone

doi:10.1155/2020/7817542

Abstract

Purpose To report the long-term visual and anatomic outcomes of intravitreal injections for macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-life clinical setting. Design Retrospective interventional case series. Methods A total of 223 consecutive eyes with ME secondary to RVO, treated with the first three intravitreal Ranibizumab or dexamethasone injections between August 2008 and September 2018, were enrolled in the study. Subsequent retreatment was guided by best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurements, aimed at achieving macular fluid regression and BCVA stability. BCVA and CMT were recorded at baseline and at subsequent annual time points. The mean number of injections administered each year and the incidence of adverse events were recorded. Results The mean BCVA and CMT at baseline were 0.79 logMar (SD 0.71) and 615.7 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p < 0.0001) and 401.04 μm (SD 257.5), respectively. The mean follow-up (FU) period was 47.8 months (min 12–max 120). At 12 months, the mean BCVA and CMT had significantly improved to 0.62 logMar (SD 0.68; p < 0.0001) and 401.04 Conclusion Intravitreal Ranibizumab and/or dexamethasone injections were found to be effective at inducing a long-lasting improvement of BCVA and CMT in a real-life clinical setting. A safety profile similar to that already well-established in Ranibizumab and dexamethasone treatment was observed, as well as a steady decrease in the number of intraocular injections required. The results support intravitreal treatments for BRVO and CRVO in patient populations with similar characteristics in similar settings.

Highlights

Retinal vein occlusion (RVO) is the second most common cause of vision loss due to retinal vascular disease, after diabetic retinopathy [1]
The Geneva study group [6], in a randomized, sham-controlled, clinical trial conducted on 1267 patients, found significantly greater improvement in the Journal of Ophthalmology mean best-corrected visual acuity (BCVA) of eyes treated with dexamethasone intravitreal implant (DEX implant; Ozurdex®, Allergan, Inc., Irvine, CA, USA) compared to controls, with a good safety profile
Significant visual and anatomic improvements among patients receiving vascular endothelial growth factor (VEGF) inhibitors have been demonstrated in randomized clinical studies including COPERNICUS, GALILEO, BRAVO, CRUISE, and VIBRANT [7,8,9,10,11]. e CRUISE study reported a mean gain in BCVA of 13.9 letters in CRVO eyes at 12 months. e BRAVO study, with a similar design to CRUISE, demonstrated mean BCVA improvements by 16.4 and 18.3 letters in the 0.3 and 0.5 mg groups, respectively, among BRVO eyes, over the 12-month study period

Summary

Introduction

Retinal vein occlusion (RVO) is the second most common cause of vision loss due to retinal vascular disease, after diabetic retinopathy [1]. Evidence from subsequent randomized controlled trials has demonstrated significant visual and anatomic improvements among patients with either CRVOor BRVO-related ME who were treated with intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors or with corticosteroids. Significant visual and anatomic improvements among patients receiving VEGF inhibitors have been demonstrated in randomized clinical studies including COPERNICUS, GALILEO, BRAVO, CRUISE, and VIBRANT [7,8,9,10,11]. E BRAVO study, with a similar design to CRUISE, demonstrated mean BCVA improvements by 16.4 and 18.3 letters in the 0.3 and 0.5 mg groups, respectively, among BRVO eyes, over the 12-month study period. Extension studies following BRAVO and CRUISE [12] have given some insight into the outcomes of anti-VEGF therapy for RVO up to 4 years after initiating treatment

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