Abstract
The purpose of this study was to assess outcomes in a real-world nonclinical trial setting of antivascular endothelial growth factor (VEGF) injections alone vs. focal laser combined with anti-VEGF injections in patients with branch retinal vein occlusion- (BRVO-) related macular edema (ME). This study included 88 BRVO with ME patients who were treated over three years at both a tertiary referral center in the Birmingham metropolitan area and satellites in rural Alabama. One group received only anti-VEGF injections (n = 56); the other group received both anti-VEGF injections and focal laser (n = 32). The following outcome measures were evaluated: initial and final visual acuities (VA), initial central subfield thickness (CST) on OCT, number of injections, number of lasers, percentage of patients with a gain of 3 lines of VA, percentage of patients with VA better than or equal to 20/40, and percentage of patients with VA worse than or equal to 20/200. We found that there was no difference in initial VA (p=0.913) or CST (p=0.961) between the two groups. The injection only group required a median of 7 injections, while the combination group required a median of 4 injections, but this was not a statistically significant difference (p=0.117). There was no difference in final VA (p=0.414) or any of the other visual outcomes between the two groups. In conclusion, focal laser did not decrease the number of injections required or improve the VA in BRVO-related ME. Although visual outcomes were similar in both groups, focal laser does not appear to be of additional benefit in BRVO-related ME in the anti-VEGF era.
Highlights
Branch retinal vein occlusion (BRVO) is the second most frequent major retinal vascular disease. ere are approximately 144,000 new cases of BRVO in the United States each year [1,2,3]. e most common reason for decreased vision secondary to BRVO is macular edema (ME) [4]
Results. ere were a total of 88 patients in this retrospective study. 56 patients received only intravitreal anti-VEGF injections (63.6%) and 32 received both intravitreal anti-VEGF injections and focal laser (36.4%). ere were no complications in either group
There was no statistical significant difference found between the numbers of injections each group received. e injection only group required a median of 7 injections, while the combination group required a median of 4 injections
Summary
Branch retinal vein occlusion (BRVO) is the second most frequent major retinal vascular disease. ere are approximately 144,000 new cases of BRVO in the United States each year [1,2,3]. e most common reason for decreased vision secondary to BRVO is macular edema (ME) [4]. E most common reason for decreased vision secondary to BRVO is macular edema (ME) [4]. Journal of Ophthalmology become the first-line treatment for patients with macular edema secondary to BRVO as well as many other retinal diseases [6]. Anti-VEGF injections have shown great efficacy but not without limitations and potential adverse effects. Intravitreal corticosteroids (such as intravitreal triamcinolone and dexamethasone) are an effective treatment for ME secondary to BRVO (and many other retinal diseases) that may offer the benefit of less frequent injections, but at the expense of an increased risk of cataracts and glaucoma [8,9,10]. Combination therapy utilizing anti-VEGF injections, corticosteroids, and/or laser can be employed as can vitrectomy surgery (when vitreomacular traction is contributing to the BRVO-related macular edema)
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