BRVO Group Research Articles

Short-term Outcomes of Ranibizumab Biosimilar CKD-701 Treatment in Macular Edema Secondary to Retinal Vein Occlusion

Purpose: To evaluate the short-term outcomes of intravitreal injection therapy using the ranibizumab biosimilar CKD-701 in macular edema due to retinal vein occlusion.Methods: We conducted a retrospective analysis of medical records from patients diagnosed with macular edema secondary to retinal vein occlusion who received intravitreal injections of CKD-701. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and after a single injection were compared. Additionally, differences in these indicators were assessed between central and branch retinal vein occlusion (CRVO/BRVO).Results: The study included 22 subjects, with 17 cases of BRVO and 5 cases of CRVO. The efficacy was evaluated at 6.0 ± 2.2 weeks after injection. CRT decreased significantly from 534.8 ± 224.9 µm before injection to 367.8 ± 162.7 µm after injection (<i>p</i> < 0.001). The logarithm of the minimum angle of resolution BCVA improved significantly from 0.58 ± 0.41 to 0.48 ± 0.37 after injection (<i>p</i> = 0.002). The CRVO group showed a greater reduction in CRT compared to the BRVO group (<i>p</i> = 0.006).Conclusions: A single injection of CKD-701 significantly improved both functional and anatomical outcomes in patients with macular edema secondary to retinal vein occlusion. Additional long-term studies are needed.

Multimodal imaging to distinguish microvascular and morphological changes in retinal vein occlusion after intravitreal ranibizumab with or without triamcinolone acetonide injection

BackgroundThe study was designed to investigate microvascular and morphological changes in retinal vein occlusion (RVO) using multimodal imaging after intravitreal ranibizumab (IVR) with or without triamcinolone acetonide (IVTA) injections.MethodsThis was a retrospective and observational study. Fifty patients (52 eyes) diagnosed with RVO were enrolled. Best corrected visual acuity (BCVA), ophthalmoscopy, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SDOCT), and optical coherence tomography angiography (OCTA) were employed sequentially both before treatment and at the last visit after treatment.ResultsThe mean logMAR VAs in BRVO eyes decreased significantly after treatment (P = 0.029). OCTA showed there was a significant difference in foveal avascular zone (FAZ) in BRVO eyes (P = 0.024), superificial foveal vessel density in both CRVO (P = 0.0004) and BRVO eyes (P = 0.02155). OCT showed the foveal thickness had significant differences after treatment in both CRVO (P < 0.0001) and BRVO eyes (P = 0.0001). BCVA was associated most commonly with ellipsoid zone integrity (P = 0.022). The BCVA in eyes treated with IVR and IVTA was significantly decreased compared with IVR only in BRVO group (P = 0.021). However, the combination of IVR + IVTA significantly improved intraocular pressure (IOP) compared with IVR only in BRVO group (P = 0.037).ConclusionBoth IVR and IVR + IVTA can significantly improve the central vision, macular structure, and functions in BRVO group. Simultaneous IVR with IVTA can significantly increase BCVA compared with IVR only in BRVO group.

Aqueous Inflammation and Ischemia-Related Biomarkers in Neovascular Glaucoma with Stable Iris Neovascularization

ABSTRACT Purpose: To characterize the aqueous levels of inflammation and ischemia-related biomarkers in a spectrum of retinal ischemic conditions, including neovascular glaucoma (NVG) with stable iris neovascularization after pan retinal photocoagulation (PRP) and anti-VEGF treatment. Methods: Aqueous samples were collected from 139 eyes including NVG (n = 12), stable NVG (n = 26), CRVO (n = 11), NPDR (n = 18), PACG (n = 18), PDR (n = 25), BRVO (n = 7) and cataract (n = 22). The levels of VEGF-A, IL-8 and EPO were measured with ELISA. Results: Aqueous VEGF-A significantly decreased after anti-VEGF and PRP, from 983.79 ± 821.16 pg/ml in the NVG group (n = 11) to 256.50 ± 51.14 pg/ml in the stable NVG group (n = 24) (P = .015). Aqueous VEGF-A in stable NVG group (256.50 ± 51.14 pg/ml, n = 24) was significantly higher (ANOVA, P < .001) than in CRVO (212.10 ± 19.84 pg/ml, n = 7, P = .017), NPDR (221.18 ± 38.21 pg/ml, n = 14, P = .015), BRVO (213.14 ± 48.50 pg/ml, n = 6, P = .028) and cataract group (185.30 ± 34.35 pg/ml, n = 22, P < .001). Aqueous IL-8 in stable NVG group (74.82 ± 10.78 pg/ml, n = 24) was significantly higher (ANOVA, P < .001) than in CRVO (65.19 ± 15.34 pg/ml, n = 11, P = .032) and cataract group (54.11 ± 12.28 pg/ml, n = 22, P < .001). Aqueous EPO in stable NVG group (17.48 ± 3.02 pg/ml, n = 24) was significantly higher (ANOVA, P < .001) than in BRVO (14.98 ± 2.57 pg/ml, n = 7, P = .034) and cataract group (13.50 ± 2.65 pg/ml, n = 22, P < .001). Aqueous concentrations of VEGF-A and IL-8 correlated positively with IOP (r = 0.413, P < .001, r = 0.349, P < .001, respectively, r = correlation coefficient). VEGF-A correlated positively with IL-8 and EPO (P < .001, P = .002, respectively). IL-8 correlated positively with EPO (P < .001). Conclusions: The aqueous levels of VEGF-A, IL-8 and EPO in NVG patients with stable iris neovascularization, who had received PRP and anti-VEGF, were still significantly higher than in control groups with some retinal ischemic conditions.

The macular vascular density and the area of foveal avascular zone in the follow eyes of monocular retinal vein occlusion patients

Objective To observe the macular vascular density and the area of foveal avascular zone(FAZ) in the follow eyes of monocular retinal vein occlusion (RVO) patients. Methods Retrospective case-control study. From May to November 2018, 78 follow eyes of 78 monocular RVO patients who were clinically diagnosed in Changsha Aier Eye Hospital were included in the study. Among them, 44 were male and 34 were female. The average age was 53.17±10.12 years. There were 42 patients with central retinal vein occlusion(CRVO group) and 36 patients with branch retinal vein occlusion (BRVO group). Forty-two eyes of 33 gender and age matched healthy volunteers were selected as the control group. Among them, 17 were male (22 eyes) and 16 were female (20 eyes), with the mean age of 53.48±10.84 years. OCT angiography was performed on all eyes in CRVO group, BRVO group and control group. The scanning region in the macular area was 6 mm× 6 mm. Macular vascular density and FAZ area in the superficial and deep retinal capillary plexi were measured. Results The mean overall vascular density measured in the entire scan was lower in the CRVO group(t=-4.26, -4.93) and BRVO group (t=-4.79, -4.74) compared with the control group in both the superficial and deep capillary plexus (P 0.05). Conclusions The macular vascular density in the follow eyes of monocular RVO patients is lower than that of normal healthy eyes. The reduce degree of vascular density in the deep capillary plexus is higher than that in the superficial plexus. Compared with normal healthy eyes, the FAZ area in the follow eyes of monocular CRVO patients decreased, while it did not change significantly in the follow eyes of monocular BRVO patients. Key words: Retinal vein occlusion; Regional blood flow; Tomographyoptical coherence

Evaluation of Superficial and Deep Capillary Plexa in Retinal Vein Occlusion Using Optical Coherence Tomography Angiography

Abstract Background: Retinal Vein Occlusion (RVO) is the second most common cause of retinal vascular disease worldwide after diabetic retinopathy and its prevalence increases with age. Aim of Study: To evaluate the retinal microvasculature in human subjects central and branch retinal vein occlusion using optical coherence tomography angiography (OCT angiogra-phy). Patients and Methods: Twenty patients were recruited from the outpatient clinic in Al-Mashreq Eye Center. The study was performed during the time period between August 2018 and February 2019. OCTA (optical coherence tomography angiography) was performed at Mashreq Eye Center. All patients received a thorough explanation of the study design and provided their written consent. Results: Our study revealed that there was no statistically significant difference between CRVO and BRVO group re-garding demographic data, refraction, BCVA, FAZ, vessel density and thickness map. Also there was no statistically significant difference between CRVO group regarding FAZ, vessel density in 2 slices. There was no statistically significant difference between BRVO group regarding FAZ in 2 slices, vessel density in 2 slices. Conclusions: We concluded that with the ability to non-invasively visualize vascular flow, OCTA could serve as a new diagnostic tool for current ophthalmic research and clinical practice.

Morphological and Functional Outcomes after Intravitreal Dexamethasone Injection for Macular Edema in Patients with Central Vein Occlusion at 48-Week Follow-Up.

Purpose The purpose of the study was to assess the efficacy of intravitreal dexamethasone implant (IDI: Ozurdex®) injection in eyes with macular edema due to retinal vein occlusion. Material and Method. A retrospective, nonrandomized study was conducted in patients with macular edema (ME) due to retinal vein occlusion (RVO) who undertook intravitreal Ozurdex® as first-line treatment. We performed a complete ocular exam including macular OCT. Results The mean BCVA (logMar) improved from 0.420.42 ± 0.23 logMar at baseline to 0.21 ± 0.23 logMar at 48 weeks in the BRVO group and from 0.72 ± 0.16 logMar at baseline to 0.31 ± 0.23 logMar at 48 weeks in the CRVO group. In both groups, CFT values decreased significantly compared to baseline (p < 0.0001 at each timepoint). Reinjection for recurrent macular edema after 18 weeks was indicated in five eyes (41.67%) in the BRVO group and in six eyes (25%) in the CRVO group. Cataract developed in two eyes (16.67%) in the BRVO group and in one eye (4.17%) in the CRVO group. The IOP was higher than 25 mmHg in two cases in the BRVO group (16.66%) and in three cases (8.33%) in the CRVO group. Conclusion Ozurdex® injected intravitreally significantly improved the mean CFT and BCVA in eyes with macular edema due to retinal vein occlusion.

Long-term outcome after vitrectomy for macular edema with retinal vein occlusion dividing into the occlusion site.

Purpose. To investigate the efficacy of treatment for macular edema secondary to retinal vein occlusion (RVO) with vitrectomy. Methods. This retrospective study identified patients with macular edema associated with RVO between January 2004 and April 2006. Inclusion criteria were eyes with (1) preoperative visual acuity (VA) of 20/40 or worse, (2) a central foveal thickness (CFT) greater than 250 μm, and (3) vitrectomy with internal limiting membrane and intravitreal triamcinolone acetonide. Each patient had their RVO classified as a major or macular BRVO or hemispheric RVO (HSRVO). Results. Forty-six eyes with major BRVO, 18 eyes with macular BRVO, and 17 eyes with HSRVO were investigated. VA was significantly improved at 24 months after surgery for each group (P < 0.05). Vision in the macular BRVO group 24 months after surgery was significantly better than that in other groups (P < 0.05). For each group, a concomitant reduction of CFT was noted at every time point when compared to preoperative values (P < 0.001). Conclusions. In macular BRVO, the postoperative vision 24 months after surgery was significantly better than the other groups. These findings suggest that additional and earlier treatments might be more important for patients with major BRVO and HSRVO than for those with macular BRVO.

Dexamethasone intravitreal implant in patients with macular oedema related to branch or central retinal vein occlusion, a retrospective study

AbstractPurpose To evaluate the anatomic and visual outcomes of one treatment with dexamethasone intravitreal implant (Ozurdex®) in eyes with macular edema secondary to branch or central vein occlusion (BRVO or CRVO) during the first six months.Methods The safety and efficacy of the dexamethasone intravitreal implant (Dex. implant) were evaluated retrospectively from January 2011 to May 2012 in a tertiary referral hospital. CRVO or BRVO diagnosis was confirmed with fluorescein angiography. At baseline, patients received a 0.7 mg dex. implant. They were evaluated at one, three and six months. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) and intraocular pressure (IOP) were collected.Results We included twenty one eyes: 28.5% had a CRVO and 71.5% a BRVO. At baseline, the mean BCVA was 47 letters (ETDRS) (52 in the BRVO group, 22 in the CRVO group). All patients had a macular edema involving the fovea. The mean central retinal thickness (CRT) was 513 micrometer [255‐780]. At one month, 47.5% of eyes had more than three line gains and the mean CRT was 286 µm. Only two eyes had an IOP increase (&gt;25 mmHg). However, at six months, only 17% of eyes had more than three line gains and the mean CRT was 380 µm. IOP remained uncontrolled with medication in one eye.Conclusion The dexamethasone intravitreal implant reduces macular edema and improves visual acuity in patients with either branch retinal vein occlusions or central retinal vein occlusions. However, this efficacy remains transient. A retreament with a dex. implant is necessary for most of the patients.

Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion

To compare cytokines in undiluted vitreous of treatment-naïve patients with macular oedema without vitreomacular traction secondary to branch (BRVO), central (CRVO) and hemi-central (H-CRVO) retinal vein occlusion. Ninety-four patients (median age 72 years, 42 men) underwent an intravitreal combination therapy, including a single-site 23-gauge core vitrectomy and the application of bevacizumab and dexamethasone due to vision-decreasing macular oedema. Among these were 43 patients with BRVO, 35 with CRVO and 16 patients with hemi-CRVO, which were distributed in a fresh or old retinal vein occlusion type (seven or more months after onset). Undiluted vitreous samples were analysed for interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF-A) with cytometric BEAD assay. Vitreous samples from patients with idiopathic epiretinal membrane served as controls (n = 14). The mean cytokine values were highest in the CRVO group with IL-6 = 64.7 pg/ml (SD ± 115.8), MCP-1 = 1015.8 pg/ml (±970.1) and VEGF-A = 278.4 pg/ml (±512.8), followed by the H-CRVO group with IL-6 = 59.9 pg/ml (SD ± 97.5), MCP-1 = 938.8 pg/ml (±561.1) and VEGF-A = 211.5 pg/ml (±232.4). The BRVO group had IL-6 = 23.2 pg/ml (SD ± 48.8), MCP-1 = 602.6 g/ml (±490.3) and VEGF-A = 161.8 pg/ml (±314.4). The values of MCP-1 and VEGF-A were significantly different for CRVO or H-CRVO versus BRVO. All values were significantly higher than in the control samples, which had 6.2 ± 3.4 pg/ml (IL-6), 253 ± 74 pg/ml (MCP-1) and 7 ± 4.9 pg/ml (VEGF-A). Within the old RVO type, only MCP-1 was significantly different for CRVO or H-CRVO versus BRVO. Both inflammatory markers and VEGF-A were higher in CRVO and H-CRVO than in BRVO undiluted vitreous samples. It seems that monocyte recruitment to the vessel wall, which might underlie the importance of eosinophils in tissue remodelling after RVO, is of special interest owing to the significant difference in MCP-1 in the older RVO types.

Impact of Intravitreal Injection of Tissue Plasminogen Activator on Full-Field Electroretinogram in Patients with Macular Oedema Secondary to Retinal Vein Occlusion

Purpose: To evaluate the retinal toxicity of intravitreal tissue plasminogen activator (tPA) injection for branch and central retinal vein occlusion (BRVO and CRVO) using the electroretinogram (ERG). Procedures: Ten BRVO patients and 5 CRVO patients were enrolled. A complete examination including full-field ERG, visual acuity, central retinal thickness (CRT), and evaluation of systemic and ocular complications was performed before and after intravitreal tPA injection. Results: No significant differences were found in the amplitude or implicit time of any ERG component after tPA injection, and no systemic or ocular complication was observed. The improvement of visual acuity was significant at month 3 in the BRVO group (p < 0.05) but not in the CRVO group. CRT significantly decreased over the course of 3 months in both groups (p < 0.01). Conclusion: Intravitreal tPA injection seems to be a safe and effective treatment option for macular oedema caused by retinal vein occlusions.

The vitreomacular interface in retinal vein occlusion

To evaluate the posterior vitreous adhesion status in patients with a history of central or branch retinal vein occlusion and to compare the results with the natural time-course of posterior vitreous detachment in healthy age-related controls. A retrospective chart review in terms of the posterior vitreous adhesion status was performed in 132 patients (133 eyes) with a history of a central (CRVO) or branch (BRVO) retinal vein occlusion. All patients underwent vitrectomy. Based on the operation reports, the vitreous adhesion status was classified as attached, partially detached or completely detached. The results were compared to the natural time-course of posterior vitreous detachment development in healthy age-related controls. Eighty-one eyes met the inclusion and exclusion criteria. Fifty-two eyes (64%) had a history of CRVO and 29 eyes (36%) a history of BRVO, respectively. In the CRVO group, the posterior vitreous was attached in 47 eyes (90%) and completely detached in five eyes (10%). In the BRVO group, the posterior vitreous was attached in 27 eyes (93%), partially detached in 1 eye (3%) and completely detached in another eye (3%). A subdivision into age classes and a comparison with healthy age-related controls [data by Weber-Krause & Eckardt (1997) Ophthalmologe, 94, 619-623] showed in patients between 65 and 69 years of age an attached posterior vitreous cortex in 72% in healthy eyes, in 100% in CRVO (p = 0.109) and in 89% in BRVO (p = 0.440), in patients between 70 and 79 years of age an attached posterior vitreous cortex in 56% in healthy eyes, in 86% in CRVO (p = 0.010) and in 100% in BRVO (p = 0.038) and in patients between 80 and 89 years of age an attached posterior vitreous cortex in 43% in healthy eyes, in 100% in CRVO (p = 0.191) and in 67% in BRVO (p = 0.582) (Fisher's exact t-test). In patients with a history of CRVO or BRVO, the posterior vitreous cortex stays attached more frequently in all age groups in comparison with the healthy age-related controls.

590 Injections intravitréennes de Bevacizumab (Avastin ®) dans le traitment de occlusions veineuses (OVCR+ OBVR)

To evaluate the effect of intravitreal bevacizumab (Avastin ® ) injections on visual acuity and foveal retinal thickness in patients with central and branch retinal vein occlusion (CRVO et BRVO). Retrospective consecutiveinterventional case series of 60 patients diagnosed with macular edema from CRVO et BRVO who received repeated intravitreal injections (1.25 mg) of bevacizumab. Main outcome measures were visual acuity and optical coherence tomography measurements in a 6-month follow-up period. Mean visual acuity improved from baseline at the 6-month follow-up. Mean central retinal thickness decreased from baseline at the 6-month follow-up. CRVO group was associated with significantly lower visual acuity than BRVO group. However, visual acuity gain was similar in both groups. Independent of duration of symptoms, Duration of treatment effect following an injection appears to be limited for most patients. No ocular or systemic adverse reactions were noted. Intravitreal injection of bevacizumab appears to be a new treatment option for patients with macular edema secondary to CRVO and BRVO. Intravitreal injection of bevacizumab appears to be a new treatment option for patients with macular edema secondary to CRVO and BRVO.

Relationship Between Blood-Aqueous Barrier Disruption and Ischemic Macular Edema in Patients with Branch or Central Retinal Vein Occlusion: Effects of Sub-Tenon Triamcinolone Acetonide Injection

The aim of this study was to study the effects of the sub-Tenon triamcinolone acetonide (STA) injection on ischemic cystoid macular edema (CME) or macular edema (ME) and blood-aqueous barrier (BAB) disruption associated with branch or central retinal vein occlusion (BRVO or CRVO). Prior to, and 1, 2, 3, and 4 months after, STA injection, central retinal thickness was measured by using optical coherence tomography and the amount of aqueous flare by using laser flare metry. In the BRVO group treated by STA, the amount of flare was significantly less at 1, 2, and 3 months after injection than in the untreated BRVO group (P < 0.05). In the CRVO group treated by STA, the amount was significantly less at 1 month after injection than in the untreated CRVO group (P < 0.05). In the BRVO group with STA treatment, central retinal thickness was significantly less at 1 and 2 months after the treatment than in the untreated BRVO group (P < 0.05). In the CRVO group with STA treatment, the thickness was significantly less at 1 month after treatment than in the untreated CRVO group (P < 0.05). A correlation test revealed the amount of aqueous flare and the central retinal thickness to be well correlated (P < 0.01). The effects of STA and its time course on CME or ME correlated well with those on BAB disruption. Since there is the close correlation between the BAB and blood-retinal barrier function, the effects of medical treatment on ME associated with BRVO or CRVO can be evaluated by means of the BAB function.