Retinal Vein Occlusion-related Macular Edema Research Articles

Real-life study on dexamethasone intravitreal implant (Ozurdex) for macular edema at a Colombian reference center

ABSTRACT Purpose To evaluate the real-life safety, morphological, and visual outcomes of the dexamethasone intravitreal implant (Ozurdex) in patients with macular edema (ME) within a low-middle-income country (LMIC) setting. Methods Patients with ME who received Ozurdex injections between 2012 and 2018 were included. Central retinal thickness (CRT), best-corrected visual acuity (BCVA), lens status, and intraocular pressure (IOP) at baseline and last follow-up were compared. Univariate and multivariate analyses identified factors associated with visual improvement. Results 154 patients were enrolled. Diabetic ME was the most common etiology (32.4%), followed by central retinal vein occlusion (18.8%), branch retinal vein occlusion (14.2%), and uveitis (9.99%). CRT was significantly reduced in all patients except those with uveitis but did not correlate with BCVA improvement. Lower baseline visual acuity (OR=1.67), younger age (OR=1.87), and ME secondary to branch retinal vein occlusion (OR=1.34) were associated with BCVA improvement (p < 0.05). During follow-up, 11 patients (7.14%) developed cataracts, and 22 (14.2%) showed increased IOP; these complications resolved without affecting final BCVA improvement. Conclusion In an LMIC setting, Ozurdex effectively reduces CRT in diabetic and retinal vein occlusion-related ME but not in uveitis. BCVA improvement depends on factors beyond CRT reduction. Cataracts and elevated IOP are manageable complications.

Poor response to first intravitreal injection for predicting unfavorable outcomes of retinal vein occlusion related macular edema.

To screen key indicators leading to unfavorable outcomes of retinal vein occlusion related macular edema (RVO-ME) within long-term follow-up duration and to evaluate their predictive values. A study involving patients with RVO-ME was conducted between April 2021 and September 2022. All eligible patients were divided into two groups (favorable and unfavorable group) according to their final best corrected visual acuity (BCVA) and whether neovascular glaucoma (NVG) occurred. The unfavorable group was further divided into subgroups 1 (with BCVA of ≥ 20/400 and < 20/60 and without NVG) and 2 (blindness group, with BCVA of < 20/400 or with NVG). Demographic, past medical history, ocular characteristics and blood parameters were compared between the groups. A total of 73 eyes from 73 Chinese Han patients (34 males vs. 39 females) with RVO-ME were enrolled. In multivariable regression analysis of continuous variables for unfavorable results, 1-month BCVA after the first intravitreal injection (IVI) was an independent risk factor (odds ratios (ORs) = 2.313, 95% confidence interval (CI) 1.387-3.858, P = 0.001). The area under the curve (AUC) of 1-month BCVA after the first IVI for predicting low vision and blindness was 0.948 (95% CI 0.859-1.000, P < .001) and 0.892 (95% CI 0.744-1.000, P < .001), with a cut-off value of 0.65 logarithm of the minimum angle of resolution (log MAR) (Snellen 20/90) and 1.15 log MAR (Snellen 20/300), respectively. The most valuable indicator for predicting low vision and blindness was poor 1-month BCVA after first IVI compared with favorable group.

Longer-Term Anti-VEGF Therapy Outcomes in Neovascular Age-Related Macular Degeneration, Diabetic Macular Edema, and Vein Occlusion-Related Macular Edema: Clinical Outcomes in 130 247 Eyes

The clinical practice visual acuity (VA) outcomes of anti-VEGF therapy for up to 5 years were assessed in patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), branch retinal vein occlusion-related macular edema (BRVO-ME), and central retinal vein occlusion-related macular edema (CRVO-ME). A retrospective analysis was performed using the Vestrum Health Retina Database. Treatment-naive patients with nAMD, DME, BRVO-ME, or CRVO-ME who received anti-VEGF injections between 2014 and 2019 and had follow-up data for ≥12 months. Data on age, sex, the number of anti-VEGF treatments, and VA were analyzed. Mean VA change up to 3 years (BRVO-ME and CRVO-ME) and 5 years (nAMD and DME). At 1, 3, and 5 years, in 67 666, 21 305, and 5208 eyes with nAMD, after a mean of 7.6, 19.5, and 32 injections, there was a mean change of+3.1,-0.2, and-2.2 letters, respectively. At 1, 3, and 5 years, in 40 832, 7728, and 1192 eyes with DME, after a mean of 6.2, 15.4, and 26.0 injections, there was a mean change of+4.7,+3.3, and+3.1 letters, respectively. At 1 and 3 years, in 12 451 and 3027 eyes with BRVO-ME, after a mean of 7.1 and 18.2 injections, there was a mean change of+9.5 and+7.7 letters, respectively. At 1 and 3 years, in 9298 and 2264 eyes with CRVO-ME, after a mean of 7.3 and 18.8 injections, there was a mean change of+8.3 and+6.0 letters, respectively (P < 0.01 for all VA changes of > 1 letter). In all 4 conditions, the mean VA increased with the mean number of anti-VEGF injections, eyes with a baseline VA of 20/40 or better tended to lose VA, and eyes with progressively worse baseline VA experienced a progressively greater VA gain at 3 years. In practice, patients with nAMD, DME, BRVO-ME, and CRVO-ME showed limited visual outcomes, with patients with nAMD tending to lose VA at 3 and 5 years. Across all 4 disorders, the mean change in VA correlated with treatment intensity at 1, 3, and 5 years. Patients with better baseline VA are more vulnerable to vision loss.

Changes in metamorphopsia after the treat-and-extend regimen of anti-VEGF therapy for macular edema associated with branch retinal vein occlusion.

This study aims to investigate the changes in metamorphopsia after administering the treat-and-extend regimen of anti-vascular endothelial growth factor therapy for branch retinal vein occlusion-associated macular edema. We retrospectively examined 27 patients (27 eyes) with macula edema due to branch retinal vein occlusion who received intravitreal injections of anti-vascular endothelial growth factor agents using the treat-and-extend regimen for ≥18 months. We evaluated best-corrected visual acuity, central macular thickness, macular edema recurrence, and amount of metamorphopsia quantified by M-CHARTS. The best-corrected visual acuity (logarithm of minimum angle of resolution) and central macular thickness significantly improved at 18 months compared to baseline, the median value (interquartile range [IQR]), 0.30 (0.15–0.52) and 459 (373–542) μm at baseline, and 0 (-0.08–0.16) and 267 (232–306) μm at 18 months. The M-CHARTS score (the mean of vertical and horizontal scores) significantly decreased at 1, 6, and 12 months compared to baseline, but worsened at 18 month, the median value (IQR), 0.45 (0.250–0.925), 0.4 (0.15–0.70), 0.4 (0.150–0.625), 0.4 (0.225–0.550) and 0.45 (0.225–0.750) at baseline, 1 month, 6 months, 12 months and 18 months, respectively. The median cumulative number of macular edema recurrences was 2 (IQR, 0.5–3.0) at 18 months. Simple linear regression and multivariate analyses revealed that the change in the mean M-CHARTS score at 18 months was significantly correlated with the baseline score and the cumulative number of macular edema recurrences. Anti-vascular endothelial growth factor therapy using the treat-and-extend regimen improved metamorphopsia in branch retinal vein occlusion-related macular edema in the short to mid-term follow-up period, but not in the long term. Macular edema recurrence may be associated with persistent metamorphopsia.

Long-Term Follow-Up Changes of Central Choroidal Thickness Thinning after Repeated Anti-VEGF Therapy Injections in Patients with Central Retinal Vein Occlusion-Related Macular Edema with Systemic Hypertension

Purpose: We investigated the thinning of central choroidal thickness (CCT) following intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs to treat central retinal vein occlusion (CRVO)-related macular edema in patients with and without systemic hypertension (HT) to assess the influence of repeated anti-VEGF therapy and HT on the choroid in CRVO eyes. Methods: We conducted a retrospective study involving 27 patients with CRVO-related macular edema from January 2014 to July 2017, with follow-ups exceeding 18 months. Visual acuity (VA), central retinal thickness (CRT), and CCT were evaluated before and after initial anti-VEGF drug treatment during follow-up. Results: The mean follow-up period was 35.2 months. Seventeen (63.0%) patients had HT. At 1 month after treatment, VA had improved in 21 (77.8%) patients, and CRT had decreased in 25 (92.6%). At the final visit, 22 (81.5%) showed improved VA, 19 (70.4%) had resolved macular edema, and the CCT had gradually become thinner with additional drug injections in all the patients. Furthermore, the mean CCT in HT patients (209.0 µm) was significantly lower than in non-HT patients (256.1 µm), and the mean injections were 7.8 and 5.3, respectively (p = 0.2067). Conclusion: The CCTs were thinner in eyes with HT than in eyes without HT both before and after the repeated anti-VEGF injections.

Comparison between Ozurdex and intravitreal anti-vascular endothelial growth factor treatment for retinal vein occlusion-related macular edema: A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatments for macular edema (ME) secondary to retinal vein occlusion (RVO), central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO). The electronic databases comprehensively searched for the studies that compared DEX with anti-VEGF treatments in patients suffering from RVO-related ME. The effectiveness was estimated using best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). All data were analyzed by Review Manager (RevMan) 5.3. According to the meta-analysis from five randomized control trials, both DEX implant and anti-VEGF agent treatments were effective, but no significant differences in BCVA and CRT were observed between these two treatments. Novartis’ two studies indicated that anti-VEGF agents significantly reduced the CRT compared with DEX implant at 6 months [weighted mean difference: 158.53 μm, 95% confidence interval (CI): (71.09, 245.96), P = 0.0004]. Furthermore, anti-VEGF agents showed some advantages on cataract formation [risk ratio (RR): 3.43, 95% CI: (1.35, 8.71), P = 0.009] and other adverse events [RR: 1.19, 95% CI: (1.09, 1.31), P = 0.0002] without heterogeneity (P = 0.20, I2 = 35%). Anti-VEGF agents were also effective treatments for cataract formation or less adverse events for RVO-related ME. In contrast, DEX implant had higher risk for IOP elevation and lower cataract incidence than anti-VEGF agents. Hence, complementary and alternative treatments are expected.

The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario.

Purpose:This study evaluated the effect of intravitreal dexamethasone implant (IDI; Ozurdex) injection for treating macular edema in patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).Methods:This prospective study included 40 eyes of 40 patients with nonischemic BRVO and 31 eyes of 31 patients with nonischemic CRVO who received IDI injection as the first-line treatment for macular edema. The best-corrected visual acuity (BCVA) value before and after the treatment; intraocular pressure; optic coherence tomography findings; and all ocular examination findings, including central foveal thickness (CFT) measurement and fluorescein angiography findings, were evaluated for each patient.Results:After the IDI injection, BCVA value increased (P < 0.001) and CFT value decreased (P < 0.001) in both groups. The recurrence rates of CFT elevation after the first and the second Ozurdex injections were 65.0% and 65.3%, respectively, in patients with BRVO and 70.9% and 68.1%, respectively, in patients with CRVO. A statistically significant correlation was observed between preinjection CFT value and postinjection recurrence of CFT elevation (P = 0.017).Conclusion:Treatment with the IDI injections resulted in significant short-term improvement in CFT and BCVA values in patients with clinically significant RVO-related macular edema. Moreover, we observed that high preinjection CFT value was associated with a risk of postinjection recurrence of CFT elevation.

The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema

Objective: To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema.Methods: Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40 mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically.Results: Forty-one eyes of 41 patients with a mean age of 63.49 ± 10.99 (55–86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p < 0.001, p < 0.001 and p = 0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p < 0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case.Conclusion: PSTA application is an effective and safe option in BRVO-related macular edema.

The Outcome of Intravitreal Ranibizumab Injection for Branch Retinal Vein Occlusion Related Macular Edema

Branch retinal vein occlusion related macular edema (BRVO-ME) is the leading cause of visual loss in patients with Branch retinal vein occlusion (BRVO). In the current study, our aim was to investigate the outcome of intravitreal ranibizumab injection for BRVO-ME. The medical records of randomised thirteen eyes of thirteen patients (7 women and 6 men) with BRVO-ME were reviewed retrospectively. Three and 10 eyes had inferior temporal and superior temporal branch retinal vein occlusion-related macular edema, respectively. At the enrollment visit, all patients received a complete ophthalmic examination, including central subfield (CSF) thickness and average cube thickness measurements using spectral-domain optical coherence tomography (SD-OCT), best corrected visual acuity (BCVA) and intraocular pressure (IOP) measurements. The median patient age was 53 years (range, 38-74). Of the patients, median CSF thickness was 453 μ (range, 221-907), median average cube thickness was 293 μ (range, 237-433), median BCVA was 0.30 logMAR unit (range, 0.05-1.00 logMAR unit), and median IOP scores was 18 mmHg (range, 15-25) at baseline. Compared with baseline, a statistical significance in median CSF thickness scores at week 1 (p=0.015), months 1 (p=0.015), 2 (p=0.030), and 3 (p=0.045) was noted. Compared with baseline, a statistical significance in median BCVA scores at months 2 (p=0.045), 3 (p=0.030), and 6 (p=0.045) was noted. Compared with baseline, no statistical significance in median IOP scores and median average cube thickness scores at week 1, months 1, 2, 3, and 6 was noted (p>0.05, for all). No statistical significance in median CSF thickness scores, median BCVA scores, median IOP scores, or median average cube thickness scores was noted between the other follow-up periods. No complication related to ranibizumab injections was detected during the follow-up period. The treatment method does not cause any increase in IOP score. Besides ranibizumab injection can cause a dramatic decrease in CSF thickness scores and a dramatic increase in BCVA scores as early as at week 1 postoperatively.

Survey of intravitreal injection techniques and treatment protocols among retina specialists in Canada

ObjectiveTo describe intravitreal injection (IVI) techniques and treatment protocols by retina specialists in Canada from August 1, 2012, to October 1, 2012. DesignCross-sectional survey. ParticipantsAll fellowship-trained retina specialists across Canada, as identified from the Canadian Ophthalmological Society directory and the Canadian Retina and Vitreous Society directory. MethodsAn anonymous 28-question survey was sent to 125 retina specialists across Canada by email. Reminder letters were sent by email, mail, and fax as necessary. ResultsA total of 75 (63%) retina specialists responded to the survey. Most IVIs were performed in the office. Most surgeons did not use gloves (61%), sterile draping (91%), or surgical mask (71%). Antisepsis was used on conjunctiva by 100% and on periocular skin by 48%. Nearly all specialists used a sterile lid speculum (91%). Common anaesthetics included topical proparacaine or lidocaine drops (90%), topical lidocaine gel (25%), topical pledget (23%), and subconjunctival lidocaine injections (23%). Most (83%) dilate the pupil before IVI. Prophylactic topical antibiotics were used by 43%; 50% of these were started immediately after IVI. Injection location was estimated by visualization by 45%. A majority (63%) inject inferotemporally. Anterior chamber paracentesis was performed routinely by 5%. Optic nerve perfusion was formally assessed by 48%. The most common treatment protocol for age-related macular degeneration was treat and extend. For both diabetic and retinal vein occlusion–related macular edema, the most common protocol was 3 initial monthly injections with PRN follow-up. ConclusionsA wide variety of IVI practice patterns exist in terms of aseptic technique, anaesthetics, prophylactic antibiotics, postinjection monitoring, and treatment protocol.

IMPACT OF INTRAVITREAL DEXAMETHASONE IMPLANT (OZURDEX) ON MACULAR MORPHOLOGY AND FUNCTION

To investigate the impact of intravitreal dexamethasone implant (Ozurdex) on macular morphology and function in eyes with macular edema secondary to central retinal vein occlusion. Twelve treatment-naive patients with decreased visual acuity because of central retinal vein occlusion-related macular edema were enrolled in this prospective uncontrolled study. Patients were treated with intravitreal Ozurdex and followed up at 1 month and 3 months for the evaluation of morphologic and functional outcomes, by means of best-corrected visual acuity, microperimetry, multifocal electroretinography, and customized high-resolution enhanced depth imaging spectral-domain optical coherence tomography scans. Twelve eyes of 12 patients (10 men, 2 women; mean age 56.2 ± 13.0 years) were included for analysis. At 1 month, mean best-corrected visual acuity, retinal sensitivity (microperimetry), multifocal electroretinography parameters, central macular thickness, and specific neurosensorial retinal measurements improved significantly. We found a significant negative correlation between retinal sensitivity and central macular thickness at 1 month and 3 months (r = -0.831, P = 0.001; r = -0.881, P = 0.001; respectively). Moreover, retinal sensitivity was negatively related to both outer and inner retinal thickness in all four intervals from the fovea. From baseline to Month 1, change in outer retinal thickness was positively related to multifocal electroretinography N1R1 amplitude change (r = 0.698, P = 0.012), whereas change in central macular thickness was negatively related to multifocal electroretinography P1R1 amplitude change (r = -0.701, P = 0.011). At 3 months, improvement of mean retinal sensitivity and central macular thickness slightly decreased. In eyes with macular edema secondary to central retinal vein occlusion, intravitreal dexamethasone provides functional benefits that correlate well with ultrastructural macular changes.

INTRAVITREAL RANIBIZUMAB (LUCENTIS) FOR BRANCH RETINAL VEIN OCCLUSION-INDUCED MACULAR EDEMA

The purpose of this study was to evaluate the effect of individualized repeated intravitreal injections of ranibizumab (Lucentis, Genentech, South San Francisco, CA) on visual acuity and central foveal thickness (CFT) for branch retinal vein occlusion-induced macular edema. This study was a prospective interventional case series. Twenty-eight eyes of 28 consecutive patients diagnosed with branch retinal vein occlusion-related macular edema treated with repeated intravitreal injections of ranibizumab (when CFT was >225 microm) were evaluated. Optical coherence tomography and fluorescein angiography were performed monthly. The mean best-corrected distance visual acuity improved from 62.67 Early Treatment of Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution = 0.74 +/- 0.28 [mean +/- standard deviation]) at baseline to 76.8 Early Treatment of Diabetic Retinopathy Study letters (logarithm of the minimum angle of resolution = 0.49 +/- 0.3; statistically significant, P < 0.001) at the end of the follow-up (9 months). The mean letter gain (including the patients with stable and worse visual acuities) was 14.3 letters (2.9 lines). During the same period, 22 of the 28 eyes (78.6%) showed improved visual acuity, 4 (14.2%) had stable visual acuity, and 2 (7.14%) had worse visual acuity compared with baseline. The mean CFT improved from 349 +/- 112 microm at baseline to 229 +/- 44 microm (significant, P < 0.001) at the end of follow-up. A mean of six injections was performed during the follow-up period. Our subgroup analysis indicated that patients with worse visual acuity at presentation (<or=50 letters in our series) showed greater visual benefit from treatment. "Rebound" macular edema was observed in 5 patients (17.85%) at the 3-month follow-up visit and in none at the 6- and 9-month follow-ups. In 18 of the 28 patients (53.6%), the CFT was <225 microm at the last follow-up visit, and therefore, further treatment was not instituted. No ocular or systemic side effects were noted. Individualized repeated intravitreal injections of ranibizumab showed promising short-term results in visual acuity improvement and decrease in CFT in patients with macular edema associated with branch retinal vein occlusion. Further studies are needed to prove the long-term effect of ranibizumab treatment on patients with branch retinal vein occlusion.

Treatment of Central Retinal Vein Occlusion-Related Macular Edema with Intravitreal Bevacizumab (Avastin®): Preliminary Results

To assess the safety and efficacy of treatment of macular edema secondary to central retinal vein occlusion (CRVO) with intravitreal bevacizumab. The ongoing prospective study included 8 consecutive patients (8 eyes) with macular edema secondary to CRVO (6 non ischemic and 2 ischemic), treated with intravitreal injection of 1.25 mg (0.05 mL) of bevacizumab. Main outcome was best corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by optical coherence tomography monthly during one year. Retreatment criteria include decrease of BCVA, persistence of macular edema on angiograms and increase of CFT. Mean age of the eight patients was 68 years (range: 50-82 years). Mean duration of symptoms before injection was 98 days (range: 3-289). Mean follow-up was 3.25 months. At baseline, mean BCVA was 0.84 logMar and mean baseline CFT was 771 microm. Mean BCVA was 0.36 and mean CFT thickness was 275 microm (n = 8) at month 1, 0.41 and 411 microm at month 2 (n = 7), 0.3 and 344 microm at month 3 (n = 6), 0.3 and 397 microm at month 4 (n = 5), respectively. In 75 % of patients, a single injection was not sufficient, and retreatment needed. No serious adverse events were observed. Treatment of macular edema secondary to CRVO with intravitreal bevacizumab injection of 1.25 mg was well tolerated and associated with marked macular thickness reduction and BCVA improvement in all patients. A trend towards reduction of foveal thickness and improvement of visual acuity was observed in both acute and chronic CRVO.