Alternative ways to optimize treatment for retinal vein occlusion with peripheral
            capillary non-perfusion: a pilot study

Тульцева, С. Н.; Astakhov, Yury S.; Новиков, С. А.; Nechiporenko, P. A.; Lisochkina, Alla B.; Ovnanyan, Andranik Y; Astakhov, Sergei Y

doi:10.5935/0004-2749.20170055

Cited by 5 publications

(7 citation statements)

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“…BCVA was reported in 16studies with a total of 1205 RVO patients before and after treatment, including 941 BRVO patients and 264 CRVO patients (Hayashi et al, 2011;Donati et al, 2012;Farese et al, 2014;Rehak et al, 2014;Pielen et al, 2015;Clark et al, 2016;Tadayoni et al, 2016;Tultseva et al, 2017;Callizo et al, 2019;Cao et al, 2019;Goel et al, 2019;Kumar et al, 2019;Terashima et al, 2019;An and Jeong, 2020;Nourinia et al, 2020;Song et al, 2020).The results of random effect model analysis(p < 0.00001,I 2 = 86%) showed that IVI is not inferior to IVI + LPC(WMD = 0.12,95%CI = -3.54-3.78,p = 0.95),neither in BRVO patients (WMD = -2.01,95%CI = -4.37-0.34,p = 0.09),nor in CRVO patients(WMD = 5.82,95%CI = -3.65-15.29,p = 0.23)(Figure 3). The CMT was described in 17 studies with 1101 RVO patients including 989 BRVO patients and 287 CRVO patients (Hayashi et al, 2011;Donati et al, 2012;Farese et al, 2014;Rehak et al, 2014;Pielen et al, 2015;Chhablani et al, 2016;Clark et al, 2016;Tadayoni et al, 2016;Tultseva et al, 2017;Callizo et al, 2019;Cao et al, 2019;Goel et al, 2019;Kumar et al, 2019;Terashima et al, 2019;Nourinia et al, 2020;Song et al, 2020;Thomley et al, 2021).The fixed effect model analysis(p = 0.27,I 2 = 16%)demonstrated that there was no significant difference in CMT between IVI + LPC group and IVI group(WMD = -4.40,95%CI = -21.33-12.53,p = 0.61),whether in BRVO patients p = 0.84) or in CRVO patients(WMD = -21.72,95%CI = -68.89-25.45,p = 0.37)(Figure <...…”

Section: Results Of Meta-analysismentioning

confidence: 99%

“…The number of injections was recorded in 11 studies with 419 RVO patients including 329 BRVO patients and 265 CRVO patients (Donati et al, 2012;Farese et al, 2014;Chhablani et al, 2016;Tomomatsu et al, 2016;Tultseva et al, 2017;Callizo et al, 2019;Goel et al, 2019;Terashima et al, 2019;An and Jeong, 2020;Nourinia et al, 2020;Thomley et al, 2021).The results of the random effect model analysis(p < 0.00001, I 2 = 97%) illustrated that there was no significant difference between the IVI + LPC group and the single IVI group(WMD = -1.14,95% CI = -2.51-0.23, p = 0.10)(Figure 5).…”

Section: Results Of Meta-analysismentioning

confidence: 99%

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Comparison of the efficiency of anti-VEGF drugs intravitreal injections treatment with or without retinal laser photocoagulation for macular edema secondary to retinal vein occlusion: A systematic review and meta-analysis

Zou

et al. 2022

Front. Pharmacol.

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Objective: To compare the efficiency of anti-VEGF drugs intravitreal injections(IVI) treatment with or without retinal laser photocoagulation(LPC) for macular edema(ME) secondary to retinal vein occlusion(RVO).Methods: The randomized controlled trials and retrospective studies including anti-VEGF drug IVI combined with retinal LPC and single IVI in the treatment of macular edema secondary to RVO were collected in PubMed, Medline, Embase, Cochrane Library, and Web of Science. We extracted the main outcome indicators including the best corrected visual acuity (BCVA), central macular thickness(CMT), the number of injections and the progress of retinal non-perfusion areas(NPAs) for systematic evaluation, to observe whether IVI + LPC could be more effective on the prognosis of RVO. We use Review Manager 5.4 statistical software to analyze the dataResults: 527 articles were initially retrieved. We included 20 studies, with a total of 1387 patients who were divided into the combination(IVI + LPC) treatment group and the single IVI group. All the patients completed the ocular examination including BCVA, slit-lamp test, fundus examination and Optical Coherence Tomography(OCT) test before and after each treatment. There was no statistical difference between the combination treatment group and single IVI group on BCVA(WMD = 0.12,95%CI = -3.54–3.78,p = 0.95),CMT(WMD = -4.40,95%CI = -21.33–12.53,p = 0.61) and NPAs(WMD = 0.01,95%CI = -0.28–0.30,p = 0.94).However, the number of IVI was decreased significantly in the combination treatment group in BRVO patients, compared to that in the single IVI group(WMD = -0.69,95%CI = -1.18∼-0.21,p = 0.005).Conclusion: In the treatment of RVO patients with macular edema, the combination of IVI and retinal LPC neither improves BCVA nor reduces CMT significantly compared with the single IVI treatment. However, the combination treatment can decrease the number of intravitreal injections in patients with BRVO, while it is not observed in CRVO patients.

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Section: Results Of Meta-analysismentioning

confidence: 99%

Section: Results Of Meta-analysismentioning

confidence: 99%

Comparison of the efficiency of anti-VEGF drugs intravitreal injections treatment with or without retinal laser photocoagulation for macular edema secondary to retinal vein occlusion: A systematic review and meta-analysis

Zou

et al. 2022

Front. Pharmacol.

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“…Although anti-VEGF therapy is superior and remains the mainstay therapy for resolving fovea-involving MO, its limitation is the short-lived effect and the ability to have an effect on retinal ischaemia remains unknown; hence progression to neovascularisation or end-stage NVG complications is a high possibility with anti-VEGF therapy alone. 15,16 Despite additional laser therapy in our cohort, there was still one patient (1.5%) who developed NVG when missing clinic attendances and treatment plan for a whole year. We are not alone in believing laser as an important adjunctive therapy to stabilize ischaemic RVO disease and to prevent the development of neovascularisation.…”

Section: Neovascular Glaucomamentioning

confidence: 88%

“…The large non-randomised cohort from Tultseva et al compared the efficacy of Ranibizumab and laser (Gp1) versus Ranibizumab alone (Gp2) in RVO patients over 24 months. 16 They also reported a high rate of retinal ischaemia in 74.1% of their whole cohort, and 4.6% progressed to NVG in Gp2 compared to 1.1% in Gp1. They also concluded that the combination therapy of anti-VEGF plus retinal laser therapy had added to the stability of VA (achievable by 5 months) in Gp1 but was highly fluctuating in Gp2.…”

Section: Neovascular Glaucomamentioning

confidence: 90%

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<p>Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice</p>

Horner¹,

Lip²,

Mushtaq³

et al. 2020

OPTH

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To report long-term efficacy and treatment outcomes of the combination therapy for treating macular oedema (MO) in retinal vein occlusions (RVOs) from a real-world UK practice. Methods: The initial reported 66 RVO patients with MO treated with combination therapy (initial Ranibizumab, later optional addition of Ozurdex and laser) were followed up to Year 3: visual acuity (VA) and central retinal thickness (CRT) were analysed against baseline and previous Year 1 results. Safety and adverse events were also recorded. Results: Baseline LogMAR VA of 0.71 (Snellen 6/30) improved to 0.48 (Snellen 6/18) at Year 3 (p=0.006); 63% experienced VA improvement (40% improved ≥3 lines), 27% had worse vision. Stability of mean VA (6/18) was already achieved at first post-loading phase review and was maintained in each subsequent year. Statistically significant CRT improvement was noted in each year (Year 3 median CRT=264µm) compared to baseline (median CRT=531µm). There was a reduction in the mean number of total injections to 2.5 in Year 3 (vs 5.5 in Year 1). Comparing Year 3 against Year 1, mean Ranibizumab injection frequency was 2.1 vs 4.3; mean Ozurdex injection frequency was 0.2 vs 1.1. In Year 3, 39.6% of patients did not require any form of injections, laser frequency was also reduced to 22.9% (vs 81.8% in Year 1). There was no endophthalmitis in the cohort, one progressed to neovascular glaucoma in Year 2 and mortality rate was recorded as 6%. Conclusion: Our real-world clinical practice for RVO patients using a combined therapy is associated with good long-term VA and anatomical outcomes with less intravitreal retreatment rates.

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Peripheral Ischemic Retinal Photocoagulation in Addition to Intravitreal Bevacizumab Versus Intravitreal Bevacizumab Alone for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion

Nourinia

Emamverdi

Ramezani

et al. 2020

Retina

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Purpose: To investigate the effects of peripheral ischemic retinal photocoagulation in addition to intravitreal bevacizumab (IVB) in the treatment of macular edema due to ischemic central retinal vein occlusion. Methods: Forty-eight eyes of 48 treatment-naive patients were randomly selected and divided into 2 groups. Group A comprised 24 eyes that were treated with three consecutive monthly injections of IVB, and Group B comprised 24 eyes that were treated with IVB plus photocoagulation of the peripheral nonperfused retina. Further IVB injections were administered as needed in both groups. Monthly follow-up was conducted for 9 months after the first injection. Results: The data of 46 patients were analyzed. Best-corrected visual acuity changes from the fourth to eighth month follow-up in comparison with the baseline were significantly higher in Group B (P = 0.002–0.044—0.002–0.002—0.012). In addition, significant differences were observed in central macular thickness in Group B throughout the study period (all P < 0.001). Group B required less frequent IVB injections during the 9-month study period. Conclusion: Photocoagulation of the retinal nonperfused area in patients with macular edema because of central retinal vein occlusion might amplify the beneficial effects of IVB on best-corrected visual acuity and central macular thickness and reduce the frequency of IVB injection.

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Alternative ways to optimize treatment for retinal vein occlusion with peripheral capillary non-perfusion: a pilot study

Abstract: The combination of ranibizumab injections and peripheral SLP in capillary non-perfusion areas can significantly decrease the number of injections and reduce neovascular complications.

Cited by 5 publications

References 0 publications

Comparison of the efficiency of anti-VEGF drugs intravitreal injections treatment with or without retinal laser photocoagulation for macular edema secondary to retinal vein occlusion: A systematic review and meta-analysis

Comparison of the efficiency of anti-VEGF drugs intravitreal injections treatment with or without retinal laser photocoagulation for macular edema secondary to retinal vein occlusion: A systematic review and meta-analysis

<p>Combination Therapy for Macular Oedema in Retinal Vein Occlusions: 3-Year Results from a Real-World Clinical Practice</p>

Peripheral Ischemic Retinal Photocoagulation in Addition to Intravitreal Bevacizumab Versus Intravitreal Bevacizumab Alone for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion

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