Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent onset central retinal vein occlusion

Ramezani, Alireza; Esfandiari, Hamed; Entezari, Morteza; Moradian, Siamak; Soheilian, Masoud; Dehsarvi, Babak; Yaseri, Mehdi

doi:10.1111/aos.12317

Cited by 24 publications

(29 citation statements)

References 47 publications

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“…Phakic status and the presence of serous macular detachment were not correlated with the mean reduction of CMT. The mean baseline intraocular pressure (IOP) was 14…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, to understand which pathophysiology plays a dominant role, we compared anti-VEGF and dexamethasone implant treatments for resistant ME secondary to BRVO. Ramezani et al (14) compared intravitreal injections of bevacizumab (IVB) and triamcinolone acetonide (IVT) and reported significant visual improvement in the IVB group compared with the IVT group. This improvement was seen 4 months after the initiation of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Eriş¹

2019

Beyoglu Eye J

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Branch retinal vein occlusion (BRVO) is the second most common type of retinal vascular disorder. Both inflammation and increased vascular endothelial growth factor (VEGF) levels play important roles in the pathogenesis of macular edema (ME) secondary to BRVO. The aim of this study was to compare the efficacy of 0.7-mg intravitreal dexamethasone implants with continued anti-VEGF treatment in patients with ME secondary to BRVO who were poor responders to at least 6 previous anti-VEGF injections. Methods: Patients exhibiting an insufficient response to at least 6 ranibizumab treatments and who subsequently underwent a dexamethasone implant were included Group 1. Patients who were at risk for cataract or glaucoma continued treatment with the same drug and were defined as Group 2. The best corrected visual acuity (BCVA) and central macular thickness (CMT) changes at month 2, 4, and 6 were measured. Results: Ninety eyes were evaluated. In Group 1, the mean baseline BCVA of 0.71±0.75 logarithm of the minimum angle of resolution (logMAR) improved to 0.53±0.62 logMAR at month 2 (p<.001), 0.67±0.72 logMAR at month 4 (p=0.325), and 1.03±0.83 logMAR at month 6 (p=.001). In Group 2, the mean baseline BCVA was 0.73±0.83 logMAR, and improved to 0.68±0.83 logMAR at month 2 (p=0.12), 0.698±0.81 logMAR at month 4 (p=0.270), and 0.76±0.80 at month 6 (p=0.546). The baseline CMT in each group was 588±176 μm and 545±165 μm, respectively (p=0.248). The mean CMT of Group 1 changed from a baseline measurement of 588±176 μm to 308±132 μm at month 2 (p<.001), 450±195 μm at month 4 (p<.001), and 510±190 μm at month 6 (p<.001). The mean CMT of Group 2 changed from a baseline value of 545±165 μm to 486±162 μm at month 2 (p<.001), 516±168 μm at month 4 (p<.001), and 528±171 μm at month 6 (p=0.037). Conclusion: Dexamethasone implants were a more effective treatment for patients with BRVO-related resistant ME than ranibizumab at month 2. However, this positive effect seems to decline rapidly in the long term.

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“…Phakic status and the presence of serous macular detachment were not correlated with the mean reduction of CMT. The mean baseline intraocular pressure (IOP) was 14…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Eriş¹

2019

Beyoglu Eye J

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“…VEGF is the most studied cytokine in the pathogenesis of iRVO (9,32,231,232) and is currently a therapeutic target of RVO treatments (37,38,43,45,46,58,79,128,167,215,243,244,288) . VEGF is an inflammatory, angiogenic and permeability factor produced by many cells, including vascular endothelial cells, pericytes, retinal pigment epithelium (RPE), Muller cells, astrocytes, and retinal ganglion cells (184) .…”

Section: A Vascular Endothelial Growth Factor (Vegf)mentioning

confidence: 99%

“…Two RCTs compared the effects of intravitreal bevacizumab and intravitreal triamcinolone acetonide (IVTA) in patients with macular edema secondary to CRVO (n=86) (244) and BRVO (n=86) (243) . Patients were randomized to receive intravitreal bevacizumab (three monthly injections of 1.25 mg) or intravitreal triamcinolone acetonide (IVTA) (two injections of 2 mg IVTA 2 months apart).…”

Section: Rave (The Rubeosismentioning

confidence: 99%

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Khayat

Williams

Lois

2018

Survey of Ophthalmology

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Retinal vein occlusion (RVO)-including central RVO, branch RVO, and hemicentral and hemispheric RVO-is the second most common vascular cause of visual loss, surpassed only by diabetic retinopathy. The presence and extent of retinal ischemia in RVO is associated with a worse prognosis. On this basis, most previously conducted studies considered ischemic retinal vein occlusion (iRVO) and non-iRVO as separate entities based on set thresholds of existing retinal ischemia as determined by fundus fluorescein angiography. Other diagnostic technologies have been used specifically in the differentiation of ischemic central retinal vein occlusion and nonischemic central retinal vein occlusion. To date, there is no fully accepted definition for iRVO. Some clinicians and researchers may favor establishing a clear differentiation between these forms of RVO; others may prefer not to consider iRVO as a separate entity. Whatever the case, retinal ischemia in RVO confers a higher risk of visual loss and neovascular complications; thus, it should be determined as accurately as possible in patients with this disease and be considered in clinical and experimental studies. Most recently conducted clinical trials evaluating new treatments for macular edema secondary to RVO included none or only few patients with iRVO based on previous definitions (i.e., few patients with sizeable areas of retinal ischemia were recruited in these trials), and thus it is unclear whether the results observed in recruited patients could be extrapolated to those with retinal ischemia. There has been scant research aiming at developing and/or testing treatments for retinal ischemia, as well as to prevent new vessel formation as a result of RVO. We provide a detailed review of the knowledge gathered over the years on iRVO, from controversies on its definition and diagnosis to the understanding of its epidemiology, risk factors and pathogenesis, the structural and functional effects of this disease in the eye and its complications, natural history, and outcomes after treatment. In each section, the definition of iRVO used is given so, independently of whether iRVO is considered a separate clinical entity or a more severe end of the spectrum of RVO, the information will be useful to clinicians to determine patient's risk, guide therapeutic decisions, and counsel patients and for researchers to design future studies.

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“…Bu maddelerin yaş tip yaşa bağlı maküla dejeneresansı (YBMD), diyabetik retinopati (DR) ve retina ven tıkanıklıklarına bağlı makü-la ödemi tedavisinde etkin olduklarını saptayan birçok çalışma yapılmıştır (6)(7)(8)(9)(10). İntravitreal enjeksiyonlarda kullanılan madde ile ilgili olarak ya da uygulama esnasında gözde yapılan manipülasyona bağlı olarak göz içi basıncında (GİB) yükselme, katarakt, endoftalmi, vitreus hemorajisi, retina dekolmanı ve retina damar tıkanıklığı gibi çeşitli göz komplikasyonları bildirilmiştir (11)(12)(13)(14)(15)(16). Ayrıca intravitreal enjeksiyonların ani inme, tromboembolik patolojiler gibi ölüme sebep olabilecek sistemik komplikasyonları da mevcuttur (17).…”

Section: Introductionunclassified

Intravitreal injections and complications

Demir¹,

Akarsu²,

Güven³

et al. 2015

Sisli Etfal

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Amaç: Yapılan intravitreal enjeksiyonların nedenlerini, kullanılan intravitreal ilaçları ve onların komplikasyon oranlarını sunmak Gereç ve Yöntem: Beş yıllık süre diliminde intravitreal enjeksiyon yapılan hastaların kartları geriye dönük olarak incelendi. İntravitreal enjeksiyonların hangi sebeplerle yapıldığı, hangi etken maddenin verildiği, hastaların yaşı, cinsiyeti ve enjeksiyonların komplikasyonları değerlendirildi. İntravitreal enjeksiyonlar ameliyathane şartlarında topikal anestezi altında %5 povidon iyodin konjonktival alana damlatılıp serum fizyolojikle yıkandıktan sonra 27 Gauge (G) iğne ile üst temporal alanda pars planadan vitreus boşluğuna girilerek yapıldı. Bütün enjeksiyonlardan sonra 4x1 dozunda %0.3 ofloksasin damla 1 hafta boyunca kullanıldı. İntravitreal enjeksiyonlarda bevacizumab 1.25-2.5 mg, ranibizumab 0.5 mg, triamsinolon asetonid yalnız kullanıldığında 4 mg ve bevacizumab ile birlikte kullanıldığında 2 mg dozunda kullanıldı. Bulgular: Bu çalışmaya 962 hasta (514 bayan, 448 erkek) alındı. Yaş ortalaması 65±20.3 (18-89) idi. Diyabetik maküla ödemi (DMÖ) için 574 hasta, yaşa bağlı koroid neovaskularizasyonu için 143 hasta, retinal ven kök tıkanıklığı için 47 hasta, retinal ven dal tıkanıklığı için 107 hasta, proliferatif diyabetik retinopati (DR) yalnız veya eşlik eden intraoküler hemoraji için 83 hasta, santral seröz koroidopati için 5 hasta ve yetişkin viteliform dejenerasyonu için 3 hasta olmak üzere toplam 962 hasta intravitreal enjeksiyon tedavisi almıştı. Beş yıllık süre zarfında 962 hastaya 4318 intravitreal injeksiyon yapılmıştı. İntravitreal enjeksiyon'da kullanılan etken maddelerin isimleri ve kullanılma oranları şöyleydi; bevacizumab (%57), ranibizumab (%17), triamsinolon asetonid (%16) ve triamsinolon asetonid+bevacizumab (%10). Sonuçlar: En sık enjeksiyon nedeni DMÖ ve en sık kullanılan etken madde bevacizumab idi. Gelişen en ciddi komplikasyon endoftalmi olup 2 olguda gelişti. Endoftalmi oranı % 0.046 idi. Bir olguda kendiliğinden açılan vitreus içi hemoraji oluştu. Psödoendoftalmi bir olguda triamsinolon enjeksiyonu sonrasında gelişti. Retina dekolmanı izlenmedi. Anahtar kelimeler: Bevacizumab, endoftalmi, intravitreal enjeksiyon, maküla, ranibizumab, triamsinolon asetonid ABSTRACT: Intravitreal injections and complicationsObjective: To report the indications of intravitreal injections, intravitreal drugs used and their complications rate Material and Method: The charts of patients who received intravitreal injection/s for 5 years period were reviewed retrospectively. Indications for intravitreal injections, which drug was used to intravitreally, age and gender of patients, and complications of intravitreal injections were evaluated. All intravitreal injections were performed under topical anesthesia with instillation of 5% povidone iodine and irrigation with saline solution at upper temporal area through the pars plana using 27 gauge needle in the operating room. Ofloxacin 0.3% drop was used 4x1 in all cases for one week. The amount and generic name of drugs used in intravi...

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Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent onset central retinal vein occlusion

Cited by 24 publications

References 47 publications

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion

Intravitreal injections and complications

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