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Mariana Lopes, Connie Chen, Voraporn Chaikitmongkol, Yulia Wolfson, Susan Bressler, Neil Bressler; Impact of Anti-VEGF Therapy on Visual Impairment from Macular Edema Due to Branch Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1127.
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Until recently, observation or grid laser treatment was the standard care for macular edema (ME) due to a branch retinal vein occlusion (BRVO). Recently, several randomized clinical trials demonstrated that treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy was superior to observation or grid laser for the treatment of ME due to BRVO. This study evaluates the magnitude of the impact of anti-VEGF therapy on visual impairment from ME due to BRVO to estimate its potential impact in a clinical setting.
A retrospective cohort study of patients with ME due to BRVO from 2002 to 2004 and from 2006 to 2011 was identified from patient records of 2 retina specialists at a university-based clinic (SBB and NMB). Eligibility included ME in one or both eyes from BRVO and treatment with grid laser from 2002 to 2004 or anti-VEGF therapy from 2006 to 2011. Those patients with less than 6 months of follow-up were excluded.
A total of 12 eyes (12 patients) from 2002 to 2004 and 16 eyes (16 patients) from 2006 to 2011 with BRVO were included. Among the 12 patients from 2002 to 2004 receiving laser for ME, 3 eyes (25%) had at least mild visual impairment (worse than 20/40 in the better-seeing eye) including 1 eye (8%) with at least moderate visual impairment (worse than 20/80 in the better-seeing eye) at presentation. At the 6-month follow-up for this cohort, 4 eyes (33%) had at least mild visual impairment, and all 4 eyes (33%) had at least moderate visual impairment, although none were legally blind (20/200 or worse in the better-seeing eye). Among the 16 patients in 2006 to 2011 receiving anti-VEGF therapy for macular edema, 3 (19%) had at least mild visual impairment, including 2 eyes (13%) with at least moderate visual impairment. At the 6-month follow-up for this cohort, 3 eyes (19%) had at least mild visual impairment, and only 1 eye (6%) had at least moderate visual impairment, and none were legally blind.
Although there are several limitations to this study inherent to its retrospective design, the conclusions provide evidence that the prevalence of at least moderate visual impairment due to ME from BRVO may be declining among people in the era of anti-VEGF therapy.
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