June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Combined intravitreal anti-vascular endothelial growth factor and grid macular laser for macular edema due to branch retinal vein occlusion
Author Affiliations & Notes
  • Grishma Bharucha
    Ophthalmology, Virginia Commonwealth University, Richmond, VA
  • Puneet Singh Braich
    Ophthalmology, Virginia Commonwealth University, Richmond, VA
  • Vikram Brar
    Ophthalmology, Virginia Commonwealth University, Richmond, VA
  • Footnotes
    Commercial Relationships Grishma Bharucha, None; Puneet Braich, None; Vikram Brar, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3746. doi:
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      Grishma Bharucha, Puneet Singh Braich, Vikram Brar; Combined intravitreal anti-vascular endothelial growth factor and grid macular laser for macular edema due to branch retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3746.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

We conducted a retrospective case series to determine whether grid macular laser combined with intravitreal anti-vascular endothelial growth factor (VEGF) injections can achieve visual and anatomic outcomes at 12 months similar to the Ranibizumab for the Treatment of Macular Edema following Branch Retinal Vein Occlusion (BRAVO) trial with fewer total anti-VEGF injections.

 
Methods
 

We identified 16 patients with macular edema after branch retinal vein occlusion (BRVO) or hemiretinal vein occlusion (HRVO) who had received grid macular laser and anti-VEGF therapy. The key exclusion criteria were intraocular corticosteroid use in the study eye within 3 months before day 0 and evidence of any clinically significant diabetic macular edema. The best corrected visual acuity (BCVA), central foveal thickness (CFT), and number of anti-VEGF injections were the main outcome measures.

 
Results
 

The mean number of anti-VEGF injections in our cohort was 3.8 compared with 8.4 in the 0.5 mg arm of the BRAVO trial (p < 0.05). The mean baseline logMAR BCVA in our cohort was 0.91 compared with 0.64 in the BRAVO trial (p < 0.05). The mean final logMAR BCVA in our cohort was 0.56 compared with 0.27 in the BRAVO trial (p < 0.05). The mean change in CFT was -237.5 µm in our cohort and -347.4 µm in the BRAVO trial (p < 0.05).

 
Conclusions
 

Our patient population differs from that of the BRAVO trial with a greater proportion of African American patients (p < 0.05) and women (p < 0.05). We have more patients with poor vision at baseline (BCVA < 20/200): 56% vs. 16% in the BRAVO trial (p < 0.05) and more patients with HRVO classification: 50% vs. 13.2% in the BRAVO trial (p < 0.05). Further, we did not have strict treatment and re-treatment criteria across the different treating physicians, including the type of anti-VEGF agent used. Despite these differences, we demonstrated similar trends in improvement in logMAR BCVA and CFT over 12 months with fewer total anti-VEGF injections. Thus, the use of grid macular laser may decrease the number of anti-VEGF injections required to achieve visual and anatomic outcomes comparable to the current available randomized control trial evidence.  

 
The change from baseline to final BCVA was 39% in our cohort and 58% in the BRAVO trial.
 
The change from baseline to final BCVA was 39% in our cohort and 58% in the BRAVO trial.
 
 
The decrease from baseline to final CFT was 61% in our cohort and 67% in the BRAVO trial.
 
The decrease from baseline to final CFT was 61% in our cohort and 67% in the BRAVO trial.

 
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