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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)
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.
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.
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).
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.
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