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Florian Weisskopf, Christian Pruente, Katja Hatz; Effect of Intravitreal Anti-VEGF Therapy to Retinal Nonperfusion in Patients treated with Lucentis (Ranibizumab) for Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1256.
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Retinal vein occlusions cause severe visual function loss due to macular edema. Off label treatment with intravitreal anti-VEGF injections is nowadays a common therapeutical choice. Despite the efficacy in reducing macular edema we noticed an increase of retinal nonperfusion in the follow up course of these patients. The purpose of this study is to evaluate the possible effect of anti-VEGF therapy to retinal perfusion. The comparison group is taken from the Central Vein Occlusion Study Group (CVOS; Arch Ophthalmol. 1993;111:1087-1095 and 1997;115:486-491).
45 eyes of 45 patients treated with intravitreal injections of LucentisR (Ranibizumab) for Central Vein Occlusion (CVO), Branch Vein Occlusion (BVO) and Hemicentral Vein Occlusion (HCVO) were followed up retrospectively at 4 months and 1 year after baseline imaging. Retinal imaging included fluorescence angiography (FAG; SpectralisTm HRA-OCT). Nonperfusion is defined as an retinal area of > 25mm2 (about 10 disc diameters) with loss of capillary perfusion seen in FAG. Small macular branch occlusions have been excluded.
24 CVO/HCVO and 21 BVO have been included in this study. At baseline we found a rate of 33% of nonperfusion (CVOS 25%), at 4 months 35% and at 1 year 65%. 19% (CVOS 15%) of the initially perfused patients converted to nonperfusion within a 4 months follow up. After 1 year 57% of these initially perfused patients presented nonperfusion compared to only 34% of ischemia after a 3 years follow up in the CVOS. On average 5 injections have been applied until nonperfusion was diagnosed after an average of 325 days.
Despite the difficult comparability of the two populations we could demonstrate a higher conversion rate to nonperfusion under anti-VEGF therapy compared to the natural course of retinal vein occlusion. Further studies have to be done to reasses these results. As most of the nonperfusion developed between 4 months and one year we recommend close follow up exams including FAG in patients treated with anti-VEGF therapy.
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