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H. Yamada, J. NIkaido, T. Ishiguro, K. Takahashi, E. Yamada; Comparison of Treatment Methods in Branch Retinal Vein Occlusion Accompanied With Macula Edema. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5392.
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Branch retinal vein occlusion (BVO) sometimes accompanies macula edema and leads to a non-reversible decrease in vision. Although several therapeutic approaches have been explored, it is not clear which therapy produces the best visual outcome. In the current study, we investigated the course of BVO accompanied with macular edema (ME) and compared treatment efficacy.
We studied patients who consulted the Kansai Medical University Hirakata Hospital between January, 2006 and July, 2008. We limited our study to those patients who had BVOME and were followed for at least 3 months after the initial visit. We only included freshly occurred cases of BVO. From a total of 598 BVO patients, 82 cases matched the criteria. Mean age of the included patients was 68.4 years and the mean follow-up term was 10.2 months.We examined the clinical records of included patients retrospectively and divided the patients into three groups. Group 1 is patients who received no treatment (n=20). Patients assigned to group 2 were those who received sub-Tennon triamcinolone injections or retinal laser photocoagulation (n=34). Group 3 is patients who underwent vitrectomy with internal limiting membrane peeling (n=28). For all three groups, we compared the patients' vision at initial examination, just before intervention, and at final examination.
In group 1, 13 eyes out of 20 (65%) improved vision spontaneously. Within group comparisons of vision before and after treatment showed no reliable difference for either group 1 (p=0.0531) or group 2 (p=0.47). Patients in group 3 had significantly improved vision after treatment (p=0.0001, paired t-test). However, there was no significant difference in visual improvement between the 3 groups (ANOVA). In contrast, the ratio of the vision dropped at final examination was statistically worse in group 1 and 2 than group 3 (p=0.0213, chi-square test).
Although vision spontaneously improved in many cases of BVOME without intervention, the untreated patients also had a worse ratio of vision at final exam. Only the vitrectomy group showed a significant improvement in vision. We suggest that vitrectomy is the most beneficial treatment for improving vision in BVOME.
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