June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Longitudinal Quantification of Retinal Nonperfusion in Eyes with Retinal Vein Occlusion Receiving Ranibizumab With or Without Targeted Peripheral Laser Photocoagulation
Author Affiliations & Notes
  • William Christopher Ou
    Retina Consultants of Houston, Houston, Texas, United States
  • David M Brown
    Retina Consultants of Houston, Houston, Texas, United States
    Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, Texas, United States
  • Charles Clifton Wykoff
    Retina Consultants of Houston, Houston, Texas, United States
    Blanton Eye Institute, Houston Methodist Hospital & Weill Cornell Medical College, Houston, Texas, United States
  • Footnotes
    Commercial Relationships   William Ou, None; David Brown, Alcon/Novartis (F), Alcon/Novartis (C), Allegro (F), Allegro (C), Allergan (F), Allergan (C), Apellis (F), Astellas (F), Clearside Biomedical (F), Clearside Biomedical (C), Genentech/Roche (F), Genentech/Roche (C), Heidelberg Engineering (C), Ohr (F), Ohr (C), Ophthotech (F), Ophthotech (C), OPTOS/Nikon (C), OPTOS/Nikon (P), Regeneron/Bayer (F), Regeneron/Bayer (C), Santen (F), Santen (C), ThromboGenics (F), ThromboGenics (C); Charles Wykoff, Alcon/Novartis (F), Alcon/Novartis (C), Alimera Sciences (C), Allegro Ophthalmics (F), Allergan (R), Allergan (F), Ampio Pharmaceuticals (F), Apellis Pharmaceutical (F), Bayer (F), Clearside Biomedical (F), Clearside Biomedical (C), D.O.R.C. (C), DRCR Network (F), Genentech/Roche (F), Genentech/Roche (C), Iconic Therapeutics (F), ONL Therapeutics (I), ONL Therapeutics (C), Ophthotech (F), Regeneron/Bayer (F), Regeneron/Bayer (C), Regeneron Pharmaceuticals (R), ThromboGenics (F), Tyrogenex (F), Valeant (C)
  • Footnotes
    Support  Research grant from Genentech, Inc., South San Francisco, CA
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1534. doi:
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      William Christopher Ou, David M Brown, Charles Clifton Wykoff; Longitudinal Quantification of Retinal Nonperfusion in Eyes with Retinal Vein Occlusion Receiving Ranibizumab With or Without Targeted Peripheral Laser Photocoagulation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1534.

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

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Abstract

Purpose : Longitudinally quantify posterior retinal nonperfusion (RNP) area over 12 months in eyes with retinal vein occlusion (RVO) receiving ranibizumab treatment with or without targeted peripheral laser photocoagulation in the prospective WAVE trial (NCT01710839). Ranibizumab has been shown to slow the progression of RNP in RVO and may even lead to reperfusion of previously nonperfused retina.

Methods : The WAVE Trial, a 12-month, phase IV, randomized trial, compared ranibizumab plus targeted laser photocoagulation to peripheral areas of RNP (combination therapy, n=24) to ranibizumab alone (monotherapy, n=6) in eyes with pre-proliferative RVO. Wide-field fluorescein angiography (WF-FA) was performed at baseline, months 4, 9 and 12. Eyes were included if they had macroscopic areas with no fluorescein filling in the area of the RVO. Areas of posterior RNP on WF-FA were delineated using Adobe Photoshop CS6. The graded area was defined as the inner and outer subfields of a 16 disc area Early Treatment Diabetic Retinopathy Study grid overlaid on each image. The images were converted to binary masks and RNP was quantified using the Optos AreaMeasurement Tool. The main outcome measure was mean change in posterior RNP area at month 12 (M12).

Results : Twenty eyes had reliable testing at all 4 time points and were included in the main analysis. At baseline, mean posterior RNP areas were 5.04 ± 4.50 mm2 and 8.30 ± 7.25 mm2 in the monotherapy and combination therapy cohorts respectively. At M12, the mean change in RNP area was 0.36 ± 0.80 mm2 in the monotherapy (n=5) cohort and 0.53 ± 1.63 mm2 in the combination therapy (n=15) cohort (P=0.76) yielding final mean RNP areas of 5.40 ± 4.99 mm2 and 8.84 ± 8.50 mm2 respectively. Outcomes were similar when eyes with reliable WF-FA at least at baseline and M12 were included (n=25). Worsening RNP was clearly evident (Figure 1) in some eyes (n=3). No definite areas of reperfusion were observed in any eyes.

Conclusions : Regardless of treatment assignment, the majority of RVO eyes analyzed had stable or slight worsening of RNP area through M12. Some eyes may experience progressive worsening of RNP despite ongoing ranibizumab treatment.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Figure 1. Patient in combination therapy cohort who had clear worsening of nonperfusion through 12 months of follow-up.

Figure 1. Patient in combination therapy cohort who had clear worsening of nonperfusion through 12 months of follow-up.

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