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Olga Rostaqui, Agnès Glacet-Bernard, Nathalie Massamba, Jennyfer Zerbib, Florence Coscas, Gabriel Coscas, Eric Souied; Early treatment with ranibizumab in severe central retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2825.
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Central retinal vein occlusion (CRVO) sometimes results in rapid and severe visual loss, often limited to counting fingers (CF). These forms have a poor prognosis and are excluded from the princeps trials on the treatment of macular edema. This study aims at evaluating the outcome of early treatment with ranibizumab in these particular clinical forms
Retrospective non comparative review of patients treated with ranibizumab and who had a visual acuity of 20/100 or less secondary to CRVO lasting for less than one month. CRVO was initially assessed by angiography and OCT. After a series of 3 intravitreal injections of ranibizumab, patients were monitored monthly for 6 months with measurement of visual acuity, biomicroscopic examination, OCT and, if needed, angiography.
Among the 19 retrospectively selected patients (14 men, mean age, 67 years), CRVO duration was 12 days on average and the vision was initially reduced to CF in 10 patients (53%), between 20/400 and 20/200 in 5 cases and between 20/160 and 20/100 in 4 cases. It was the second involved eye in 4 patients. The mean central retinal thickness was 807 μ initially and 377µ at the end of follow-up. At the end of follow-up, only 2 patients recovered a vision greater than 20/40, 6 had between 20/200 and 20/40, and the majority remained below 20/200 (58%). Fifteen patients (79%) underwent panretinal photocoagulation for extensive retinal peripheral ischemia. In 2 eyes, intravitreal haemorrhage occurred between the 4th and the 6th months.
In this pilot study, early treatment with ranibizumab seemed to slightly improve vision in immediately severe CRVO, usually corresponding to an ischemic form. Angiographic monitoring of the patients is essential to identify peripheral ischemia and to prevent neovascular complications.
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