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Raafay Sophie, Gulnar Hafiz, Diana V. Do, Quan D. Nguyen, Sharon Solomon, Ingrid Zimmer-Galler, Howard Ying, Adrienne W. Scott, David Baranano, Peter A. Campochiaro; Five-Year Follow Up Of Ranibizumab For Retinal Vein Occlusion: Intermittent Treatment To Control Edema Does Not Prevent Progressive Worsening Of Retinal Nonperfusion. Invest. Ophthalmol. Vis. Sci. 2012;53(14):918.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the long term effect of intermittent treatment with ranibizumab (RBZ) to control macular edema on visual outcome and retinal nonperfusion (RNP) in patients with retinal vein occlusion (RVO).
20 patients with BRVO and 20 patients with CRVO were treated with 3 monthly RBZ injections and then seen every two months and treated with RBZ as needed to control edema. Fluorescein angiograms were done at several time points throughout the 5 years of follow up and RNP was graded.
Of 11 patients with BRVO who completed 5 years of follow up, the amount RNP at baseline was none in one, mild in one, moderate in 3, severe in 3, and ungradable in 3. Two patients showed improvement in RNP at month 3 (M3) and none showed worsening. Between M3 and 5 years, 6 patients showed worsening of RNP causing severe loss of BCVA in 3, and 5 patients showed no change. The peak mean improvement in BCVA was 22.1 letters and the mean improvement at 5 years was 13 letters due primarily to RNP-related loss of BCVA. Of 10 patients with CRVO who completed 5 years of follow up, the amount of RNP at baseline was none in one, mild in 4, moderate in 2, and ungradable in 3. All 6 patients with gradable RNP showed improvement at M3. Between M3 and 5 years, 4 patients showed worsening of RNP causing severe loss of BCVA in 2, and 6 showed no definite change RNP. The peak mean improvement in BCVA was 19.7 letters and the mean improvement at 5 years was 8.4 letters due primarily to RNP-related loss of BCVA.
In patients with RVO, RNP improved or remained unchanged after 3 monthly injections of RBZ, but during 57 months of infrequent injections, several patients showed worsening of RNP and loss of vision. Over the course of 5 years, infrequent treatment with RBZ to control edema may not be sufficient to prevent worsening of RNP and loss of BCVA in some patients.
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