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Matej Polomsky, Veronica Kon-Jara, Nauman Chaudhry, Travis A. Meredith, Maurice B. Landers, Odette Houghton; Intravitreal Ranibizumab Therapy for Persistent Cystoid Macular Edema secondary to Retinal Vein Occlusions following Standard Bevacizumab Therapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):921.
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To propose Ranibizumab as a rescue therapy for persistent cystoid macular edema (CME) secondary to Retinal Vein Occlusions.
A retrospective chart review. Twenty-five patients with a diagnosis of retinal vein occlusions (RVO) who underwent complete ophthalmological examination, fundus photography, spectral domain optical coherence and fluorescein angiography were studied. Twelve patients that showed a significant residual macular edema despite continuous bevacizumab therapy were selected. Intravitreal injections of 0.5 mg of Ranibizumab were performed as often as needed in a standard sterile fashion.
Eight patients with central retinal vein occlusions (CRVO) and 4 patients with Branch retinal vein occlusion (BRVO) were identified. All patients had at least 6 months of follow up (range of 6-63 months, mean 25.5) with an average of 7.66 intravitreal injections of 1.25 mg of bevacizumab. Before starting treatment with Ranibizumab, mean central macular thickness (CMT) was 675.43 microns and mean visual acuity (VA) was 20/200 (1.00 logMAR). After a mean of 3.9 injections of Ranibizumab, mean CMT decreased to 298.3 microns and VA improved to 20/80 (0.60 logMAR). Two out of the twelve patients did not improve vision, one secondary to a brunescent cataract and the other patient developed ischemic CRVO.
Intravitreal Ranibizumab may be an effective rescue therapy in cases of CME secondary to RVO with a suboptimal or partial response to intravitreal bevacizumab. This appears to be more common in eyes with CRVO. Whether this reduced efficacy is a result of re-packaged bevacizumab is still unknown. Future prospective clinical trials with larger samples sizes are needed to answer this question.
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