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Olga Y. Truneva, Irina V. Davydova, Natalia N. Olunina; Preliminary Results of Combined Anti-VEGF Therapy and Laser Photocoagulation (LPC) in Patients with Retinal Vein Occlusion (RVO): Pilot Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2951.
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© ARVO (1962-2015); The Authors (2016-present)
One of the severe complications of RVO is cystoid macular edema (CME), which challenges the performance of grid LPC. We study the efficacy of combined treatment including retinal LPC and intravitreal injections of ranibizumab on visual acuity (VA) and retinal morphology in patients with RVO-associated CME.
Study included 7 patients (7 eyes) with RVO (2 central RVO and 5 branch RVO), aged 44-54 years. Mean VA was 20/100. Mean±St.D. optical coherent tomography (OCT)-measured central retinal thickness (CRT) was 562.5±96.0µm. Patients were treated with monthly intravitreal injections of ranibizumab 0.5mg followed by panretinal or grid LPC, wavelength 532 nm. Number of injections varied from 2 to 3. LPC was added in 3-4 weeks after the first injection, as the CRT reduced and non-perfusion areas appeared on the fluorescent angiography (FA). Ranibizumab was discontinued when OCT showed resolution of macular cysts and normalization of retinal topography. Patients are followed up with VA, fundoscopy, FA and OCT for 10 months.
In all cases, CME significantly regressed within 2 weeks after the first injection of ranibizumab. CRT at 2-week time point reduced by (Mean±St.D.) 332.6±33.0µm. Mean VA improved to 20/50. All patients noted decreased metamorphopsias and central scotomas. Two patients received LPC 2 weeks after the first injection. Both developed recurrent CME 6-8 weeks after the LPC. Their CME resolved after additional injections of ranibizumab and LPC. The rest 5 patients received three monthly injections of ranibizumab. Their CME improved gradually after each injection and fully resolved after the third injection. LPC in these 5 patients was performed step-by-step as both the CME and the hemorrhages along the main arcades resolved, according to the OCT and FA. At 4-month time point after the last treatment, none of the patients had recurrence of macular edema.
Use of ranibizumab in central and branch RVO results in rapid resolution of CME and recovery of macular topography and provides optimized conditions for the sufficient extent of LPC. In combination, ranibizumab and LPC are effective in achieving better outcomes in VA than LPC alone. Follow up with the patients and new patient recruitment is in progress.
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