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C. Xiao, T. Jayasundera, M. K. Khuthaila, J. Galic, M. Oh, M. Kapusta, J. C. Chen; Intravitreal Injections for Macular Edema From Central Retinal Vein Occlusion: If at First You Don’t Succeed, Do You Try, Try Again?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5130.
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To assess the predictive value of the initial response to intravitreal triamcinolone acetonide (IVTA) or bevacizumab (IVB) injections in long term visual outcome for patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO).
Retrospective chart review of consecutive patients treated with either IVB or IVTA for ME secondary to CRVO. Visual acuity (VA), ophthalmic examination, optical coherence tomography (OCT) and fluorescein angiography (FA) findings were recorded for each patient.
A total of 41 patients were included in the study: 23 had improved VA and 18 had no improvement. VA improvement after the first injection correlates with the final VA improvement (p<0.0001). Amongst all 41 patients, 68% (n=28) improved after the first injection, and 71% (n=20) of these patients had an improvement in their final VA compared to their VA prior to first injection. Of the 13 patients who did not experience improvement in VA after the first injection, only 3 (23%) had an improvement in final VA compared to their pre-injection VA (p = 0.003). Patients presenting with an intermediate VA (20/50 - 20/200) tended to benefit the most from medical intervention (p = 0.08).
Patients showing an initial improvement in VA after the first injection are most likely to benefit from ongoing treatment. Those who fail to respond initially tend not to benefit from additional injections. Patients presenting with an intermediate VA (20/50 - 20/200) tend to benefit the most from medical intervention.
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