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Mika Hosogi, Yuki Morizane, Shuhei Kimura, Mio Hosokawa, Shinichiro Doi, Fumio Shiraga; Results of treating branch retinal vein occlusion with intravitreal ranibizumab injections for one year using a treat and extend regimen and predictive factors for macula edema . Invest. Ophthalmol. Vis. Sci. 2016;57(12):5360.
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© ARVO (1962-2015); The Authors (2016-present)
The best approach to treating branch retinal vein occlusion (BRVO) with vascular endothelial growth factor inhibitors remains controversial. We evaluated the therapeutic efficacy of intravitreal ranibizumab injection (IVR) for BRVO using a treat and extend (TAE) regimen in a retrospective, observational clinical study and also explored predictive factors for the recurrence of macular edema (ME).
Thirty seven eyes of 37 patients (16 men, 21 women; mean age ± SD: 70.3 ± 12.4 y) newly diagnosed with BRVO were treated with IVR using a TAE regimen for one year. Monthly injections continued until the central retinal thickness (CRT) was ≤ 300 μm, as determined by optical coherence tomography, when the re-treatment interval was extended by 4 weeks, up to a maximum of 12 weeks. If the CRT was > 300 μm, the interval was reduced by 2 weeks. The main outcome measures were changes in the best corrected visual acuity (BCVA) and the CRT and the annual number of IVR injection. We also investigated the predictive factors for the recurrence of ME by assessing prognostic variables, including age, sex, BCVA, CRT, and occlusion site, and the presence of non-perfused areas over 5 optic discs in diameter, serous retinal detachment, and a history of high blood pressure.
After 1 y, the mean BCVA (logarithm of the minimal angle of resolution, log MAR) improved significantly from 0.40 ± 0.33 to 0.09 ± 0.21 (p < 0.0002, paired t-test) and the mean CRT decreased significantly from 443.9 ± 110.2 μm to 270.6 ± 65.8 μm (p < 0.0001, paired t-test). The mean number of IVR injections was 6.0 ± 2.0 per year (range 4 - 12). Edema recurred in 20 cases (64.5%). Predictive factors for the recurrence of ME identified by univariate analyses were a high logMAR BCVA (p = 0.008, Wilcoxon rank-sum test), older age (p = 0.028, Wilcoxon rank-sum test), and occlusion of a major vain (p = 0.001, Fisher’s exact test), which was the only factor also identified by multivariate logistic regression (p = 0.034, odds ratio = 0.009).
A TAE regimen for IVR therapy in BRVO was highly effective in improving and maintaining both BCVA and CRT at 1 year. Patients with major vein occlusions may be at particular risk of recurrence of ME.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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