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Takatoshi Maeno, Ryuya Hashimoto, Kenichirou Asou, Makoto Ubuka, Keisuke Yata, Hidetaka Masahara; Efficacy of combination therapy with arteriovenous sheathotomy without vitrectomy and anti-VEGF injections for BRVO. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4271. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Anti-VEGF is the first-line treatment for macular edema (ME) associated with branch retinal vein occlusion (BRVO), although arteriovenous (AV) sheathotomy is also shown to have limited effectiveness. The mechanism of each treatment is different - one suppresses vascular permeability while the other improves the blood flow in the occluded vessel; however, their synergistic effects have not yet been examined. As a prospective, clinical pilot study, we examined the total number of anti-VEGF injections required at month 12, after AV sheathotomy without vitrectomy in combination with anti-VEGF for BRVO.
Six eyes of 6 consecutive cases (4 males, 2 females; average age 68.3 years.) with a best-corrected visual acuity (BCVA) in log MAR of ≤ 0.3 due to ME associated with BRVO were followed for 12 months. Using a 23-gauge knife, AV sheathotomy without vitrectomy was performed for all cases. The change in blood flow in the occluded vein was quantitatively measured intraoperatively using laser speckle flowgraphy, before and after AV sheathotomy. On the second postoperative day, an anti-VEGF agent was injected into the same eye. During the 12 month follow-up period, pro re nata injections were administered when changes in foveal exudation and BCVA were evident. The total number of anti-VEGF injections, central retinal thickness (CRT), and BCVA 12 months postoperatively were noted. This prospective study was in full compliance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board/Ethics Committee of Toho University Sakura Medical Center.
The number of additional injections of the anti-VEGF agent over 12 months was 0.67 on average (0 injections in 4 cases, 1 injection in 1 case, and 3 injections in 1 case). Blood flow during surgery increased an average 30.7% after AV sheathotomy. The decrease in CRT from baseline to month 12 was statistically significant (457.5 μm to 288.7 μm; P = 0.004), as was the improvement in BCVA (0.46 to 0.08; P = 0.001).
Combination treatment of AV sheathotomy without vitrectomy and anti-VEGF for BRVO effectively reduces ME and improves BCVA.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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