COMMENTARY

Can a VEGF Inhibitor Be Used to Effectively Treat Macular Edema Associated With Perfused Central Retinal Vein Occlusions?

C. Robert Bernardino, MD

Disclosures

November 10, 2008

Introduction

A major cause of vision loss after central retinal vein occlusion (CRVO) is macular edema. There are many strategies to address this problem, including laser therapy and intravitreal steroid injections.[1,2] Vascular endothelial growth factor inhibition has been very effective in treating age-related macular degeneration. This study sought to evaluate its efficacy for macular edema following CRVO.

 

Ranibizumab for the Treatment of Macular Edema Associated with Perfused Central Retinal Vein Occlusions

 

Pieramici DJ, Rabena M, Castellarin AA, Nasir M, et al
Ophthalmology. 2008;115:e47-e54

Ranibizumab for the Treatment of Macular Edema Associated with Perfused Central Retinal Vein Occlusions

Pieramici DJ, Rabena M, Castellarin AA, Nasir M, et al Ophthalmology. 2008;115:e47-e54

Summary

In this prospective study, 10 patients were randomized to receive intravitreal ranibizumab injections of either 0.3 or 0.5 mg. Injections were given at 0 months, 1 month, and 2 month followed by additional injections as needed for persistent macular edema. This study included only patients who had perfused CRVO, defined as no sign of macular ischemia or neovascularization.

Among the 10 subjects, the average duration of CRVO symptoms before enrollment was 20.7 weeks. The average number of injections received in 9 months was 4.5 injections, and follow-up was at least 24 months.

At 6 months follow-up, 1 patient's visual acuity had improved by ≥ 15 letters; 7 of 10 patients had stabilization of vision. Mean reduction of central retinal thickness was 272 µm at 3 months; at 6 months, CRT regressed back to baseline. Only 1 patient had an adverse effect, which was recurrence of macular edema.

Comment

This study demonstrated the safety and efficacy of intravitreal ranibizumab for perfused CRVO. However, the therapeutic effects seemed to lapse after 3 months, highlighting the need for multiple treatments or adjuvant therapy. Also of note is that both doses were equally efficacious. However, this was a small pilot study; a larger data pool may elicit differences between the 2 dosing schemes.

Abstract

Comments

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