COMMENTARY

Intraocular Injections After Retinal Vein Occlusion

Jasmina Bajric, MD; Sophie J. Bakri, MD

Disclosures

January 31, 2013

Benefit From Bevacizumab for Macular Edema in Central Retinal Vein Occlusion: Twelve-Month Results of a Prospective, Randomized Study

Epstein DL, Algvere PV, von Wendt G, Seregard S, Kvanta A
Ophthalmology. 2012;119:2587-2591

Study Summary

Intravitreal bevacizumab can significantly improve visual acuity in patients with macular edema secondary to central retinal vein occlusion (CRVO). This was investigated by a Swedish group of investigators who conducted a sham-controlled, double-masked, prospective, randomized study on 60 eyes with macular edema secondary to CRVO. Patients were randomly assigned to intravitreal bevacizumab (n = 30) or sham injections (n = 30) every 6 weeks for the first 6 months, then during the second 6 months of the study all patients received bevacizumab at 6-week intervals. The primary outcome was the proportion of patients gaining 15 or more ETDRS letters at 12 months.

The bevacizumab/bevacizumab (bz/bz) group gained 16.1 letters at week 48 whereas the sham/bevacizumab (sh/bz) group gained only 4.6 letters (P < .05). Both groups had similar mean reductions in retinal thickness at week 48 (435 μm in the bz/bz group vs 404 μm in the sh/bz group).

This study suggests that bevacizumab significantly improves visual outcome when given every 6 weeks to patients with macular edema secondary to CRVO. Delaying treatment by 6 months negatively affects visual outcome. Because both the bz/bz group and the sh/bz group had similar improvements in retinal thickness, visual improvement cannot be attributed to resolution of macular edema alone. The investigators postulate that long-lasting macular edema may lead to macular damage that cannot be restored after resolution of macular edema.

Viewpoint

This study, along with previous subanalyses of the ranibizumab studies (CRUISE/BRAVO) and intravitreal dexamethasone implant studies, all point to the conclusion that a delay in initiating therapy for macular edema resulting from CRVO can negatively affect the visual outcome. Ophthalmologists should discuss with patients initiation of treatment at an early stage to prevent irreversible damage to the macula from long-standing macular edema.

Abstract

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