• Peripheral retinal ischemia
• Retinal cerclage
• Retinal detachment
• Secondary neovascular glaucoma

• Ozurdex
• aflibercept
• intraocular treatment
• macular edema
• retinal ischemia
• visual impairment

• Retinal vein occlusion
• glaucoma
• high intraocular pressure
• neovascular glaucoma

• National Key Research and Development Program of China

To evaluate the anatomic and functional outcomes in eyes of patients with macular edema (ME) caused by central retinal vein occlusion (CRVO) who were lost to follow-up (LTFU) for more than 6 months following treatment with anti-vascular endothelial growth factor (VEGF) therapy and to determine the predictive factors of visual prognosis in these patients.

This study was conducted as a retrospective, case series investigation. Patients whose eyes were receiving intravitreal anti-VEGF treatment for CRVO-ME, with the next follow-up visit occurring more than 6 months following treatment were identified. Baseline disease characteristics (at the last visit before being LTFU), cause and duration of treatment interruption, and the resulting disease progression, complications, and outcomes were assessed. Baseline characteristics predictive of visual outcome were also analyzed.

This study included a total of 17 eyes of 17 patients. The mean duration of being LTFU was 7.8 ± 2.1 months. On the return visit after being LTFU, 7 of 17 eyes (41.2%) developed neovascular complications. Despite treatment, 12 eyes (70.1%) lost ≥3 best-corrected visual acuity (BCVA) lines, with 2 eyes (11.8%) developing a final BCVA of hand motion or more severe. At the final visit, the mean logarithm of minimal angle of resolution (logMAR) BCVA deteriorated significantly compared to before being LTFU (P < 0.001). The increasing duration of being LTFU is associated with a deterioration of visual acuity prognosis.

In CRVO-ME patients who are receiving anti-VEGF therapy, unintentional treatment interruptions can cause visually disastrous consequences, including irreversible blindness. Patients who were LTFU for a long period should be strongly warned about their poor visual prognosis.

• anti-vascular endothelial growth factor
• central retinal vein occlusion
• loss to follow-up
• macular edema

• Adult
• Aged
• Angiogenesis Inhibitors/therapeutic use
• Aqueous Humor/metabolism
• Cytokines/metabolism
• Female
• Follow-Up Studies
• Humans
• Intravitreal Injections
• Macular Edema/diagnosis
• Macular Edema/metabolism
• Male
• Middle Aged
• Recombinant Fusion Proteins/therapeutic use
• Recurrence
• Retinal Vein Occlusion/drug therapy
• Retinal Vein Occlusion/metabolism
• Retrospective Studies
• Tomography, Optical Coherence
• Visual Acuity

• Administration, Ophthalmic
• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors/therapeutic use
• Bevacizumab/therapeutic use
• Drug Combinations
• Drug Therapy, Combination
• Female
• Fovea Centralis/pathology
• Humans
• Intraocular Pressure/physiology
• Intravitreal Injections
• Macular Edema/diagnostic imaging
• Macular Edema/drug therapy
• Macular Edema/etiology
• Male
• Middle Aged
• Ophthalmic Solutions
• Pilot Projects
• Ranibizumab/therapeutic use
• Receptors, Vascular Endothelial Growth Factor/therapeutic use
• Recombinant Fusion Proteins/therapeutic use
• Retinal Vein Occlusion/complications
• Retinal Vein Occlusion/diagnostic imaging
• Retinal Vein Occlusion/drug therapy
• Sulfonamides/therapeutic use
• Thiophenes/therapeutic use
• Timolol/therapeutic use
• Tomography, Optical Coherence
• Vascular Endothelial Growth Factor A/antagonists & inhibitors
• Visual Acuity/physiology

The purpose of this study was to determine the efficacy of combined intravitreal bevacizumab and triamcinolone in the treatment of macular edema due to retinal vein occlusion. A prospective randomized trial was conducted in the Department of Ophthalmology, Osijek University Hospital Centre in Osijek including 51 patients divided into three groups depending on the drug received. The first group received 1.25 mg intravitreal bevacizumab, the second group received 1 mg intravitreal triamcinolone, and the third group received a combination of 1.25 mg bevacizumab and 1 mg intravitreal triamcinolone on the same day. Changes in the central macular thickness, intraocular pressure and visual acuity were monitored during the follow up period. The retinal perfusion status was evaluated by fluorescein angiography. The group that received combined treatment had better outcome in terms of reduction of macular thickness. There was no statistically significant intraocular pressure elevation among the three treatment groups or within each group of patients. A positive trend regarding visual improvement was observed in the group receiving combined treatment in spite of the lowest initial visual acuity, highest value of macular thickness and longest mean duration of symptoms. In conclusion, combined treatment with bevacizumab and triamcinolone for the treatment of retinal vein occlusion is more potent, safe, efficient and cost-effective. It can also be recommended because fewer injections are needed in patients undergoing treatment for macular edema.

• Bevacizumab
• Intravitreal application
• Macular edema
• Retinal vein occlusion
• Triamcinolone

• Cornea
• Empty basement membrane sleeves
• Neovascularization
• Regression
• Revascularization
• Sprouting angiogenesis

• Angiogenesis Inhibitors/pharmacology
• Animals
• Basement Membrane/metabolism
• Basement Membrane/pathology
• Cell Movement/drug effects
• Corneal Neovascularization/drug therapy
• Corneal Neovascularization/metabolism
• Corneal Neovascularization/pathology
• Endothelial Cells/metabolism
• Endothelial Cells/pathology
• Male
• Pericytes/metabolism
• Pericytes/pathology
• Rats
• Rats, Wistar

• 2012-2472 Vetenskapsrådet

• Ozurdex
• dexamethasone
• macular edema
• retinal vein occlusion
• treatment-resistant
• vitrectomy

• aflibercept
• bevacizumab
• central retinal vein occlusion
• macular edema
• ranibizumab
• recurrent

Various combination treatment regimens have been tried to improve the short-term efficacy of intravitreal monotherapy for the treatment of macular oedema (MO) secondary to retinal vein occlusion (RVO). Our study introduces the RandOL protocol (Ranibizumab and Ozurdex with Laser photocoagulation) of initial anti-VEGF therapy, controlling recurrent non-ischaemic MO with an intravitreal steroid and applying laser therapy to non-perfused retina. We describe our 12-month follow-up experience on timing for adjunctive therapy and real-world effectiveness and safety data.

A retrospective analysis was carried out on 66 consecutive treatment-naive RVO patients with MO who received our RandOL treatment regimen. Baseline visual acuity (VA) and central retinal thickness (CRT) were compared with 12-month result.

At 12 months, 77% had significant VA improvement, 52% had ≥3-line improvement, and 15% were worse. Significant improvements in CRT were observed in 97% (baseline median CRT=531 μm (IQR 435–622) reduced to 245 μm (IQR 221–351, P<0.001) at 12 months); 76% achieved a dry fovea at 1 year. Mean number of total injections required was 5.5 (range 2–11) and 6% required ≥9 injections in 1 year. Although 70% received additional Ozurdex, 82% received ≥1 sessions of laser therapy. The BRVO subgroup achieved better VA and CRT improvement at 1 year, but small numbers limit definitive statistical conclusions.

Our real-world results using a combination treatment protocol for RVO-related MO achieved similar desirable anatomical and visual outcomes as with a single-agent therapy with less intravitreal re-treatment rates at first year. Randomised controlled studies are needed to evaluate the role of laser and the ideal timing of combination therapy.

To evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab.

This retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later.

At the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively).

Unlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.

• Bevacizumab
• Macular edema
• Natural history
• Recurrence
• Retinal vein occlusion

• Macula
• Retina

To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.

A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points.

All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P<0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P<0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 μm at 4 months (P<0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P<0.05) in this patient population and partially limited analysis of other end points.

DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.

• anti-VEGF
• cataract progression
• intravitreal dexamethasone implant
• multifocal electroretinography
• retinal vein occlusion

• bevacizumab
• central retinal vein
• central subfield foveal thickness
• intravitreal injection
• macular edema

Peripheral retinal ischemia not detectable by conventional fluorescein angiography has been proposed to be a driving force for rebound edema in retinal vein occlusions. In this report, we examine the treatment of peripheral retinal ischemia with targeted retinal photocoagulation (TRP) to manage a patient’s rebound edema.

To assess the extent of peripheral nonperfusion, an Optos 200Tx device was used. To target the treatment to peripheral ischemia areas, a Navilas Panretinal Laser was used.

A 64-year-old male with a central retinal vein occlusion and a visual acuity 20/300, and central macular thickness 318 μm presented with rubeosis. Angiography revealed extensive peripheral nonperfusion. Despite TRP to areas of irreversible ischemia, after 2 months, he continued show rubeosis and rebound edema. Additional TRP laser was repeatedly added more posteriorly to areas of reversible nonperfusion, resulting in eventual resolution of rubeosis and edema.

In this study, we demonstrate the use of widefield imaging with targeted photo-coagulation of peripheral ischemia to treat rebound edema, while preserving most peripheral vision. In order to treat rebound edema, extensive TRP, across reversible and nonreversible areas of ischemia, had to be performed – not just in areas of nonreversible peripheral ischemia. These areas need to be mapped during episodes of rebound edema, when ischemia is at its maximum. In this way, by doing the most TRP possible, the cycle of rebound edema can be broken.

• macular edema
• retinal vein occlusion

Retinal vein occlusion (RVO) is the second vascular retinal cause of visual loss and defined by the occlusion of a retinal vein. It is divided into branch retinal vein occlusion or central retinal vein occlusion, depending on the location of occlusion. RVO has severe medical, financial and social implications on the patients. The diagnosis of the disease is easier nowadays with the use of spectral domain optical coherence tomography and fluorescein angiography. The treatment options for RVO have changed dramatically over the past few years with the introduction of the intravitreal injections of dexamethasone (Ozurdex), bevacizumab (Avastin), ranibizumab (Lucentis) and aflibercept (EYLEA), along with the panretinal laser photocoagulation, abandoning former treatment modalities and surgical solution. This manuscript is a review of current literature about RVO with emphasize on the pathophysiology, risk factors and prevention, diagnosis and sub-group categorization and treatments including medical and surgical. Since no official guidelines are available for the treatment of RVO patients, and considering the latest developments in the treatment options, and the variety of follow-up and treatment modalities, this manuscript aims to provide tools and knowledge to guide the physician in treating RVO patients, based on the latest publications from the literature and on several of the patients characteristics.

• Retinal vein occlusion
• Pathophysiology
• Prevention
• Diagnosis
• Treatment

• Angiogenesis Inhibitors/therapeutic use
• Antibodies, Monoclonal, Humanized/therapeutic use
• Bevacizumab
• Combined Modality Therapy
• Drainage/methods
• Humans
• Infant, Newborn
• Infant, Premature
• Laser Coagulation/adverse effects
• Lasers, Semiconductor/adverse effects
• Male
• Retinal Detachment/etiology
• Retinal Detachment/therapy
• Retinopathy of Prematurity/surgery
• Scleral Buckling/methods
• Treatment Outcome

• Angiogenesis Inhibitors/therapeutic use
• Antibodies, Monoclonal, Humanized/therapeutic use
• Bevacizumab
• Clinical Trials as Topic
• Diabetic Retinopathy/drug therapy
• Diabetic Retinopathy/physiopathology
• Drug Therapy, Combination
• Glucocorticoids/therapeutic use
• Humans
• Intravitreal Injections
• Macular Edema/drug therapy
• Macular Edema/physiopathology
• Retinal Vein Occlusion/drug therapy
• Retinal Vein Occlusion/physiopathology
• Treatment Outcome
• Triamcinolone Acetonide/therapeutic use
• Vascular Endothelial Growth Factor A/antagonists & inhibitors
• Visual Acuity/physiology
• Vitrectomy

• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors/administration & dosage
• Antibodies, Monoclonal, Humanized/administration & dosage
• Bevacizumab
• Female
• Humans
• Intravitreal Injections
• Macular Edema/diagnosis
• Macular Edema/drug therapy
• Macular Edema/etiology
• Male
• Middle Aged
• Recurrence
• Retina/pathology
• Retinal Vein Occlusion/complications
• Retinal Vein Occlusion/diagnosis
• Retinal Vein Occlusion/drug therapy
• Retreatment
• Retrospective Studies
• Tomography, Optical Coherence
• Vascular Endothelial Growth Factor A/antagonists & inhibitors
• Visual Acuity/physiology