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Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study

  • Josep CallizoEmail author
  • Abed Atili
  • Nina Antonia Striebe
  • Sebastian Bemme
  • Nicolas Feltgen
  • Hans Hoerauf
  • Thomas Bertelmann
Retinal Disorders

Abstract

Background

The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO).

Methods

Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2 weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38 weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated.

Results

Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38 weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2 μm ± 138.4 μm and 538.9 μm ± 156.9 μm in BEV (P < 0.1697). At 38 weeks, CRT decreased in both groups significantly, 98.2 μm in the BEV + GRID (P = 0.02) and 141.7 μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3–6) with no significant difference between groups.

Conclusions

Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.

Keywords

Branch retinal vein occlusion Macular edema Bevacizumab Anti-VEGF Grid laser photocoagulation 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Rogers SL, McIntosh RL, Lim L et al (2010) Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 117:1094–1101.e5.  https://doi.org/10.1016/j.ophtha.2010.01.058 CrossRefGoogle Scholar
  2. 2.
    Jaulim A, Ahmed B, Khanam T, Chatziralli IP (2013) Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature. Retina (Philadelphia, Pa) 33:901–910.  https://doi.org/10.1097/IAE.0b013e3182870c15
  3. 3.
    Ho M, Liu DTL, Lam DSC, Jonas JB (2016) Retinal vein occlusions, from basics to the latest treatment. Retina (Philadelphia, Pa) 36:432–448.  https://doi.org/10.1097/IAE.0000000000000843 CrossRefGoogle Scholar
  4. 4.
    Lam FC, Chia SN, Lee RMH (2015) Macular grid laser photocoagulation for branch retinal vein occlusion. Cochrane Database Syst Rev CD008732.  https://doi.org/10.1002/14651858.CD008732.pub2
  5. 5.
    The Branch Vein Occlusion Study Group (1984) Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol 98:271–282Google Scholar
  6. 6.
    Branch Vein Occlusion Study Group (1986) Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein occlusion. A randomized clinical trial. Arch Ophthalmol 104:34–41Google Scholar
  7. 7.
    Donati S, Barosi P, Bianchi M et al (2012) Combined intravitreal bevacizumab and grid laser photocoagulation for macular edema secondary to branch retinal vein occlusion. Eur J Ophthalmol 22:607–614.  https://doi.org/10.5301/ejo.5000085 CrossRefGoogle Scholar
  8. 8.
    Spandau U, Wickenhäuser A, Rensch F, Jonas J (2007) Intravitreal bevacizumab for branch retinal vein occlusion. Acta Ophthalmol Scand 85:118–119.  https://doi.org/10.1111/j.1600-0420.2006.00850.x CrossRefGoogle Scholar
  9. 9.
    Rabena MD, Pieramici DJ, Castellarin AA et al (2007) Intravitreal bevacizumab (Avastin) in the treatment of macular edema secondary to branch retinal vein occlusion. Retina (Philadelphia, Pa) 27:419–425.  https://doi.org/10.1097/IAE.0b013e318030e77e CrossRefGoogle Scholar
  10. 10.
    Pai SA, Shetty R, Vijayan PB et al (2007) Clinical, anatomic, and electrophysiologic evaluation following intravitreal bevacizumab for macular edema in retinal vein occlusion. Am J Ophthalmol 143:601–606.  https://doi.org/10.1016/j.ajo.2006.12.037 CrossRefGoogle Scholar
  11. 11.
    Pielen A, Feltgen N, Isserstedt C et al (2013) Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review. PLoS One 8:e78538.  https://doi.org/10.1371/journal.pone.0078538 CrossRefGoogle Scholar
  12. 12.
    Berger AR, Cruess AF, Altomare F et al (2015) Optimal treatment of retinal vein occlusion: Canadian expert consensus. Ophthalmologica 234:6–25.  https://doi.org/10.1159/000381357 CrossRefGoogle Scholar
  13. 13.
    Tadayoni R, Waldstein SM, Boscia F et al (2016) Individualized stabilization criteria-driven ranibizumab versus laser in branch retinal vein occlusion: six-month results of BRIGHTER. Ophthalmology 123:1332–1344.  https://doi.org/10.1016/j.ophtha.2016.02.030 CrossRefGoogle Scholar
  14. 14.
    Azad SV, Salman A, Mahajan D et al (2014) Comparative evaluation between ranibizumab combined with laser and bevacizumab combined with laser versus laser alone for macular oedema secondary to branch retinal vein occlusion. Middle East Afr J Ophthalmol 21:296–301.  https://doi.org/10.4103/0974-9233.142264 CrossRefGoogle Scholar
  15. 15.
    Taban M, Sharma S, Williams DR et al (2009) Comparing retinal thickness measurements using automated fast macular thickness map versus six-radial line scans with manual measurements. Ophthalmology 116:964–970.  https://doi.org/10.1016/j.ophtha.2008.12.033 CrossRefGoogle Scholar
  16. 16.
    Jaissle GB, Leitritz M, Gelisken F et al (2009) One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 247:27–33.  https://doi.org/10.1007/s00417-008-0916-2 CrossRefGoogle Scholar
  17. 17.
    Hikichi T, Higuchi M, Matsushita T et al (2014) Two-year outcomes of intravitreal bevacizumab therapy for macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol 98:195–199.  https://doi.org/10.1136/bjophthalmol-2013-303121 CrossRefGoogle Scholar
  18. 18.
    Yilmaz T, Cordero-Coma M (2012) Use of bevacizumab for macular edema secondary to branch retinal vein occlusion: a systematic review. Graefes Arch Clin Exp Ophthalmol 250:787–793.  https://doi.org/10.1007/s00417-012-2016-6 CrossRefGoogle Scholar
  19. 19.
    Campochiaro PA, Heier JS, Feiner L et al (2010) Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 117:1102–1112.e1.  https://doi.org/10.1016/j.ophtha.2010.02.021 CrossRefGoogle Scholar
  20. 20.
    Clark WL, Boyer DS, Heier JS et al (2016) Intravitreal aflibercept for macular edema following branch retinal vein occlusion: 52-week results of the VIBRANT study. Ophthalmology 123:330–336.  https://doi.org/10.1016/j.ophtha.2015.09.035 CrossRefGoogle Scholar
  21. 21.
    Salinas-Alamán A, Zarranz-Ventura J, Caire González-Jauregui JM et al (2011) Intravitreal bevacizumab associated with grid laser photocoagulation in macular edema secondary to branch retinal vein occlusion. Eur J Ophthalmol 21:434–439.  https://doi.org/10.5301/EJO.2010.6101 CrossRefGoogle Scholar
  22. 22.
    Yang C-S, Liu J-H, Chung Y-C et al (2015) Combination therapy with intravitreal bevacizumab and macular grid and scatter laser photocoagulation in patients with macular edema secondary to branch retinal vein occlusion. J Ocul Pharmacol Ther 31:179–185.  https://doi.org/10.1089/jop.2014.0069 CrossRefGoogle Scholar
  23. 23.
    Campochiaro PA, Aiello LP, Rosenfeld PJ (2016) Anti-vascular endothelial growth factor agents in the treatment of retinal disease: from bench to bedside. Ophthalmology 123:S78–S88.  https://doi.org/10.1016/j.ophtha.2016.04.056 CrossRefGoogle Scholar
  24. 24.
    Farese E, Cennamo G, Velotti N et al (2014) Intravitreal bevacizumab combined with grid photocoagulation in recurrent macular edema secondary to retinal vein occlusion. Eur J Ophthalmol 24:761–770.  https://doi.org/10.5301/ejo.5000448 CrossRefGoogle Scholar
  25. 25.
    Pielen A, Mirshahi A, Feltgen N et al (2015) Ranibizumab for branch retinal vein occlusion associated macular edema study (RABAMES): six-month results of a prospective randomized clinical trial. Acta Ophthalmol 93:e29–e37.  https://doi.org/10.1111/aos.12488 CrossRefGoogle Scholar
  26. 26.
    Campochiaro PA, Hafiz G, Mir TA et al (2015) Scatter photocoagulation does not reduce macular edema or treatment burden in patients with retinal vein occlusion: the RELATE trial. Ophthalmology 122:1426–1437.  https://doi.org/10.1016/j.ophtha.2015.04.006 CrossRefGoogle Scholar
  27. 27.
    Tadayoni R, Waldstein SM, Boscia F et al (2017) Sustained benefits of ranibizumab with or without laser in branch retinal vein occlusion: 24-month results of the BRIGHTER study. Ophthalmology 124:1778–1787.  https://doi.org/10.1016/j.ophtha.2017.06.027 CrossRefGoogle Scholar
  28. 28.
    Feucht N, Schönbach EM, Lanzl I et al (2013) Changes in the foveal microstructure after intravitreal bevacizumab application in patients with retinal vascular disease. Clin Ophthalmol 7:173–178.  https://doi.org/10.2147/OPTH.S37544 CrossRefGoogle Scholar
  29. 29.
    Kang J-W, Yoo R, Jo YH, Kim HC (2017) Correlation of microvascular structures on optical coherence tomography angiography with visual acuity in retinal vein occlusion. Retina (Philadelphia, Pa) 37:1700–1709.  https://doi.org/10.1097/IAE.0000000000001403 CrossRefGoogle Scholar
  30. 30.
    Liu MM, Wolfson Y, Bressler SB et al (2014) Comparison of time- and spectral-domain optical coherence tomography in management of diabetic macular edema. Invest Ophthalmol Vis Sci 55:1370–1377.  https://doi.org/10.1167/iovs.13-13049 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyUniversity Medical Center GoettingenGoettingenGermany
  2. 2.Augen Praxis Klinik EsslingenEsslingenGermany

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