Changes in Retinal Nonperfusion Associated with Suppression of Vascular Endothelial Growth Factor in Retinal Vein Occlusion

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• 作者：Tahreem A. Mir ; MD ; Saleema Kherani ; MD ; Gulnar Hafiz ; MD ; MPH ; Adrienne W. Scott ; MD ; Ingrid Zimmer-Galler ; MD ; Adam S. Wenick ; MD ; PhD ; Sharon Solomon ; MD ; Ian Han ; MD ; David Poon ; MD ; Lingmin He ; MD ; Syed Mahmood Shah ; MD ; Christopher J. Brady ; MD ; Catherine Meyerle ; MD ; Akrit Sodhi ; MD ; PhD ; Marguerite O. Linz ; Raafay Sophie ; MD ; Peter A. Campochiaro ; MD ; ^{pcampo@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BRVO ; branch retinal vein occlusion ; CRVO ; central retinal vein occlusion ; PRN ; pro re nata ; RELATE ; Ranibizumab Dose Comparison (0.5 mg and 2.0 mg) and the Role of Laser in the Management of Retinal Vein Occlusion ; RNP ; retinal nonperfusion ; RVO ; retinal vein occlusion ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：123
• 期：3
• 页码：625-634.e1
• 全文大小：2860 K

文摘

To assess changes in retinal nonperfusion (RNP) in patients with retinal vein occlusion (RVO) treated with ranibizumab.

Design

Secondary outcome measure in randomized double-masked controlled clinical trial.

Participants

Thirty-nine patients with central RVO (CRVO) and 42 with branch RVO (BRVO).

Methods

Subjects were randomized to 0.5 or 2.0 mg ranibizumab every month for 6 months and then were re-randomized to pro re nata (PRN) groups receiving either ranibizumab plus scatter laser photocoagulation or ranibizumab alone for an additional 30 months.

Main Outcome Measures

Comparison of percentage of patients with increased or decreased area of RNP in patients with RVO treated with 0.5 versus 2.0 mg ranibizumab, during monthly injections versus ranibizumab PRN, and in patients treated with ranibizumab PRN versus ranibizumab PRN plus laser.

Results

In RVO patients given monthly injections of 0.5 or 2.0 mg ranibizumab for 6 months, there was no significant difference in the percentage who showed reduction or increase in the area of RNP. However, regardless of dose, during the 6-month period of monthly injections, a higher percentage of patients showed a reduction in area of RNP and a lower percentage showed an increase in area of RNP compared with subsequent periods of ranibizumab PRN treatment. After the 6-month period of monthly injections, BRVO patients, but not CRVO patients, randomized to ranibizumab PRN plus laser showed significantly less progression of RNP compared with patients treated with ranibizumab PRN.

Conclusions

Regardless of dose (0.5 or 2.0 mg), monthly ranibizumab injections promote improvement and reduce progression of RNP compared with PRN injections. The addition of scatter photocoagulation to ranibizumab PRN may reduce progression of RNP in patients with BRVO, but a statistically significant reduction was not seen in patients with CRVO.