Long-term outcomes in ranibizumab-treated patients with retinal vein occlusion; the role of progression of retinal nonperfusion

Abstract

Purpose: To determine the percentage of ranibizumab-treated patients with retinal vein occlusion (RVO) who had resolution of edema for at least 6 months after the last injection, along with factors and outcomes that correlate with resolution.

Design: Post hoc analysis of open-label clinical trial.

Methods: Twenty patients with branch RVO (BRVO) and 20 with central RVO (CRVO) received ranibizumab monthly for 3 months and as needed for recurrent/persistent macular edema, no more frequently than every 2 months. Patients still requiring injections after month 40 received scatter and grid laser photocoagulation to try to reduce the need for injections. Main outcome measures included the percentage of patients who had resolution of edema, change in best-corrected visual acuity (BCVA) from baseline, and change in area of retinal nonperfusion in central subfields.

Results: Nine patients with BRVO (45%) had edema resolution from injections alone after a mean of 20.2 months, 4 resolved after addition of laser, 4 were unresolved through 72 months, and 3 exited prior to resolution. Five patients with CRVO (25%) resolved from injections alone after a mean of 14.0 months, 8 remained unresolved through 72 months despite addition of laser, and 7 exited prior to resolution. For BRVO or CRVO, there was a negative correlation between posterior retinal nonperfusion area and BCVA at months 18, 24, and 36 (P < .05).

Conclusions: In patients with RVO, infrequent ranibizumab injections to control edema may not be sufficient to prevent progression of retinal nonperfusion, which may contribute to loss of visual gains.

Trial registration: ClinicalTrials.gov NCT00407355.

Copyright © 2013 Elsevier Inc. All rights reserved.

Figures

Figure 1

Change in area of posterior retinal nonperfusion over time in patients with branch retinal vein occlusion (BRVO, Top row) or central retinal vein occlusion (CRVO, Bottom row). (Top left) The area of retinal nonperfusion in the inner and outer subfields on each gradable fluorescein angiogram is plotted between baseline and month 36 in patients with BRVO. (Top right) Mean and median area of retinal nonperfusion for BRVO patients with a gradable fluorescein angiogram at baseline. (Bottom left) The area of retinal nonperfusion in the inner and outer subfields on each gradable fluorescein angiogram is plotted between baseline and month 36 in patients with CRVO. (Bottom right) Mean and median area of retinal nonperfusion for CRVO patients with a gradable fluorescein angiogram at baseline.

Figure 2

Grading of retinal nonperfusion on fluorescein angiograms of branch vein occlusion patients. (Top) Categorical grading of retinal nonperfusion in patients without 5-year follow-up. (Bottom) Categorical grading of retinal nonperfusion in patients with 5-year follow-up. BL = baseline; M = month; NG = nongradable; Mod = moderate.

Figure 3

Grading of retinal nonperfusion on fluorescein angiograms of central vein occlusion patients. (Top) Categorical grading of retinal nonperfusion in patients without 5-year follow-up. (Bottom) Categorical grading of retinal nonperfusion in patients with 5-year follow-up. BL = baseline; M = month; NG = nongradable; Mod = moderate.