Intravitreal Ranibizumab For Treating Central Retinal Vein Occlusion And Idiopathic Choroidal Neovascularization

Part IComparison of the Safety and Efficacy of Intravitreal Ranibizumab with and without Triamcinolone Acetonide for Treating Macular Edema Secondary to Central Retinal Vein OcclusionPurpose:The main consequence of central retinal vein occlusion (CRVO) that causes irreversible visual loss is macular edema (ME), which is very difficult to treat. In recent years, intravitreal injections of triamcinolone acetonide (IVTA)or anti-VEGF agents have been effective, to a certain extent. Unfortunately, triamcinolone acetonide has serious side effects and ranibizumab is very expensive, so both therapies have certain restrictions.In an effort to determine the optimal therapy, this study was designed to compare clinical outcomes and safety of intravitreal ranibizumab (IVR, Lucentis(?)) monotherapy and IVR combined with intravitreal triamcinolone acetonide in eyes with ME secondary to CRVO.Methods:Study conduct adhered to the tenets of the Declaration of Helsinki. This prospective, controlled study examined patients presenting to the Second People’s Hospital of Jinan City with ME secondary to CRVO between August2012and February2013. This study examined57eyes (57patients) with ME secondary to CRVO. Patients were randomly divided into two treatment groups; those that received IVR (0.5mg; Lucentis, Genentech, South San Francisco, CA) monotherapy (n=30eyes) and those that received combination treatment with IVR (0.5mg) and IVTA(1mg; Kunming Jida Pharmaceutical Co., Ltd., Kunming, China, n=27eyes). Further intravitreal treatment was administered as necessary.Results:All57patients completed at least6months of follow-up. At baseline, mean (±standard error) best-corrected visual acuity (BCVA) was45.8±23.2letters in the IVR group and47.3±19.3letters in the IVR+IVTA group (p=0.790). Significant improvement in BCVA over baseline was observed in both groups at all six study visits (IVR group:p=0.0003,0.0001,0.0018,0.0145,0.0107,0.005; IVR+IVTA group:p=0.0001,0.0001,0.0004,0.0068,0.0007,0.0002), with no significant BCVA differences between groups.Significant reduction in mean central subfield thickness, compared to baseline, was also observed in both groups at all six study visits (IVR group, p=0.0001; IVR+IVTA group, p=0.0001), with no significant difference between groups in the magnitude of macular thickness reduction.Intraocular pressure at baseline was normal in both groups at13.3±3.3mm Hg in the IVR group and14.8±3.7mmHg in the IVR+IVTA group (p=0.111). No significant differences from baseline were seen in IOP for either group at any time point examined. Additionally, there was no difference in IOP between treatment groups at3,4, or5months, but it was significantly higher in the IVR+IVTA groups at1,2, and6months. Although there were no significant changes in mean IOP from baseline,3eyes had an IOP>21mmHg in the IVR+IVTA group. All episodes of elevated IOP were controlled with antiglaucomatous medication.The average number of injections administered in the IVR group was4.23±0.56injections. This was significantly higher than the3.42±0.41injections given to the IVR+ IVTA group (p=0.0001). No significant cataract formation was observed, and no serious complications or the injection procedure (e.g., endophthalmitis, retinal detachment) occurred.Conclusions:Treating ME secondary to CRVO with IVR or IVR+IVTA had similar effects on central macular thickness and BCVA in patients with ME secondary to CRVO over a6-month follow-up period. The mean number of intravitreal injections was higher in the IVR group than in the IVR+IVTA group. Part ⅡClinical efficacy of intravitreal ranibizumab in early and mid-idiopathic choroidal neovascularizationBackground:In recent years, a number of reports have shown that bevacizumab, one of the anti-VEGF monoclonal antibodies, achieved good effects in treating idiopathic choroidal neovascularization (ICNV). In2012, after ranibizumab was approved for sale in China, we used it to treat ICNV. We achieved good effects in some patients, but it had a limited effect in other patients. Therefore, we reviewed our ICNV patients and allocated them into two groups according to the length of the treatment course, the early group and the mid group, to observe the effects in the different groups and the effect of disease duration on prognosisMethods:This retrospective, case-controlled study examined44patients with ICNV in one eye initially treated with intravitreal ranibizumab (0.5mg). Further intravitreal treatments were administered as necessary. Patients were divided into two groups according to disease duration, i.e.,<3months or3-6months (early and mid groups), and the data compared.Results:The changes in BCVA and CMT were monitored over time to determine and compare the efficacy of treatment in the two groups. Significant differences existed in BCVA and CMT between the groups at all time points (Table2). This means that early treatment may lead to better visual improvement and greater reduction of macular leakage. At the last follow-up visit (12months),19eyes (79.1%) in the early group and10eyes (50.0%) in the mid group had a visual gain of>15ETDRS letters, and the difference was statistically significant (x2=4.130, p=0.042).IOP at baseline was normal in both groups at13.9±4.1mmHg in the early group and15.±3.9mmHg in the mid group (p=0.291). No significant differences were observed from baseline IOP values in either group at any time point examined. Additionally, there was no difference in IOP between the two groups at1,3,6,9, or12months. Although there were no significant changes in mean IOP from baseline, three eyes had an IOP of<10mmHg on the first day after the injection (6and7mmHg), and one eye had an IOP>21mmHg (25mmHg). All values normalized3days after injection without any drug intervention.The average number of injections administered in the mid group was2.53±1.76injections. This was significantly higher than the1.22±1.01injections administered to the early group (t=3.090, p=0.0035). No significant cataract formation was observed, and no serious complications from the injection procedure (e.g., endophthalmitis or retinal detachment) occurred.Conclusions:early treatment of ICNV can result in better visual prognosis, more obvious CMT decrease, and fewer numbers of injections over a1-year follow-up period.