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Original article

Intravitreal Steroid and Anti-VEGF in Macular Edema Secondary to Retinal Vein Occlusion

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Summary

Aims: To evaluate the effectiveness and safety of combined intravitreal steroid and anti-VEGF treatment in patients with retinal vein occlusion at an  ophthalmological referral center in Colombia.

Material and Methods: This is an analytical, longitudinal study of patients with macular edema secondary to retinal vein occlusion, who underwent treatment of combined intravitreal steroid and Anti-VEGF therapy at the Ophthalmology Department’s Retina and Vitreous Unit, collected from an anonymized database.

Results: The study included 39 eyes from an anonymized secondary source, from January 2016 to December 2024. After an average follow-up of 18.7 months, a significant improvement in best-corrected visual acuity (from 1.22 to 0.93 LogMAR, p = 0.01) and a statistically significant reduction in central macular thickness (CMT) (from 567.5 to 236 μm, p = 0.01) were observed, with 76.9% of patients achieving a CMT < 300 μm. Intraocular pressure remained stable (15.18 vs. 15.69 mmHg). Most patients received Bevacizumab (64%) and Triamcinolone (66%), and 67% required intravitreal reinjections. The central retinal vein occlusion group showed visual improvement and a decrease in CMT, although 24% experienced complications, mainly elevated intraocular pressure and cataract progression. The superotemporal vein occlusion and inferotemporal vein occlusion groups also showed visual improvement and a reduction in CMT, with few complications.

Conclusion: Combination therapy was effective in improving visual function and reducing macular edema in different types of retinal vein occlusion.

References

  1. Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2000; 98:133-141.
  2. Rogers SL, McIntosh RL, Lim L, et al. Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology. 2010;117(6):1094-1101.e5. doi:10.1016/j.ophtha.2010.01.058
  3. Cornish EE, Zagora SL, Spooner K, Fraser-Bell S. Management of macular oedema due to retinal vein occlusion: an evidence-based systematic review and meta-analysis. Clin Exp Ophthalmol. 2023;51(4):313-338. doi:10.1111/ceo.14225¨
  4. Hariprasad SM, Sheth V, Chiranand P. Combination therapy for retinal vein occlusion: the complexity of this multifactorial disease state suggests a need for a tailored treatment approach. Med Retina Feature. 2010 Jun.
  5. Arepalli S, Bessette A, Kaiser PK. Branch retinal vein occlusion. In: Ryan SJ, editor. Ryan’s Retina. 5th ed. Philadelphia: Elsevier; 2013. p.1177-1188.
  6. Campochiaro PA, Heier JS, Feiner L, et al.; BRAVO Investigators. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010;117(6):1102-1112.e1. doi:10.1016/j.ophtha.2010.02.021
  7. Campochiaro PA, Clark WL, Boyer DS, et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion: the 24-week results of the VIBRANT study. Ophthalmology. 2015;122(3):538-544. doi:10.1016/j.ophtha.2014.08.031
  8. Narayanan R, Panchal B, Das T, et al.; MARVEL Study Group. A randomised, double-masked, controlled study of the efficacy and safety of intravitreal bevacizumab versus ranibizumab in the treatment of macular oedema due to branch retinal vein occlusion: MARVEL Report No. 1. Br J Ophthalmol. 2015;99(7):954-959. doi:10.1136/bjophthalmol-2014-306543
  9. Petrovic N, Todorovic D, Sarenac Vulovic T, Sreckovic S, Zivic F, Risimic D. Combined treatment of persistent diabetic macular edema with aflibercept and triamcinolone acetonide in pseudophakic eyes. Medicina (Kaunas). 2023;59(5):982. doi:10.3390/medicina59050982
  10. Namvar E, Yasemi M, Nowroozzadeh MH, Ahmadieh H. Intravitreal Injection of Anti-Vascular Endothelial Growth Factors Combined with Corticosteroids for the Treatment of Macular Edema Secondary to Retinal Vein Occlusion: A Systematic Review and Meta-Analysis. Semin Ophthalmol. 2024;39(1):109-119. doi:10.1080/088205 38.2023.2249527
  11. Tatsumi T. Current treatments for diabetic macular edema. Int J Mol Sci. 2023;24(11):9591. doi:10.3390/ijms24119591
  12. Campochiaro PA, Heier JS, Feiner L, et al. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end-point results of a phase III study. Ophthalmology. 2010;117(6):1102-1112.e1.
  13. Brown DM, Campochiaro PA, Bhisitkul RB, et al. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study (CRUISE). Ophthalmology. 2010;117(6):1124-1133.
  14. Haller JA, Bandello F, Belfort R Jr, et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion: twelve-month study results. Ophthalmology. 2011;118(12):2453-2460.
  15. Singer MA, Sadda SR, Stevens T, Johnson RN, Hoggatt J, Tanenbaum L. Long-term results of combination therapy using anti-VEGF agents and dexamethasone intravitreal implant for retinal vein occlusion: an investigational case series. Ophthalmic Surg Lasers Imaging Retina. 2016;47(4):336-342.
  16. Maturi RK, Chen V, Raghinaru D, et al. A 12-month, single-masked, randomized controlled study of dexamethasone intravitreal implant in combination with ranibizumab compared with ranibizumab monotherapy in patients with macular edema due to central retinal vein occlusion. Ophthalmology. 2014;121(12): 2310-2316.
  17. Zur D, Iglicki M, Loewenstein A. Improvement and deterioration in diabetic macular edema: an OCT-based analysis of structural markers. Retina. 2019;39(3):386-394.
  18. Chan EW, Eldeeb M, Sun V, et al. Disorganization of Retinal Inner Layers and Ellipsoid Zone Disruption Predict Visual Outcomes in Central Retinal Vein Occlusion. Ophthalmol Retina. 2018;2(9):830- 838.
  19. Browning DJ, Stewart MW, Lee C, Campbell J. Quantitative longitudinal assessment of ellipsoid zone integrity in retinal vein occlusion with macular edema. Ophthalmology. 2020;127(8):1071- 1078.
  20. Sasajima H, Zako M, Murotani K, et al. Visual Prognostic Factors in Eyes with Subretinal Fluid Associated with Branch Retinal Vein Occlusion. Ophthalmol J Clin Med. 2023;12(8):2909. doi:10.3390/jcm12082909
  21. Haller JA, Bandello F, Belfort R Jr, et al; OZURDEX GENEVA Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117(6):1134-1146.e3. doi:10.1016/j.ophtha.2010.03.032
  22. Ip MS, Scott IU, VanVeldhuisen PC, et al.; SCORE Study Research Group. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5. Ophthalmology. 2009;116(9):1448- 1454. doi:10.1016/j.ophtha.2009.06.019
  23. Moisseiev E, Goldstein M, Waisbourd M, Loewenstein A. Long-term evaluation of patients treated with intravitreal dexamethasone implant (Ozurdex) for macular edema due to retinal vein occlusion. Eye (Lond). 2013;27(1):65-71. doi:10.1038/eye.2012.221
  24. Lee JH, Lee WK. Rapid progression of cataract to mature stage after intravitreal dexamethasone implantation. BMC Ophthalmol. 2019;19(1):240. doi:10.1186/s12886-019-1237-5
  25. Chen YL, Chen HQ, Zhang SQ, et al. Comparative efficacy of pharmacotherapy for macular edema secondary to retinal vein occlusion: a network meta-analysis. Front Pharmacol. 2021;12:752048. doi:10.3389/fphar.2021.752048
  26. Zhang W, Wang J, Ke X, Guo J, Zhang J, Xu G. Efficacy and effectiveness of anti-VEGF or steroids monotherapy versus combination treatment for macular edema secondary to retinal vein occlusion: a systematic review and meta-analysis. BMC Ophthalmol. 2022;22(1):375. doi:10.1186/s12886-022-02590-z
  27. Du X, Chen Y, Zhang C, Wang S, Jiang Y. The efficacy of simultaneous injection of dexamethasone implant and ranibizumab into vitreous cavity on macular edema secondary to central retinal vein occlusion. Front Med (Lausanne). 2022;9:874223. doi:10.3389/fmed.2022.874223