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Early peripheral laser photocoagulation of nonperfused retina improves vision in patients with central retinal vein occlusion (Results of a proof of concept study)

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To evaluate the effect of combination of ranibizumab and laser photocoagulation to peripheral retinal areas of nonperfusion in patients with non-ischemic central retinal vein occlusion (CRVO) without neovascularizations.

Methods

This prospective, proof of concept study randomized 22 CRVO patients into two arms. The RL group (ranibizumab + laser; n = 10) received ranibizumab with additive laser photocoagulation; the control R group (n = 12) was treated with ranibizumab only. All patients received three initial monthly ranibizumab injections followed by PRN regimen. Changes in best corrected visual acuity (BCVA) and in central retinal thickness (CRT) were documented over 6 months.

Results

Median of BCVA improved in the RL group from 65 ETDRS letters (interquartile range IQR = 10 letters) at baseline to 70 (IQR = 23.2) letters at month 6. In the control group BCVA remained stable [baseline: 61 (IQR = 19.5) and month 6: 61 (IQR = 22) letters]. CRT decreased between baseline and final visit in the RL group from 547 (IQR = 513) μm to 246.5 (IQR = 346.3) μm, and in the control group from 637.5 (IQR = 344) μm to 423 (IQR = 737) μm. More pronounced improvements in BCVA were seen in the RL group (medians = 14 vs. 6.5 letters) although the observed group differences were not statistically significant due to small samples.

Conclusions

The selective laser photocoagulation of peripheral areas of nonperfusion seems to lead to additional visual improvement in patients with CRVO. A larger replication trial is necessary to confirm the results of this proof of concept study.

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References

  1. Rogers S, McIntosh RL, Cheung N, Lim L, Wang JJ, Mitchell P, Kowalski JW, Nguyen H, Wong TY, International Eye Disease Consortium (2010) The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology 17:313–319

    Article  Google Scholar 

  2. Rehak M, Wiedemann P (2010) Retinal vein thrombosis: pathogenesis and management. J Thromb Haemost 8:1886–1894

    Article  CAS  PubMed  Google Scholar 

  3. Hayreh SS, Zimmerman MB (2012) Ocular neovascularization associated with central and hemicentral retinal vein occlusion. Retina 32:1553–1565

    Article  PubMed  Google Scholar 

  4. Boyd SR, Zachary I, Chakravarthy U, Allen GJ, Wisdom GB, Cree IA, Martin JF, Hykin PG (2002) Correlation of increased vascular endothelial growth factor with neovascularization and permeability in ischemic central vein occlusion. Arch Ophthalmol 120:1644–1645

    Article  CAS  PubMed  Google Scholar 

  5. Koss MJ, Pfister M, Rothweiler F, Michaelis M, Cinatl J, Schubert R, Koch FH (2012) Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion. Acta Ophthalmol 90:e98–e103

    Article  PubMed  Google Scholar 

  6. Gallego-Pinazo R, Dolz-Marco R, Díaz-Llopis M (2012) Ranibizumab is not bevacizumab for retinal vein occlusions. Graefes Arch Clin Exp Ophthalmol 250:955–956

    Article  PubMed  Google Scholar 

  7. Ramezani A, Esfandiari H, Entezari M, Moradian S, Soheilian M, Dehsarvi B, Yaseri M (2012) Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 250:1149–1160

    Article  CAS  PubMed  Google Scholar 

  8. Campochiaro PA, Brown DM, Awh CC, Lee SY, Gray S, Saroj N, Murahashi WY, Rubio RG (2011) Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology 118:2041–2049

    Article  PubMed  Google Scholar 

  9. Rehak M, Hollborn M, Iandiev I, Pannicke T, Karl A, Wurm A, Kohen L, Reichenbach A, Wiedemann P, Bringmann A (2009) Retinal gene expression and Müller cell responses after branch retinal vein occlusion in the rat. Invest Ophthalmol Vis Sci 5:2359–2367

    Article  Google Scholar 

  10. Noma H, Funatsu H, Mimura T, Eguchi S, Shimada K (2011) Role of soluble vascular endothelial growth factor receptor-2 in macular oedema with central retinal vein occlusion. Br J Ophthalmol 95:788–792

    Article  PubMed  Google Scholar 

  11. Spaide RF (2011) Peripheral areas of nonperfusion in treated central retinal vein occlusion as imaged by wide-field fluorescein angiography. Retina 31:829–837

    Article  PubMed  Google Scholar 

  12. Tsui I, Kaines A, Havunjian MA, Hubschman S, Heilweil G, Prasad PS, Oliver SC, Yu F, Bitrian E, Hubschman JP, Friberg T, Schwartz SD (2011) Ischemic index and neovascularization in central retinal vein occlusion. Retina 31:105–110

    Article  PubMed  Google Scholar 

  13. Stefánsson E (2001) The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology. Acta Ophthalmol Scand 79:435–440

    Article  PubMed  Google Scholar 

  14. Spaide RF (2013) Prospective study of peripheral panretinal photocoagulation of areas of nonperfusion in central retinal vein occlusion. Retina 33:56–62

    Article  PubMed  Google Scholar 

  15. The Central Vein Occlusion Study Group (1995) A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. Ophthalmology 102:1434–1444

    Article  Google Scholar 

  16. Jaissle GB, Szurman P, Bartz-Schmidt K (2005) Recommendation for the procedure of intravitreal injections of the German Retina Society, the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Klin Monatsbl Augenheilkd 222:390–395

    Article  CAS  PubMed  Google Scholar 

  17. Drechsler F, Köferl P, Hollborn M, Wiedemann P, Bringmann A, Kohen L, Rehak M (2012) Effect of intravitreal anti-vascular endothelial growth factor treatment on the retinal gene expression in acute experimental central retinal vein occlusion. Ophthalmic Res 47:157–162

    Article  CAS  PubMed  Google Scholar 

  18. Heier JS, Campochiaro PA, Yau L, Li Z, Saroj N, Rubio RG, Lai P (2012) Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology 119:802–809

    Article  PubMed  Google Scholar 

  19. Campochiaro PA, Bhisitkul RB, Shapiro H, Rubio RG (2013) Vascular endothelial growth factor promotes progressive retinal nonperfusion in patients with retinal vein occlusion. Ophthalmology 120:795–802

    Article  PubMed  Google Scholar 

  20. Shimura M, Yasuda K, Nakazawa T, Takeshita T, Shiono T, Sakamoto T (2010) Combination therapy for retinal vein occlusion. Ophthalmology 117:1858e1–1858e3

    Google Scholar 

  21. Goldenberg-Cohen N, Dadon S, Avraham BC, Kramer M, Hasanreisoglu M, Eldar I, Weinberger D, Bahar I (2008) Molecular and histological changes following central retinal artery occlusion in a mouse model. Exp Eye Res 87:327–333

    Article  CAS  PubMed  Google Scholar 

  22. Tolentino MJ, Miller JW, Gragoudas ES, Jakobiec FA, Flynn E, Chatzistefanou K, Ferrara N, Adamis AP (1996) Intravenous injections of vascular endothelial growth factor produce retinal ischemia and microangiopathy in an adult primate. Ophthalmology 103:1820–1828

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest

The authors have no conflicts of interest that are relevant to the content of this manuscript. The clinical trial received grant support from the Clinical Trial Centre Leipzig, which is supported by the Federal Ministry of Education and Research (Bundesministerium fur Bildung und Forschung, BMBF) FKZ 01KN1102, and has been supported by Novartis Pharma Germany.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany

    Matus Rehak, Eric Tilgner, Franziska G. Rauscher & Peter Wiedemann

  2. Clinical Trial Centre (ZKS) Leipzig, University of Leipzig, Leipzig, Germany

    Annegret Franke & Oana Brosteanu

Authors
  1. Matus Rehak
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  2. Eric Tilgner
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  3. Annegret Franke
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  4. Franziska G. Rauscher
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  5. Oana Brosteanu
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  6. Peter Wiedemann
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Corresponding author

Correspondence to Peter Wiedemann.

Additional information

EudraCT 2010-020441-27, and in the German Clinical Trials Register DRKS00000711

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Rehak, M., Tilgner, E., Franke, A. et al. Early peripheral laser photocoagulation of nonperfused retina improves vision in patients with central retinal vein occlusion (Results of a proof of concept study). Graefes Arch Clin Exp Ophthalmol 252, 745–752 (2014). https://doi.org/10.1007/s00417-013-2528-8

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  • DOI: https://doi.org/10.1007/s00417-013-2528-8

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