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


METHODS
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.
Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Raafay
R
Sophie
Gulnar
G
Hafiz
Adrienne W
AW
Scott
Ingrid
I
Zimmer-Galler
Quan Dong
QD
Nguyen
Howard
H
Ying
Diana V
DV
Do
Sharon
S
Solomon
Akrit
A
Sodhi
Peter
P
Gehlbach
Elia
E
Duh
David
D
Baranano
Peter A
PA
Campochiaro
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D010211:Papilledema / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D000069579:Ranibizumab; D012008:Recurrence; D012169:Retinal Vein / Q000473:pathology; D012170:Retinal Vein Occlusion / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D019233:Retreatment; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab