title: Ranibizumab for Branch Retinal Vein Occlusion Associated Macular Edema Study (RABAMES): six-month results of a prospective randomized clinical trial.
abstract: OBJECTIVE
  To compare standard-of-care grid laser photocoagulation versus intravitreal ranibizumab (IVR) versus a combination of both in the treatment of chronic (>3 months) macular oedema secondary to branch retinal vein occlusion.
  
  
  METHODS
  Prospective, randomized, multicentre clinical trial. Thirty patients with a best-corrected visual acuity (BCVA) between 20/320 and 20/40 were randomized 1:1:1 to receive grid laser or three monthly injections of 0.5 mg IVR or both followed by 3 months of observation.
  
  
  RESULTS
  Mean change from baseline BCVA at month 6 was +2 letters [laser; 0.04 logMAR, 95% confidence interval (-0.17; 0.25)], +17 letters [IVR; 0.34 (0.19; 0.5)] and +6 letters [combination; 0.12 (0.01; 0.24)] (IVR versus laser p = 0.02 and IVR versus combination p = 0.02). At month 3, mean improvement in central retinal thickness (CRT) was 90.6 μm (laser) (-18.65; 199.8), 379.5 μm (IVR) (204.2; -554.8), and 248 μm (167.2; -328.8) (combination) (IVR versus laser p = 0.005, laser versus combination p = 0.02). During the observation period, CRT improved in laser [37.6 μm (-66.82; 142.0)], but deteriorated in IVR [-142.4 μm (-247.6; -37.16)] and combination [-171.7 μm (-250.4; -92.96)] (laser versus IVR p = 0.01, laser versus combination p = 0.002) indicating recurrent oedema. Less laser retreatments (at 8 weeks) were required in combination group (2/10) than grid group (7/10).
  
  
  CONCLUSIONS
  Six-month results suggest that ranibizumab may be superior to grid laser in improving visual acuity. Grid combined with IVR neither enhanced functional and morphological improvement of IVR nor did it prevent or prolong recurrence of oedema. In IVR groups, CRT increased slowly after stopping injections, whereas improvement in visual acuity was sustained, indicating that morphological changes occur prior to functional impairment.
authors.affiliation: Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Eye Hospital, Hannover Medical School, Hannover, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Pielen
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshahi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Feltgen
authors.forename: Katrin
authors.initials: K
authors.lastname: Lorenz
authors.forename: Christina
authors.initials: C
authors.lastname: Korb
authors.forename: Bernd
authors.initials: B
authors.lastname: Junker
authors.forename: Caroline
authors.initials: C
authors.lastname: Schaefer
authors.forename: Isabella
authors.initials: I
authors.lastname: Zwiener
authors.forename: Lars-Olof
authors.initials: LO
authors.lastname: Hattenbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D008269:Macular Edema / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab; D012008:Recurrence; D012170:Retinal Vein Occlusion / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab
keywords: anti-VEGF; branch retinal vein occlusion; grid laser; intravitreal injections; macular oedema; ranibizumab