Effects of intravitreal anti-vascular endothelial growth factor treatment on retinal vasculature in retinal vein occlusion as determined by ultra wide-field fluorescein angiography.
OBJECTIVE
To investigate both peripheral and central retinal vascular changes after intravitreal anti-vascular endothelial growth factor (VEGF) therapy in the setting of acute retinal vein occlusion (RVO).


METHODS
Two patients with macular edema, one secondary to central RVO (CRVO) and one secondary to branch RVO (BRVO), underwent ultra wide-field (200°) photography and fluorescein angiography before and after a single intravitreal injection of an anti-VEGF agent. The patient with CRVO received an intravitreal injection of ranibizumab (0.5 mg/0.05 mL). The patient with BRVO received an intravitreal injection of bevacizumab (1.25 mg/0.05 mL). The eye with CRVO was reevaluated with ultra wide-field photography and fluorescein angiography at 7 days and 35 days after treatment. The eye with BRVO was reevaluated with ultra wide-field photography and fluorescein angiography at 30 days after treatment. Photographs and fluorescein angiographic results were analyzed for posttreatment changes in arteriovenous transit time, vessel caliber, vessel leakage, peripheral capillary nonperfusion, retinal hemorrhages, and nerve fiber layer infarcts.


RESULTS
In both eyes, there were no changes detected in the arteriovenous transit time or peripheral capillary nonperfusion after anti-VEGF therapy. A reduction in intraretinal hemorrhages and nerve fiber layer infarcts was observed at 7 days and 35 days after treatment in the patient with CRVO and at 30 days after treatment in the patient with BRVO. A decrease in vessel caliber was observed at 7 days after treatment in the patient with CRVO and at 30 days after treatment in the patient with BRVO. In the patient with CRVO, an increase in vessel caliber with a recurrence of vascular leakage was noted at the visit on Day 35.


CONCLUSIONS
Anti-VEGF therapy in the setting of RVO may initially decrease vessel caliber, retinal hemorrhages, and nerve fiber layer infarcts but does not appear to affect arteriovenous transit time or areas of peripheral capillary nonperfusion after a single treatment. The beneficial effects of anti-VEGF therapy in RVO appear transient, and multiple injections may be required for control of macular edema. Ultra wide-field angiography can be a useful tool in monitoring the treatment of RVO.
From the *Vitreous Retina Macula Consultants of New York, New York, New York; †LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; and ‡Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York.
Sushma K
SK
Vance
Louis K
LK
Chang
Yutaka
Y
Imamura
K Bailey
KB
Freund