title: [Comparison of early management of central retinal vein occlusion with ranibizumab versus hemodilution].
abstract: OBJECTIVE
  This study was designed to evaluate and compare the efficacy of early treatment of CRVO with either hemodilution by erythrocytopheresis or intravitreal (IVT) ranibizumab, or both.
  
  
  METHODS
  A multicentric prospective randomized study including patients with CRVO for less than 1 month was designed. Patients were randomized into 3 treatment groups: hemodilution (HD group), 3 monthly intravitreal injections of ranibizumab followed by PRN treatment (IVT group), or combined treatment (IVT+HD group). A monthly evaluation during a 6-month follow-up included best-corrected visual acuity (BCVA) and macular thickness measurements with OCT. Fluorescein angiography was performed at baseline, month 2 and month 6. Local and systemic tolerability of the different treatments were also compared.
  
  
  RESULTS
  Forty-four CRVO patients were included between February 2010 and June 2013: 20 in the IVT group, 13 in the HD group and 11 in the HD+IVT group. The mean duration of CRVO at baseline was 10 days and 16 days at the time of treatment without any significant difference between groups. Retinal ischemia was present at baseline in 40% of eyes in each group. After a 6-month follow-up, no difference between the 3 groups was observed in BCVA (10.5 ETDRS letters, 14.6 and 14.1 in the IVT group, HD group and IVT+HD group respectively, P=0.726) or in macular thickness (398 μ, 440 μ and 379 μ respectively, P=0.465). The time until treatment from CRVO onset, ranging from 1 to 35 days, was not correlated to final outcomes. No significant difference in the mean number of IVT (3.2 in the IVT+HD group vs 3.7 in the IVT group) was observed at 6 months.
  
  
  CONCLUSIONS
  No difference in BCVA nor in macular thickness was seen at M6 between the study groups. The duration of CRVO at the time of the initiation of the treatment was not correlated to better visual outcomes. Therefore, etiologic treatment with HD can still be proposed as a first-line treatment in young patients, which allows delaying or avoiding the IVT treatment and its potential side effects. Anti-VEGF IVT still remains an effective option in every case and can be started one month after the beginning of the CRVO.
authors.affiliation: Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France. Electronic address: martingraber@sfr.fr.
authors.forename: M
authors.initials: M
authors.lastname: Graber
authors.affiliation: Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors.forename: A
authors.initials: A
authors.lastname: Glacet-Bernard
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Fardeau
authors.affiliation: Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors.forename: N
authors.initials: N
authors.lastname: Massamba
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Atassi
authors.affiliation: Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors.forename: O
authors.initials: O
authors.lastname: Rostaqui
authors.affiliation: Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors.forename: F
authors.initials: F
authors.lastname: Coscas
authors.affiliation: Groupe hospitalier Pitié-Salpêtrière, université Paris VI, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Le Hoang
authors.affiliation: Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France.
authors.forename: E H
authors.initials: EH
authors.lastname: Souied
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D061345:Early Medical Intervention; D005260:Female; D006438:Hemodilution; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab / Q000627:therapeutic use*; D012170:Retinal Vein Occlusion / Q000628:therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab
keywords: Central retinal vein occlusion; Combined treatment; Early treatment; Erythrocytopheresis; Hemodilution; Hémodilution; IVT; Intravitreal injection; Ischémie rétinienne; Neovascularization; Néovascularisation; Occlusion de la veine centrale de la rétine; Ranibizumab; Retinal ischemia; Thérapie combinée; Traitement précoce; Érythrocytaphérèse