Original Article Comparative Evaluation Between Ranibizumab Combined with Laser and Bevacizumab Combined with Laser Versus Laser Alone for Macular Oedema Secondary to Branch Retinal Vein Occlusion Shorya Vardhan Azad, Amjad Salman1, Deepankur Mahajan, Siddharth Sain, Rajvardhan Azad
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ABSTRACT Purpose: To evaluate the anatomical and functional efficacy of combination therapy of intravitreal ranibizumab with laser or intravitreal bevacizumab with laser treatment compared to only laser treatment for macular edema due to branch retinal vein occlusion (BRVO). Materials and Methods: Thirty eyes of 30 patients with BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received a single dose of intravitreal Ranibizumab followed by grid laser treatment, Group 2 received a single dose of intravitreal Bevacizumab followed by grid laser treatment, and Group 3 received grid laser alone. Outcomes at 6 months follow-up were reported. Data were collected on best corrected visual acuity (BCVA), central foveal thickness (CFT), and gain in lines of Snellen acuity. Results: At 6 month follow‑up, the difference in the mean BCVA and CFT between the three treatment groups was not statistically significant (P > 0.05, all comparisons). Six eyes (60%) in Group 1, four eyes (40%) in Group 2 and two eyes (20%) in Group 3 had a statistically significant gain of ≥3 lines of Snellen acuity (P 0.05 all comparisons). Visual outcomes
The mean BCVA in the three inter ventional groups was assessed at baseline (presentation), and 1 month, 3 months, and 6 months after intervention [Figure 1]. At baseline, there were no statistically significant differences in the mean BCVA (decimal notation) between Group 1, Group 2 and
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
297
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion
Group 3 (0.177 ± 0.085, 0.1663 ± 0.103 and 0.21 ± 0.12, respectively) (P > 0.05 all comparisons). The same trend was observed at each of the subsequent follow‑up visits. At one month follow‑up, the mean BCVA (decimal notation) in Group 1, Group 2, and Group 3 was 0.397 ± 0.17, 0.365 ± 0.23 and 0.38 ± 0.28, respectively (P > 0.05, all comparisons). At the third months follow‑up, the mean BCVA (decimal notation) in Group 1, Group 2, and Group 3 treatment groups was 0.423 + 0.13, 0.337 ± 0.23 and 0.399 ± 0.28, respectively (P > 0.05, all comparisons). At the sixth months follow‑up, the mean BCVA (decimal notation) in Group 1, Group 2, and Group 3 was 0.44 ± 0.12, 0.38 ± 0.21 and 0.399 ± 0.28, respectively (P > 0.05, all comparisons). Visual gain in Snellen acuity in terms of additional lines (compared to baseline) was evaluated compared to baseline out to six months [Table 1]. At 1 month after intervention, 6 of 10 (60%) eyes in Group 1, 3 of 10 (30%) eyes in Group 2 and 2 of 10 (20%) eyes in Group 3 showed a visual gain of ≥3 lines on Snellen acuity (compared to baseline). These intergroup differences were statistically significant (P 0.05, all comparisons). The same trend was observed at each of the subsequent follow‑up visits. At the 1 month follow‑up visit, the mean CFT in Group 1, Group 2, and Group 3 was 236.6 ± 126.37 microns, 254.3 ± 106.9 microns and 274.1 ± 83.41 microns respectively (P > 0.05, all comparisons). At the 3 months follow‑up visit, the mean CFT in Group 1, Group 2 and Group 3 was 216.0 ± 69.12 microns, 284.7 ± 130.4 microns and 207.2 ± 39.52 microns, respectively (P > 0.05, all comparisons). At 6 months following intervention, the mean CFT in Group 1, Group 2 and Group 3 was 216.2 ± 63.85 microns, 241.0 ± 88.9 microns and 204.1 ± 38.34 microns respectively (P > 0.05, all comparisons) [Figures 3‑5].
DISCUSSION BRVO is the one of the most common cause of retinal pathology after diabetic retinopathy. In most patients, macular edema is the
Figure 2: Changes in the mean retinal thickness measured with optical coherence tomography in the three groups over 6 months following treatment
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion
Figure 3: Changes in the fundus, fluorescein angiography and optical coherence tomography in Group 1 at 1, 3, and 6 months follow up
Figure 4: Changes in the fundus, fluorescein angiography and optical coherence tomography in Group 2 at 1, 3, and 6 months follow up
predominant cause of visual loss although severe non‑perfusion of perifoveal capillaries is an additional cause of reduced vision. Elevated intraocular levels of VEGF have been demonstrated in eyes with BRVO and this has been linked to vascular leakage.19 Thus, there is a strong rationale for using VEGF antagonists such as ranibizumab and bevacizumab in eyes with macular edema following BRVO. The natural history of macular edema secondary to BRVO was delineated in the Branch Vein Occlusion Study (BVOS).9 BVOS also demonstrated a benefit with grid photocoagulation in eyes with BRVO of 3-18 months duration and visual acuity 20/40-20/200.9 Treated eyes were more likely to gain 2 lines of visual acuity (65%) compared to untreated eyes (37%).9
Furthermore, treated eyes were more likely to have 20/40 or better vision at 3 years follow-up (60% vs 34% untreated), with a mean visual acuity improvement of 1.3 lines ETDRS versus 0.2 lines in the untreated group.9 Although the effect of anti‑VEGF agents is very rapid and dramatic, the effect is short‑lived and repeated injections are required which increases the cost of treatment. If the prolonged effects of laser (i.e. sustained stoppage of vascular leakage as compared to the temporary effects of intravitral injections) can be combined with the rapid effect of intravitreal injections of anti‑VEGF agents, then it not only reduces the number of intravitreal injections but also reduces the financial burden of treatment, which is very important in developing countries such as India.
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
299
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion
Figure 5: Changes in the fundus, fluorescein angiography and optical coherence tomography in Group 3 at 1, 3, and 6 months follow up
The largest study to date involving ranibizumab for macular edema following BRVO (BRAVO study) found that an intraocular injection of 0.3 or 0.5 mg of ranibizumab provided a rapid, effective treatment for macular edema due to BRVO.14 The BRAVO study utilized a monthly injection of ranibizumab for 6 months, with an option of rescue laser beginning from three months, if eligible. 14 Rescue laser eligibility was defined as clearing of hemorrhage with visual acuity of 250 microns.14 In the present study however, a different protocol was used. All patients received anti‑VEGF agents at the first visit, followed by laser after 7-10 days as soon maximal effect of anti‑VEGF agent was expected. This was performed on the following two premises; first, to reduce the number of intravitreal injections required, thereby reducing the cost of treatment and circumventing potential adverse effects of intravitreal injections; secondly, to provide a reduction in vascular leakage by photocoagulating the areas of leakage to create a prolonged and sustained effect. The degree of improvement in visual acuity and reduction in CFT in the present study, where intravitreal ranibizumab was used was comparable to the BRAVO study14 despite different treatment protocols between studies. Although several studies have found intravitreal bevacizumab to be effective in reducing macular edema secondary to BRVO, to our knowledge no study has compared the efficacy of intravitreal ranibizumab and bevacizumab. Intravitreal ranibizumab appeared more effective than bevacizumab in terms of ≥3 line visual gain of Snellen acuity at the 1 month, 3 months, and 6 months follow‑up visits [Table 1]. However reduction in CFT in patients treated with ranibizumab, compared to patients treated with bevacizumab and laser did not produce a statistically significant outcome. The reason for the slightly better results 300
with ranibizumab could be related to the smaller molecular size, allowing rapid penetration through the retinal layers as well as greater affinity for VEGF established by ranibizumab. However the small sample size in our study precludes a definitive conclusion about superiority of ranibizumab. Although laser is the current gold standard for treatment of macular edema due to BRVO, the BVOS9 study found a modest improvement in patients treated with laser photocoagulation. Laser treatment cannot be performed on patients with fresh venous occlusions owing to retinal hemorrhages and it takes several months for the haemorrhages to clear. During this time, severe retinal edema could compromise retinal cells leading to permanent structural damage. Both improvement in visual acuity and reduction in CFT appeared to be better in eyes that had received intravitreal ranibizumab therapy as compared to eyes treated with laser alone during the entire study. In conclusion, both ranibizumab and bevacizumab for macular edema due to BRVO resulted in a gain in visual acuity and a rapid reduction in intraretinal thickness. These anti‑VEGF agents could be combined with a more permanent treatment such as laser photocoagulation, which would yield much better results than any single mode of treatment alone. However, a larger sample size and longer follow up to evaluate the observations of this study.
REFERENCES 1. 2.
Klein R. Retinopathy in population based study. Trans Am Ophthalmol Soc 1992;90:561‑94. Gewaily D, Greenberg PB. Intravitreal steroids versus macular
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion edema secondary to central vein occlusion. Cochrane Database Syst Rev 2009;1:CD007324. 3. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten‑year incidence of retinal vein occlusion in an older population: The Blue Mountains Eye Study. Arch Ophthalmol 2006;124:726‑32. 4. Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, et al. The Framingham Eye Study I: Outline and major prevalence findings. Am J Epidemiol 1977;106:17‑32. 5. Klein R, Moss SE, Meuer SM, Klein BE. The 15‑year cumulative incidence of retinal vein occlusion: The Beaver Dam Eye Study. Arch Ophthalmol 2008;126:513‑8. 6. Rehak J, Rehak M. Branch retinal vein occlusion: Pathogenesis, visual prognosis, and treatment modalities. Curr Eye Res 2008;33:111‑31. 7. Noma H, Funatsu H, Yamasaki M, Tsukamoto H, Mimura T, Sone T, et al. Pathogenesis of macular edema with branch retinal vein occlusion and intraocular levels of vascular endothelial growth factor and interleukin‑6. Am J Ophthalmol 2005;140:256‑61. 8. Chahal PS, Fallon TJ, Kohner EM. Measurement of blood‑retinal barrier function in central retinal vein occlusion. Arch Ophthalmol 1986;104:554‑7. 9. Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group. Am J Ophthalmol 1984;98:271‑82. 10. Scott IU, Ip MS, Van Veldhuisen PC, Oden NL, Blodi BA, Fisher M, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion: The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6. Study Research Group. Arch Ophthalmol 2009;127:1115‑28. 11. Prager F, Michels S, Kriechbaum K, Georgopoulos M, Funk M, Geitzenauer W, et al. Intravitreal bevacizumab (Avastin) for macular oedema secondary to retinal vein occlusion: 12‑month results of a prospective clinical trial. Br J Ophthalmol 2009;93:452‑6. 12. Jaissle GB, Leitritz M, Gelisken F, Ziemssen F, Bartz‑Schmidt KU,
13.
14.
15.
16.
17.
18.
19.
Szurman P. One‑year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2009;247:27‑33. Wong I, Koo S, Chan C. Effect of intravitreal bevacizumab (IVB) in treating macular edema secondary to branch retinal vein occlusion (BRVO). Retina 2010;30:710. Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC, et al. Ranibizumab for macular edema following branch retinal vein occlusion: Six‑month primary end point results of a phase III study. Ophthalmology 2010;117:1102‑12. Rouvas A, Petrou P, Ntouraki A, Douvali M, Ladas I, Vergados I. Intravitreal ranibizumab (Lucentis) for branch retinal vein occlusion‑induced macular edema: Nine‑month results of a prospective study. Retina 2010;30:893‑902. Mirshahi A, Roohipoor R, Lashay A, Mohammadi SF, Mansouri MR. Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion: A non‑randomised controlled clinical trial. Br J Ophthalmol 2005;89:64‑9. Noma H, Funatsu H, Mimura T, Eguchi S, Shimada K. Visual acuity and foveal thickness after vitrectomy for macular edema associated with branch retinal vein occlusion: A case series. BMC Ophthalmol 2010;10:11. Chung EJ, Freeman WR, Koh HJ. Visual acuity and multifocal electroretinographic changes after arteriovenous crossing sheathotomy for macular edema associated with branch retinal vein occlusion. Retina 2008;28:220‑5. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994;331:1480‑7.
Cite this article as: Azad SV, Salman A, Mahajan D, Sain S, Azad R. Comparative evaluation between ranibizumab combined with laser and bevacizumab combined with laser versus laser alone for macular oedema secondary to branch retinal vein occlusion. Middle East Afr J Ophthalmol 2014;21:296-301. Source of Support: Nil, Conflict of Interest: None declared.
Announcement
iPhone App A free application to browse and search the journal’s content is now available for iPhone/iPad. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is Compatible with iPhone, iPod touch, and iPad and Requires iOS 3.1 or later. The application can be downloaded from http://itunes.apple.com/us/app/medknow-journals/ id458064375?ls=1&mt=8. For suggestions and comments do write back to us. Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
301
Copyright of Middle East African Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Access this article online
ABSTRACT Purpose: To evaluate the anatomical and functional efficacy of combination therapy of intravitreal ranibizumab with laser or intravitreal bevacizumab with laser treatment compared to only laser treatment for macular edema due to branch retinal vein occlusion (BRVO). Materials and Methods: Thirty eyes of 30 patients with BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received a single dose of intravitreal Ranibizumab followed by grid laser treatment, Group 2 received a single dose of intravitreal Bevacizumab followed by grid laser treatment, and Group 3 received grid laser alone. Outcomes at 6 months follow-up were reported. Data were collected on best corrected visual acuity (BCVA), central foveal thickness (CFT), and gain in lines of Snellen acuity. Results: At 6 month follow‑up, the difference in the mean BCVA and CFT between the three treatment groups was not statistically significant (P > 0.05, all comparisons). Six eyes (60%) in Group 1, four eyes (40%) in Group 2 and two eyes (20%) in Group 3 had a statistically significant gain of ≥3 lines of Snellen acuity (P 0.05 all comparisons). Visual outcomes
The mean BCVA in the three inter ventional groups was assessed at baseline (presentation), and 1 month, 3 months, and 6 months after intervention [Figure 1]. At baseline, there were no statistically significant differences in the mean BCVA (decimal notation) between Group 1, Group 2 and
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
297
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion
Group 3 (0.177 ± 0.085, 0.1663 ± 0.103 and 0.21 ± 0.12, respectively) (P > 0.05 all comparisons). The same trend was observed at each of the subsequent follow‑up visits. At one month follow‑up, the mean BCVA (decimal notation) in Group 1, Group 2, and Group 3 was 0.397 ± 0.17, 0.365 ± 0.23 and 0.38 ± 0.28, respectively (P > 0.05, all comparisons). At the third months follow‑up, the mean BCVA (decimal notation) in Group 1, Group 2, and Group 3 treatment groups was 0.423 + 0.13, 0.337 ± 0.23 and 0.399 ± 0.28, respectively (P > 0.05, all comparisons). At the sixth months follow‑up, the mean BCVA (decimal notation) in Group 1, Group 2, and Group 3 was 0.44 ± 0.12, 0.38 ± 0.21 and 0.399 ± 0.28, respectively (P > 0.05, all comparisons). Visual gain in Snellen acuity in terms of additional lines (compared to baseline) was evaluated compared to baseline out to six months [Table 1]. At 1 month after intervention, 6 of 10 (60%) eyes in Group 1, 3 of 10 (30%) eyes in Group 2 and 2 of 10 (20%) eyes in Group 3 showed a visual gain of ≥3 lines on Snellen acuity (compared to baseline). These intergroup differences were statistically significant (P 0.05, all comparisons). The same trend was observed at each of the subsequent follow‑up visits. At the 1 month follow‑up visit, the mean CFT in Group 1, Group 2, and Group 3 was 236.6 ± 126.37 microns, 254.3 ± 106.9 microns and 274.1 ± 83.41 microns respectively (P > 0.05, all comparisons). At the 3 months follow‑up visit, the mean CFT in Group 1, Group 2 and Group 3 was 216.0 ± 69.12 microns, 284.7 ± 130.4 microns and 207.2 ± 39.52 microns, respectively (P > 0.05, all comparisons). At 6 months following intervention, the mean CFT in Group 1, Group 2 and Group 3 was 216.2 ± 63.85 microns, 241.0 ± 88.9 microns and 204.1 ± 38.34 microns respectively (P > 0.05, all comparisons) [Figures 3‑5].
DISCUSSION BRVO is the one of the most common cause of retinal pathology after diabetic retinopathy. In most patients, macular edema is the
Figure 2: Changes in the mean retinal thickness measured with optical coherence tomography in the three groups over 6 months following treatment
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion
Figure 3: Changes in the fundus, fluorescein angiography and optical coherence tomography in Group 1 at 1, 3, and 6 months follow up
Figure 4: Changes in the fundus, fluorescein angiography and optical coherence tomography in Group 2 at 1, 3, and 6 months follow up
predominant cause of visual loss although severe non‑perfusion of perifoveal capillaries is an additional cause of reduced vision. Elevated intraocular levels of VEGF have been demonstrated in eyes with BRVO and this has been linked to vascular leakage.19 Thus, there is a strong rationale for using VEGF antagonists such as ranibizumab and bevacizumab in eyes with macular edema following BRVO. The natural history of macular edema secondary to BRVO was delineated in the Branch Vein Occlusion Study (BVOS).9 BVOS also demonstrated a benefit with grid photocoagulation in eyes with BRVO of 3-18 months duration and visual acuity 20/40-20/200.9 Treated eyes were more likely to gain 2 lines of visual acuity (65%) compared to untreated eyes (37%).9
Furthermore, treated eyes were more likely to have 20/40 or better vision at 3 years follow-up (60% vs 34% untreated), with a mean visual acuity improvement of 1.3 lines ETDRS versus 0.2 lines in the untreated group.9 Although the effect of anti‑VEGF agents is very rapid and dramatic, the effect is short‑lived and repeated injections are required which increases the cost of treatment. If the prolonged effects of laser (i.e. sustained stoppage of vascular leakage as compared to the temporary effects of intravitral injections) can be combined with the rapid effect of intravitreal injections of anti‑VEGF agents, then it not only reduces the number of intravitreal injections but also reduces the financial burden of treatment, which is very important in developing countries such as India.
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
299
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion
Figure 5: Changes in the fundus, fluorescein angiography and optical coherence tomography in Group 3 at 1, 3, and 6 months follow up
The largest study to date involving ranibizumab for macular edema following BRVO (BRAVO study) found that an intraocular injection of 0.3 or 0.5 mg of ranibizumab provided a rapid, effective treatment for macular edema due to BRVO.14 The BRAVO study utilized a monthly injection of ranibizumab for 6 months, with an option of rescue laser beginning from three months, if eligible. 14 Rescue laser eligibility was defined as clearing of hemorrhage with visual acuity of 250 microns.14 In the present study however, a different protocol was used. All patients received anti‑VEGF agents at the first visit, followed by laser after 7-10 days as soon maximal effect of anti‑VEGF agent was expected. This was performed on the following two premises; first, to reduce the number of intravitreal injections required, thereby reducing the cost of treatment and circumventing potential adverse effects of intravitreal injections; secondly, to provide a reduction in vascular leakage by photocoagulating the areas of leakage to create a prolonged and sustained effect. The degree of improvement in visual acuity and reduction in CFT in the present study, where intravitreal ranibizumab was used was comparable to the BRAVO study14 despite different treatment protocols between studies. Although several studies have found intravitreal bevacizumab to be effective in reducing macular edema secondary to BRVO, to our knowledge no study has compared the efficacy of intravitreal ranibizumab and bevacizumab. Intravitreal ranibizumab appeared more effective than bevacizumab in terms of ≥3 line visual gain of Snellen acuity at the 1 month, 3 months, and 6 months follow‑up visits [Table 1]. However reduction in CFT in patients treated with ranibizumab, compared to patients treated with bevacizumab and laser did not produce a statistically significant outcome. The reason for the slightly better results 300
with ranibizumab could be related to the smaller molecular size, allowing rapid penetration through the retinal layers as well as greater affinity for VEGF established by ranibizumab. However the small sample size in our study precludes a definitive conclusion about superiority of ranibizumab. Although laser is the current gold standard for treatment of macular edema due to BRVO, the BVOS9 study found a modest improvement in patients treated with laser photocoagulation. Laser treatment cannot be performed on patients with fresh venous occlusions owing to retinal hemorrhages and it takes several months for the haemorrhages to clear. During this time, severe retinal edema could compromise retinal cells leading to permanent structural damage. Both improvement in visual acuity and reduction in CFT appeared to be better in eyes that had received intravitreal ranibizumab therapy as compared to eyes treated with laser alone during the entire study. In conclusion, both ranibizumab and bevacizumab for macular edema due to BRVO resulted in a gain in visual acuity and a rapid reduction in intraretinal thickness. These anti‑VEGF agents could be combined with a more permanent treatment such as laser photocoagulation, which would yield much better results than any single mode of treatment alone. However, a larger sample size and longer follow up to evaluate the observations of this study.
REFERENCES 1. 2.
Klein R. Retinopathy in population based study. Trans Am Ophthalmol Soc 1992;90:561‑94. Gewaily D, Greenberg PB. Intravitreal steroids versus macular
Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
Azad, et al.: Combination Therapy in Macular Oedema Secondary to Branch Retinal Vein Occlusion edema secondary to central vein occlusion. Cochrane Database Syst Rev 2009;1:CD007324. 3. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten‑year incidence of retinal vein occlusion in an older population: The Blue Mountains Eye Study. Arch Ophthalmol 2006;124:726‑32. 4. Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, et al. The Framingham Eye Study I: Outline and major prevalence findings. Am J Epidemiol 1977;106:17‑32. 5. Klein R, Moss SE, Meuer SM, Klein BE. The 15‑year cumulative incidence of retinal vein occlusion: The Beaver Dam Eye Study. Arch Ophthalmol 2008;126:513‑8. 6. Rehak J, Rehak M. Branch retinal vein occlusion: Pathogenesis, visual prognosis, and treatment modalities. Curr Eye Res 2008;33:111‑31. 7. Noma H, Funatsu H, Yamasaki M, Tsukamoto H, Mimura T, Sone T, et al. Pathogenesis of macular edema with branch retinal vein occlusion and intraocular levels of vascular endothelial growth factor and interleukin‑6. Am J Ophthalmol 2005;140:256‑61. 8. Chahal PS, Fallon TJ, Kohner EM. Measurement of blood‑retinal barrier function in central retinal vein occlusion. Arch Ophthalmol 1986;104:554‑7. 9. Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group. Am J Ophthalmol 1984;98:271‑82. 10. Scott IU, Ip MS, Van Veldhuisen PC, Oden NL, Blodi BA, Fisher M, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion: The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6. Study Research Group. Arch Ophthalmol 2009;127:1115‑28. 11. Prager F, Michels S, Kriechbaum K, Georgopoulos M, Funk M, Geitzenauer W, et al. Intravitreal bevacizumab (Avastin) for macular oedema secondary to retinal vein occlusion: 12‑month results of a prospective clinical trial. Br J Ophthalmol 2009;93:452‑6. 12. Jaissle GB, Leitritz M, Gelisken F, Ziemssen F, Bartz‑Schmidt KU,
13.
14.
15.
16.
17.
18.
19.
Szurman P. One‑year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2009;247:27‑33. Wong I, Koo S, Chan C. Effect of intravitreal bevacizumab (IVB) in treating macular edema secondary to branch retinal vein occlusion (BRVO). Retina 2010;30:710. Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC, et al. Ranibizumab for macular edema following branch retinal vein occlusion: Six‑month primary end point results of a phase III study. Ophthalmology 2010;117:1102‑12. Rouvas A, Petrou P, Ntouraki A, Douvali M, Ladas I, Vergados I. Intravitreal ranibizumab (Lucentis) for branch retinal vein occlusion‑induced macular edema: Nine‑month results of a prospective study. Retina 2010;30:893‑902. Mirshahi A, Roohipoor R, Lashay A, Mohammadi SF, Mansouri MR. Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion: A non‑randomised controlled clinical trial. Br J Ophthalmol 2005;89:64‑9. Noma H, Funatsu H, Mimura T, Eguchi S, Shimada K. Visual acuity and foveal thickness after vitrectomy for macular edema associated with branch retinal vein occlusion: A case series. BMC Ophthalmol 2010;10:11. Chung EJ, Freeman WR, Koh HJ. Visual acuity and multifocal electroretinographic changes after arteriovenous crossing sheathotomy for macular edema associated with branch retinal vein occlusion. Retina 2008;28:220‑5. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994;331:1480‑7.
Cite this article as: Azad SV, Salman A, Mahajan D, Sain S, Azad R. Comparative evaluation between ranibizumab combined with laser and bevacizumab combined with laser versus laser alone for macular oedema secondary to branch retinal vein occlusion. Middle East Afr J Ophthalmol 2014;21:296-301. Source of Support: Nil, Conflict of Interest: None declared.
Announcement
iPhone App A free application to browse and search the journal’s content is now available for iPhone/iPad. The application provides “Table of Contents” of the latest issues, which are stored on the device for future offline browsing. Internet connection is required to access the back issues and search facility. The application is Compatible with iPhone, iPod touch, and iPad and Requires iOS 3.1 or later. The application can be downloaded from http://itunes.apple.com/us/app/medknow-journals/ id458064375?ls=1&mt=8. For suggestions and comments do write back to us. Middle East African Journal of Ophthalmology, Volume 21, Number 4, October - December 2014
301
Copyright of Middle East African Journal of Ophthalmology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
