Comparison of Short-term Effects of Intravitreal Injection of Three Modalities on Central Retinal Vein Occlusion

Ji-Seong Jeong; Dong-Woo Lee; Byoung-Seon Kim; Woong-Sun Yoo; In Young Chung; Jong-Moon Park

doi:10.3341/jkos.2019.60.11.1072

Journal List > J Korean Ophthalmol Soc > v.60(11) > 1137323

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeong, Lee, Kim, Yoo, Chung, and Park: Comparison of Short-term Effects of Intravitreal Injection of Three Modalities on Central Retinal Vein Occlusion

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(11): 1072-1079.

Published online: 19 November 2019

DOI: https://doi.org/10.3341/jkos.2019.60.11.1072

Comparison of Short-term Effects of Intravitreal Injection of Three Modalities on Central Retinal Vein Occlusion

Ji-Seong Jeong, MD^1,², Dong-Woo Lee, MD^1,², Byoung-Seon Kim, MD^1,², Woong-Sun Yoo, MD^1,^2,³, In Young Chung, MD, PhD^1,^2,³, Jong-Moon Park, MD, PhD^1,^2,³

¹Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea.

²Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea.

³Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.

Address reprint requests to Jong-Moon Park, MD, PhD. Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea. Tel: 82-55-750-8171, Fax: 82-55-758-4158, parkjm@gnu.ac.kr

Received 22 May 2019 Revised 11 July 2019 Accepted 24 October 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the short-term effects of intravitreal bevacizumab alone, low-dose bevacizumab combined with low-dose triamcinolone injection, and intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in patients with macular edema following central retinal vein occlusion (CRVO).

Methods

The medical records of 70 patients (70 eyes) with macular edema secondary to CRVO were reviewed retrospectively. Of these, 25 eyes (IVB group) were injected with intravitreal bevacizumab, 23 eyes (intravitreal low-dose bevacizumab and triamcinolone injection [IVB+IVTA] group) were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL), and 20 eyes (intravitreal dexamethasone implant [IVD] group) were injected with an intravitreal dexamethasone implant. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) of treated eyes were measured before injection and at 1 month and 3 months after injection.

Results

Groups were similar in age and gender distribution. At 1 month, the CMT of all groups was significantly lower, and the BCVA of all groups had increased significantly in patients with CRVO; there were no significant differences among the three groups (p = 0.246, p = 0.974). At 3 months, the CMT and BCVA had improved significantly only in the IVD and IVB+IVTA groups; the short-term effect was comparable to the IVD group. IOP showed no significant change at 3 months after injection for all groups.

Conclusions

Considering various clinical variables in the treatment of macular edema associated with CRVO, intravitreal injection of bevacizumab, low-dose bevacizumab combined with triamcinolone, and dexamethasone implants may be used selectively.

Keywords: Bevacizumab, Dexamethasone, Intravitreal injections, Retinal vein occlusion, Triamcinolone

Figures and Tables

Figure 1

Changes of central macular thickness (CMT) among study groups during 3 months of follow up period. The CMT of all groups was decreased at postoperative 1 month and 3 months compared with baseline. IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant.

Figure 2

Comparison of central macular thickness (CMT) among study groups at postoperative 3 months. Note that the CMT of IVB group was increased significantly more than IVD and IVB+IVTA groups. IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant; Mo = month(s).

Figure 3

Changes of visual acuity among study groups during 3 months of follow up period. At postoperative 1 month, the best corrected visual acuity (BCVA) of all groups was increased significantly. At postoperative 3 months, the BCVA was significantly improved only in the intravitreal dexamethasone implant group compared with baseline. logMAR = logarithm of the minimal angle of resolution; IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection.

Figure 4

Changes of intraocular pressure (IOP) among study groups during 3 months of follow up period. The IOP showed no significant change at postoperative 3 months after injection in all three groups. IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant.

Table 1

Baseline and demographic characteristics

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

IVB = intravitreal bevacizumab injection; IVB+IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant; M:F = male:female; FA = fluorescein angiography; IVI = intravitreal injection; DM = diabetes mellitus; HTN = hypertension; CMT = central macular thickness; BCVA = best-corrected visual acuity; logMAR= logarithm of the minimal angle of resolution; IOP = intraocular pressure.

^*Kruskal-Wallis test.

Table 2

Comparison of CMT in the three groups

Values are presented as mean ± standard deviation.

IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant; CMT = central macular thickness; Post-op = postoperative.

^*Kruskal-Wallis test; ^†p-value compared with baseline, Wilcoxon signed rank test.

Table 3

Comparison of visual acuity in the three groups

Values are presented as mean ± standard deviation.

IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant; BCVA = best corrected visual acuity; logMAR = logarithm of the minimal angle of resolution; Post-op = postoperative.

^*Kruskal-Wallis test; ^†p-value compared with baseline, Wilcoxon signed rank test.

Table 4

Comparison of IOP in the three groups

Values are presented as mean ± standard deviation.

IOP = intraocular pressure; IVB = intravitreal bevacizumab injection; IVB + IVTA = intravitreal low-dose bevacizumab and triamcinolone injection; IVD = intravitreal dexamethasone implant; Post-op = postoperative.

^*Kruskal-Wallis test; ^†p-value compared with baseline, Wilcoxon signed rank test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

References

1. Rogers SL, McIntosh RL, Lim L, et al. Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology. 2010; 117:1094–1101.e5.

2. Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2000; 98:133–143.

3. McAllister IL. Central retinal vein occlusion: a review. Clin Exp Ophthalmol. 2012; 40:48–58.

4. Yoshimura T, Sonoda KH, Sugahara M, et al. Comprehensive analysis of inflammatory immune mediators in vitreoretinal diseases. PLoS One. 2009; 4:e8158.

5. The Central Vein Occlusion Study Group M report. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. Ophthalmology. 1995; 102:1425–1433.

6. Ip MS, Scott IU, VanVeldhuisen PC, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5. Arch Ophthalmol. 2009; 127:1101–1114.

7. Prager F, Michels S, Kriechbaum K, 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; 93:452–456.

8. Zhang H, Liu ZL, Sun P, Gu F. Intravitreal bevacizumab for treatment of macular edema secondary to central retinal vein occlusion: eighteen-month results of a prospective trial. J Ocul Pharmacol Ther. 2011; 27:615–621.

9. Brown DM, Campochiaro PA, Singh RP, et al. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010; 117:1124–1133.e1.

10. Korobelnik JF, Holz FG, Roider J, et al. Intravitreal aflibercept injection for macular edema resulting from central retinal vein occlusion: one-year results of the phase 3 GALILEO study. Ophthalmology. 2014; 121:202–208.

11. Heier JS, Clark WL, Boyer DS, et al. Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: two-year results from the COPERNICUS study. Ophthalmology. 2014; 121:1414–1420.e1.

12. Haller JA, Bandello F, Belfort R Jr, et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011; 118:2453–2460.

13. Yoon YH, Kim JW, Lee JY, et al. Dexamethasone intravitreal implant for early treatment and retreatment of macular edema related to branch retinal vein occlusion: the multicenter COBALT study. Ophthalmologica. 2018; 240:81–89.

14. Ehrlich R, Ciulla TA, Moss AM, Harris A. Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion: 6 months of follow-up. Graefes Arch Clin Exp Ophthalmol. 2010; 248:375–380.

15. Shin MH, Kang HJ, Seo JS, Chung IY. Combined low dose bevacizumab-triamcinolone versus bevacizumab single intravitreal injection for branch retinal vein occlusion. J Korean Ophthalmol Soc. 2018; 59:650–656.

16. Kim BS, Chung IY, Park JM, Han YS. Comparison of intravitreal bevacizumab alone injection and intravitreal combination low-dose bevacizumab-triamcinolone injection or diabetic macular edema. J Korean Ophthalmol Soc. 2014; 55:1155–1161.

17. Kim BJ, Kim HW, Han YS, et al. Comparison of bevacizumab and combined low-dose bevacizumab and triamcinolone in central retinal vein occlusion. J Korean Ophthalmol Soc. 2016; 57:438–444.

18. Kiire CA, Chong NV. Managing retinal vein occlusion. BMJ. 2012; 344:e499.

19. Tuuminen R, Loukovaara S. Increased intravitreal angiopoietin-2 levels in patients with retinal vein occlusion. Acta Ophthalmol. 2014; 92:e164–e165.

20. Jung SH, Kim KA, Sohn SW, Yang SJ. Association of aqueous humor cytokines with the development of retinal ischemia and recurrent macular edema in retinal vein occlusion. Invest Ophthalmol Vis Sci. 2014; 55:2290–2296.

21. Tuuminen R, Loukovaara S. High intravitreal TGF-β1 and MMP-9 levels in eyes with retinal vein occlusion. Eye (Lond). 2014; 28:1095–1099.

22. Ehlken C, Grundel B, Michels D, et al. Increased expression of angiogenic and inflammatory proteins in the vitreous of patients with ischemic central retinal vein occlusion. PLoS One. 2015; 10:e0126859.

23. Hsu J, Kaiser RS, Sivalingam A, et al. Intravitreal bevacizumab (avastin) in central retinal vein occlusion. Retina. 2007; 27:1013–1019.

24. Iturralde D, Spaide RF, Meyerle CB, et al. Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina. 2006; 26:279–284.

25. Matsumoto Y, Freund KB, Peiretti E, et al. Rebound macular edema following bevacizumab (Avastin) therapy for retinal venous occlusive disease. Retina. 2007; 27:426–431.

26. Choi SW, Kim HW, Yun IH. Intravitreal bevacizumab treatment of macular edema in central retinal vein occlusion. J Korean Ophthalmol Soc. 2010; 51:707–715.

27. Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology. 2003; 110:681–686.

28. Campochiaro PA, Nguyen QD, Hafiz G, et al. Aqueous levels of fluocinolone acetonide after administration of fluocinolone acetonide inserts or fluocinolone acetonide implants. Ophthalmology. 2013; 120:583–587.

29. Lee K, Jung H, Sohn J. Comparison of injection of intravitreal drugs with standard care in macular edema secondary to branch retinal vein occlusion. Korean J Ophthalmol. 2014; 28:19–25.

30. Ali RI, Kapoor KG, Khan AN, Gibran SK. Efficacy of combined intravitreal bevacizumab and triamcinolone for branch retinal vein occlusion. Indian J Ophthalmol. 2014; 62:396–399.

31. Cekiç O, Cakir M, Yazici AT, et al. A comparison of three different intravitreal treatment modalities of macular edema due to branch retinal vein occlusion. Curr Eye Res. 2010; 35:925–929.

32. Haritoglou C, Kook D, Neubauer A, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 2006; 26:999–1005.

33. Tano Y, Sugita G, Abrams G, Machemer R. Inhibition of intraocular proliferations with intravitreal corticosteroids. Am J Ophthalmol. 1980; 89:131–136.

34. Chang-Lin JE, Attar M, Acheampong AA, et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant. Invest Ophthalmol Vis Sci. 2011; 52:80–86.

TOOLS

Similar articles