For years, branch retinal vein occlusion is still a controversial disease in many aspects. An increasing amount of data is available regarding classification, pathogenesis, risk factors, natural history, and therapy of branch retinal vein occlusion. Some of the conclusions may even change our impression of branch retinal vein occlusion. It will be beneficial for our doctors to get a deeper understanding of this disease and improve the treatment skills. The aims of this review is to collect the information above and report new ideas especially from the past a few years.

/pdf/new-developments-in-the-classification-pathogenesis-risk-47mxq1qx73.pdf

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

SummaryWhat is known and objective
Therapeutic effects of anti-VEGF agents, corticosteroids and laser therapy have been previously examined for treating macular oedema secondary to branch and central retinal vein occlusion (BRVO and CRVO). However, anti-VEGF efficacy has not been previously compared to corticosteroid or laser therapy efficacy. We performed a meta-analysis to compare these treatments.

Methods
Pertinent publications were identified through comprehensive literature searches. Therapeutic effects were estimated using best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP). The Review Manager (version 5.3.5) was used to perform searches.

Results and discussion
Eleven randomized, controlled trials that included 1045 RVO patients were identified. For eyes with BRVO, anti-VEGF therapy improved BCVA significantly more than corticosteroid/laser therapy at 3 (P=.0002), 6 (P<.00001) and 12 months (P<.00001). For eyes with CRVO, this difference was only significant at 6 months (P=.002). The same was true when efficacy was examined using CRT at 3 and 6 months (BRVO: both P<.00001, CRVO 6 months: P=.02). Long-term efficacy of anti-VEGF agents was limited in eyes with BRVO and CRVO. Improvements in BCVA were similar at 1 and 3 months (P=.74), but BCVA decreased between 3 and 6 months (P=.03). In contrast, BCVA progressively decreased 1 and 6 months following corticosteroid/laser therapy (both P<.00001). Lastly, eyes that had been treated with anti-VEGF agents had significantly lower IOP changes than eyes treated with corticosteroids/laser 3 and 6 months after initiating therapy (both P<.00001).

What is new and conclusion
Anti-VEGF agents improve BCVA and reduce CRT more effectively and longer than corticosteroid/laser in eyes with RVO. Anti-VEGF agents also have a lower risk of elevating IOP. Additionally, anti-VEGF agents are more effective for treating BRVO than CRVO.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jcpt.12551

Comparison between anti-VEGF therapy and corticosteroid or laser therapy for macular oedema secondary to retinal vein occlusion: A meta-analysis.

Purpose: To study therapeutic efficacy of combination of intravitreal triamcinolone acetonide and intravitreal bevacizumab for treatment of macular edema associated with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Method: This prospective interventional study included 20 eyes of 20 patients with fresh retinal vein occlusion (RVO) of less than three months duration. Treatment involved intravitreal injection with 1.25 mg bevacizumab and 1mg triamcinolone acetonide. Result: The mean age of patients was 63.81 years. There were 10 patients each of BRVO and CRVO. Both groups showed significant improvement in mean baseline visual acuity, however BRVO patients fared better than CRVO patients at all visits. Mean baseline central macular thickness (CMT) in BRVO and CRVO patients was 381.70 microns, and 572.50 microns, respectively with mean reduction of 131.40 and 182.1 microns, respectively. This reduction was significant at all visits during the course of the follow-up. Rise in intraocular pressure (IOP) ≥ 21 mm Hg was found in 5 BRVO and 4 CRVO patients. Cataract development and progression was found 2 BRVO and 1 CRVO patient. There was no case of retinal detachment or endophthalmitis. Conclusion: Combined treatment with intravitreal bevacizumab and intravitreal triamcinolone acetonide causes structural and functional improvement in form of reduction of macular edema and improvement in visual acuity in eyes with both BRVO and CRVO.

/pdf/combined-treatment-with-intravitreal-bevacizumab-and-heo5tf4xyp.pdf

Combined Treatment with Intravitreal Bevacizumab and Intravitreal Triamcinolone in Retinal Vein Occlusion in Indian Eyes

PURPOSE To evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab. METHODS This retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later. RESULTS At the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively). CONCLUSIONS Unlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.

/pdf/natural-short-term-course-of-recurrent-macular-edema-4ze8b6za1y.pdf

Natural Short-term Course of Recurrent Macular Edema Following Intravitreal Bevacizumab Therapy in Branch Retinal Vein Occlusion.

Purpose: To report the effects and intraocular pressure (IOP) results of intravitreal injection of bevacizumab alone compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with central retinal vein occlusion. Methods: In total, 40 eyes of 40 patients diagnosed with central retinal vein occlusion were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL), and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness (CMT), and IOP of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. Results: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, CMT decreased significantly at 1 month, 2 months, and 3 months after injection (p 0.05). The BCVA, IOP, and CMT at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05). Conclusions: The CMT of both groups decreased significantly, and BCVA of both groups increased significantly in patients with central retinal vein occlusion. Injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of central retinal vein occlusion. J Korean Ophthalmol Soc 2016;57(3):438-444

https://synapse.koreamed.org/upload/SynapseData/PDFData/0035jkos/jkos-57-438.pdf

Comparison of Bevacizumab and Combined Low-dose Bevacizumab and Triamcinolone in Central Retinal Vein Occlusion

Branch retinal vein occlusion (BRVO) is the second most common major retinal vascular disease after diabetic retinopathy [1] Epidemiologic studies found that the prevalence of BRVO ranged from 03% [2] to 16% [3], and major risk factors for the condition were increasing age, hypertension, and co-existing cardiovascular disease [2-6]

Macular edema is a major cause of visual acuity loss attributable to BRVO [7-9] The Branch Vein Occlusion Study [7] found that grid photocoagulation was effective for treatment of macular edema The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) project showed that grid photocoagulation was the best option for standard care when used to treat macular edema secondary to BRVO [10]

In recent decades, several novel treatments for BRVO have been introduced in major studies such as the BRAVO [11] and GENOVA studies [12] However, the effects of such treatments remain unclear [1,9,13] Furthermore, the cited works did not mimic the true clinical situation in that intravitreal bevacizumab injections (IVBs) were consecutively administered over a 3-month period to form a loading dose, the treatment strategy to be adopted after initial treatment failure was not considered, and lastly, no study has compared intravitreal triamcinolone acetate, bevacizumab, and drug combination injections for the treatment of macular edema secondary to BRVO

In the present study, we reviewed the medical records of patients treated for visual loss caused by macular edema secondary to BRVO 1) to evaluate whether intravitreal triamcinolone acetate, bevacizumab, and a combination of triamcinolone and bevacizumab injections, with or without rescue laser therapy, improved visual acuity compared with standard care of the type administered in the SCORE study, and 2) to determine whether such treatment modalities reduced unfavorable outcomes in patients with macular edema caused by BRVO, compared with those of the SCORE study

https://synapse.koreamed.org/upload/SynapseData/PDFData/0065kjo/kjo-28-19.pdf

Comparison of Injection of Intravitreal Drugs with Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion

Objectives: To investigate patients with Proliferative Diabetic Retinopathy (PDR) using ultra-wide field fluorescein angiography (UWFA) images and to compare the detection rate of PDR progression using conventional seven standard field angiography (7SF) images. Methods: One hundred and one eyes of 67 patients with PDR who underwent fluorescein angiography using the Optos Optomap Panoramic 200A imaging system were included. Three hundred three images of 101 eyes at different time points (initial, Post-Panretinal Photocoagulation [PRP], and follow-up) were evaluated. In comparing 101 follow-up with 101 post-PRP images, we found newly developed Neovascularization (NNV) and newly developed non-perfusion (NNP) areas, which were then analyzed using two different methodologies: UWFA and 7SF. NNVs were counted while NNP area was measured in pixels using ImageJ software. Results: UWFA detected 21 eyes with NNV, which was approximately twice the number of eyes detected using 7SF (11 eyes). Ten eyes presented with NNV outside the 7SF area with apparently clean 7SF without NNV. UWFA detected 25 eyes with NNP areas, which was more than the six eyes detected using 7SF (19 eyes). Six eyes presented with NNP areas outside the 7SF, which were apparently fully perfused by 7SF. In addition, UWFA detected 2.59 times more NNP area than that by 7SF. Conclusion: Compared with conventional 7SF imaging, UWFA shows significantly improved retinal visualization and improves progression detection rates in patients with PDR.

/pdf/ultra-wide-field-angiography-improves-the-detection-of-2dj2xa35q7.pdf

Ultra-Wide Field Angiography Improves the Detection of Proliferative Diabetic Retinopathy Progression

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Comparison of Injection of Intravitreal Drugs with Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion

Ultra-Wide Field Angiography Improves the Detection of Proliferative Diabetic Retinopathy Progression