Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion
Branch retinal vein occlusion (BRVO) is one of the most common occurring retinal vascular abnormalities. The pathogenesis of BRVO is thought to involve both retinal vein compression and damage to the vessel wall, possibly leading to thrombus formation at sites where retinal arterioles cross retinal veins. The most common cause of visual loss in patients with BRVO is macular oedema (MO). Grid or focal laser photocoagulation has been shown to reduce the risk of visual loss and improve visual acuity (VA) in up to two thirds of individuals with MO secondary to BRVO, however, limitations to this treatment exist and newer modalities have suggested equal or improved efficacy. Recently, antiangiogenic therapy with anti-vascular endothelial growth factor (anti-VEGF) has been used successfully to treat MO resulting from a variety of causes. As elevated intraocular levels of VEGF have been demonstrated in patients with retinal vein occlusions there is a strong basis for the hypothesis that anti-VEGF agents may be beneficial in the treatment of vascular leakage and MO. To investigate the efficacy and safety of intravitreal anti-VEGF agents for preserving or improving vision in the treatment of MO secondary to BRVO. We searched CENTRAL of any prior treatment.
Available from: PubMed Central
- "Procedures for slowing vision deterioration include laser therapy for RVO, retrobulbar or intraocular injection of triamcinolone for macular edema, vitrectomy for vitreous hemorrhage, and drainage valve implantation for glaucoma. New anti-vascular endothelial growth factor agents have been tested for treatment of malformed vessels or macular edema complicated with RVO [24,48-50]. However, the association of RRH with other congenital vascular malformations, such as Sturge–Weber syndrome and macroaneurysm, continues to make it a challenging condition for doctors. "
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Retinal racemose hemangioma (RRH) is a rare congenital disorder that often co-occurs with other ocular complications. In this study, we present a case of RRH complicated with retinal vein obstruction in three branches and provide a review of ocular complications and associations with RRH.
One case of RRH is presented. Fundus examination, fluorescein angiography (FFA) and optical coherence tomography (OCT) of the patient identified Group 3 RRH complicated with retinal vein occlusions in the superotemporal, inferotemporal, and inferonasal branches. Macular edema, which causes visual impairment, was detected. A brief literature review was also presented. The PubMed database was searched for RRH or related keywords to find reports of ocular complications or associations published on or before Dec. 31, 2013. A total of 140 papers describing167 RRH cases were found. The mean age of diagnosis was 22.97 years. Ocular complications were mentioned in 32 (19.16%) cases. Retinal vein occlusion (46.88%) was the major ocular complication in RRH, followed by hemorrhage (34.38%). Eight (4.79%) cases were associated with other ocular diseases such as Sturge–Weber syndrome , Morning glory disc anomaly and macroaneurysm.
Although RRH is a relatively non-progressive condition, its complications may lead to vision loss and should be treated in time.
Available from: Marianne Levon Shahsuvaryan
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ABSTRACT: The reflectivity of optical coherence tomographic (OCT) images has been used to evaluate retinal diseases. The purpose of this study was to determine whether a significant correlation exists between the reflectivity of subretinal fluid (SRF) and the concentration of intravitreal cytokines in eyes with diabetic macular edema (DME).
A retrospective comparative study of eyes with DME with SRF prior to vitrectomy. The reflectivity of the SRF was determined from the OCT images. Vitreous samples were collected during vitrectomy and analyzed for the concentrations of vascular endothelial growth factor (VEGF), interleukin (IL)-6, and IL-8. To determine the factors in the SRF that could affect the reflectivity, the aqueous humor of isolated swine eyes was replaced by saline with plasma, albumin, or fibrinogen and the reflectivity of the anterior chamber was determined by anterior segment OCT.
The average OCT reflectivity of the SRF was 3.52 arbitrary units (AU) (15 eyes, range 0.01-20.7 AU). The average concentration of VEGF was 870.1 pg/ml, that of IL-6 was 131.7 pg/ml, and that of IL-8 was 224.1 pg/ml. The degree of OCT reflectivity was significantly correlated with the intravitreal VEGF concentration (r=0.516; P=0.049, Spearman's rank correlation coefficient) but not with IL-6 or IL-8. In the swine eyes, the presence of plasma, bilirubin, and fibrinogen in the anterior chamber led to significant increases in the reflectivity.
The significant correlation between the reflectivity of SRF and intravitreal VEGF indicates that OCT can be used to monitor the level of VEGF in eyes with DME.
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