Intravitreal ranibizumab following bevacizumab for macular edema due to retinal vein occlusion

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Abstract

Purpose

Macular edema is the main cause of visual impairment secondary to retinal vein occlusions (RVO). Current treatment is based on intravitreal injections of corticosteroids or VEGF inhibitors. Bevacizumab was first used in the eye on an off-label basis, whereas ranibizumab was approved in this indication in January 2012 in France. Our work’s objective was to analyse the becoming of patients who received bevacizumab then ranibizumab successively in management of RVO.

Methods

This study includes the patients treated effectively with intravitreal bevacizumab for macular edema due to RVO and next treated with intravitreal ranibizumab. We included 9 patients presented with a central retinal vein occlusion (CRVO) and 6 patients with a branch retinal vein occlusion (BRVO). Ophthalmological examination performed after intravitreal injections consists in logMAR visual acuity and central macular thickness measurement by OCT.

Results

Intravitreal injections of anti-VEGF allowed an improvement of the visual acuity and a reduction of the central macular thickness. Final visual acuity was better after treatment with ranibizumab than after bevacizumab in patients presenting with CRVO ( the average gain of visual acuity was 0.30 logMAR). No infectious complication was noted.

Conclusion

The therapeutic transition from bevacizumab to ranibizumab stabilizes both visual acuity improvement and decrease of macular thickness even in long time treated patients, despite vision impairment produced by old edema, worsening cataract, or apparition of retinal ischemia areas. In this short series of patients, replacement of bevacizumab by ranibizumab didn’t have negative impact on visual results despite treatment was continued on a longer time course.

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