DOI: 10.1097/IAE.0b013e3181d50aa9
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Issn Print: 0275-004X
Publication Date: 2010/04/01
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Excerpt
Despite the promising results, the proper timing in initiating treatment for newly diagnosed BRVOs with macular edema was not suggested. The authors did analyze the time from symptom onset to first treatment but the range varied from 2 weeks to 48 weeks. For new-onset BRVOs, especially those with good macular perfusion, edema may subside with time, and the disease's natural course may be favorable even without any treatment. If an “observation window” was defined and treatment given only to those who did not show any spontaneous resolution during that period, only then can the credit be attributed to the effect of IVB. In the classic Branch Retinal Vein Occlusion Study,2 3 months was given to allow spontaneous resolution before treatment with grid laser was initiated. In the study by Prager et al,3 IVB was given for cases in which edema persisted for at least 3 months without signs of resolution, and in the study by Jaissle et al,4 a mean observation period of 6 months was given between onset of BRVO and the first IVB treatment. If IVB was given to cases with a history as short as a few weeks, it may only add potential risks when spontaneous improvement is likely.
Second, outcome comparison with other treatment options or placebo was not made, which limits the impact of the results no matter how successful the authors were in achieving their treatment targets. Although no control arm was included, outcome comparison with the classic Branch Retinal Vein Occlusion Study2 is still possible, as was done in the study by Jaissle et al4 with the help of a converted visual acuity chart. We would be delighted to see if the authors can supplement the article with this piece of information.
The perfusion status of the macular was also underevaluated. In the study by Jaissle et al,4 all cases with macular ischemia were excluded because of the poor treatment response potential. Including all subjects regardless of perfusion status may eliminate selection bias, but the results between the two subgroups should be more thoroughly investigated. Because fluorescein angiogram was performed in all cases, a direct comparison between those with and without perfusion should be made. In the article, this parameter was only included in the stepwise multiple regression analysis, which may have underestimated the effect of this important factor. Subgroup analysis in this regard may be required.
