Ranibizumab in Macular Edema Secondary to Retinal Vein Occlusion in a Real Life Practice: A Retrospective Case Series

INTRODUCTION: The present study evaluated treatment outcomes of intravitreal ranibizumab (IVR) use in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), and mean number of visits and injections of first year of treatment.
METHODS: The study was a retrospective case series. Newly diagnosed RVO patients who had macular edema for <3 months at first admission, were treatment naïve for ME, and had follow-up of at least 12 months were included. Some patients received initial loading dose of 3 consecutive monthly injections. There were no strict criteria for administering loading dose. Patients were followed monthly, and single injection of IVR was repeated when visual acuity decreased by 1 or more lines on Early Treatment Diabetic Retinopathy Study chart compared to most recent visit, or any increase in central retinal thickness (CRT) in optical coherence tomography images was observed. Primary outcome measures of this study included change in best corrected visual acuity (BCVA) and CRT. Secondary outcome measures were number of visits and number of injections administered.
RESULTS: Mean BCVA at baseline and months 3, 6, 9, and 12 was 0.27±0.27 decimals (range: 0.1–0.8), 0.42±0.28 decimals (range: 0.1–1.0), 0.39±0.26 decimals, (range: 0.01–0.8), 0.37±0.29 decimals (range: 0.01–0.9), and 0.42±0.30 decimals (range: 0.01-0.9), respectively. Mean BCVA was statistically better than mean baseline BCVA at all time points except month 9 (p=0.06 for month 9, and p<0.05 for month 3, 6, and 12). Mean CRT at baseline, months 3, 6, 9, and 12 was 581±188 microns (range: 300–894), 439±152 microns (range: 246–874), 383±149 microns, (range: 221–830), 425±238 microns (range: 235–1147), and 359±101 microns (range: 229–655), respectively. Mean CRT level was statistically lower than mean baseline BCVA (p<0.05 for all) at all time points. At month 12, 17 of the 45 patients (37.8%) had anatomically inactive ME and did not require injections. Mean number of planned visits at month 12 was 4.8±1.0 (range: 2–7), and number of completed visits was 4.5±1.2 (range: 1–6) (94.2% completion). Mean number of planned injections at month 12 was 3.8±1.5 (range: 1–8), and number of injections performed was 3.5±1.4 (range: 1–7) (92.0% completion).
DISCUSSION AND CONCLUSION: Ranibizumab is an effective agent in treatment of ME secondary to RVO with regard to visual and anatomical outcomes. Number of visits and injections were lower than prospective multicenter studies, as expected, yet functional and anatomical outcomes were acceptable.