Nonischemic retinal vein occlusion treated with ranibizumab increases or stabilizes visual acuity

Key Points

Atlanta-One-year follow-up results of a small study of ranibizumab (Lucentis, Genentech) in patients with nonischemic retinal vein occlusion show that all treated patients gained visual acuity (VA) or that VA remained stable, although this improvement was accompanied by decreases in contrast sensitivity and reading ability, said Alfredo Pece, MD. He presented a summary of the study at the annual meeting of the American Academy of Ophthalmology.

When a good response to the therapy was observed with an improvement of VA, then reading ability and contrast sensitivity improved as well. On the contrary, when a recurrence of macular edema was present, then VA, reading ability, and contrast sensitivity worsened, said Dr. Pece, director of the Department of Ophthalmology at Melegnano Hospital, Milan, Italy.

The study that he and his colleagues conducted included 17 eyes of 17 patients, nine with central retinal vein occlusion (CRVO) and eight with branch retinal vein occlusion (BRVO). The median follow-up was 1 year.

An additional dose of ranibizumab was administered if a loss of VA of more than 5 letters was observed during a follow-up examination, if an increase in cystoid macular edema was apparent on the OCT, or if FA showed signs of worsening.

Improvement of more than three lines of VA was seen in about 90% of the full cohort, whereas VA in the other 10% remained stable, Dr. Pece said.

A decline in vision, however, was observed at 3, 6, and 9 months following the initial injection among the CRVO patients, and a similar curve was seen for contrast sensitivity and reading fluency.

Results also were good in the BRVO arm, although the same declines in VA, contrast sensitivity, and reading fluency were observed at follow-up visits. A reduction in central retinal thickness was observed in all cases. The drug was well tolerated, and no adverse local or systemic events were seen.

Dr. Pece suggested that individualized treatment may be the best approach to anti-vascular endothelial growth factor (VEGF) therapy for retinal vein occlusion, and he also proposed that re-treatment every 2 to 3 months might be the most effective schedule in most patients. Long-term studies with larger enrollment are needed to assess the safety and efficacy of this therapeutic approach, he said. This study is ongoing.

Other recent studies

Dr. Pece presented his findings in the context of two other recent studies of anti-VEGF therapy in retinal vein occlusion, both of which reported improved vision for most patients: