Combined Intravitreal Ranibizumab And577nm Laser Photocoagulation For Macular Edema Secondary To Retinal Vein Occlusion

ObjectiveTo observe effectiveness and safety of combination intravitreal injections of ranibizumab and577nm fundas laser photocoagulation for macular edema secondary to RVO.MethodsTo observe84eyes of84patients with macular edema secondary to RVO, including44BRVO eyes and40CRVO eyes. The patients were divided into three groups by different treatments:control group just receiving577nm grid laser phtocoagulation for mucula and scatter laser phtocoagulation at nonperfusion area, experimental A group reciveing ranibizumab combined scatter phtocoagulation, experimental B group recieving ranibizumab combined micro pulse laser photocoagulation for macula and scatter laser phtocoagulation at nonperfusion area. There are12,16,16eyes in BRVO and12,14,14eyes in CRVO respectively. All the patients were followed up on1week after photocoagulation and every month to6th month. They were all examined for BCVA, intraocular pressure, FFA and OCT before and after treatment. In the follow-up time, the non-perfusion area would recieve scatter laser photocoagulation repeatly. Repeated injections were received in necessary. The BCVA, CRT, injection times and ocular and systemic adverse reactions about drugs and treatments were followed up.ResultsThe difference of age, course, mean BCVA, intraocular pressure, CRT in RVO eyes before therapy is not statistically meaningful(P>0.05). The difference of BCVA on1week after laser photocoagulation,1,3,6months after treatment in BRVO control group is not statistically meaningful(P>0.05) respectively. The difference of BCVA on3rd day,1week after laser photocoagulation,3,6months after treatment in BRVO expiremental A,B group is statistically meaningful(P<0.05) respectively, but on1month is not statistically meaningful(P>0.05). The difference of BCVA between BRVO expiremental A and B group is not statistically meaningful(P>0.05) in any time.The difference of BCVA on1week after laser photocoagulation,1,3,6months after treatment in CRVO control group is not statistically meaningful(P>0.05) respectively. The difference of BCVA on3rd day,3,6months after treatment in BRVO expiremental A,B group is statistically meaningful(P<0.05) respectively, but on1week after laser photocoagulation,1month is not statistically meaningful(P>0.05). The difference of BCVA between CRVO expiremental A and B group is not statistically meaningful(P>0.05) in any time.The difference of intraocular pressuer beween before and after treatment is not statistically meaningful(P>0.05) in every group of RVO eyes. The difference is statistically meaningful(P<0.05).The CRT is tend to decrease after3month in control group of RVO eyes while the expiremental group decreaes dramatically. Three group decrease (83.91±79.91)、(195.50±167.31)、(248.81±112.66) μm in BRVO eyes and (48.67±55.98)、(299.64±293.87)、(252.64±287.66) μm in CRVO eyes after6months. The difference is statistically meaningful(P<0.05).The mean repeated times of injection in expiremental groups was (2.81±0.83)、(1.94±0.68) in BRVO eyes, which the difference is statistically meaningful (P＜0.05). And the times of injection in expiremental groups was (3.57±0.85)、(3.79±0.89) in CRVO eyes, which the difference is not statistically meaningful (P＜0.05).BCVA post-treatment was correlated to BCVA pre-treatment and disease course(P<0.05)in any RVO. There are6subconjunctival hemorrhage in BRVO expiremental group,7in CRVO expiremental group. All are absorbed in2weeks.1high intraocular pressure in BRVO expiremental B group,1iris neovalscularization and veatrious hemorrhage in CRVO control group. No other ocular and system adverse events related to injection and drugs are followed up.Conclusion1. In the treatment of RVO with ME, intravitreal injection of Lucentis can reduce retinal neovascularization and the degree of CRT, improve the visual function. Repeated injections are needed in necessary.2. Taking577nm scatter laser photocoagulation will reduce the retinal thickness in macular edema due to retinal vein occlusion. It will promote edema absorption, but the extent is less than intravitreal ranibizumab. Scatter laser photocoagulation is helpless to visual improvement. 3.Combining intravitreal injection of ranibizumab and577nm laser photocoagulation can reduce the degree of CRT, improve the visual function in a short time. It has less complication, and is a safe and effective method to macular edema due to retinal vein occlusion. In6months, combing laser photocoagulation, BRVO with ME eys recieve at least2injections, CRVO with ME eys will need at least3times, then the retinal function will tend to be stable. For remaining function time of0.5mg Lucentis in most patients vitrous is staying no more than1month, so combing laser photocoagulation and follow-up time will whin1month, to be sure the necessary repeat injection and laser photocoagulation.4. Combining intravitreal injection of ranibizumab and577nm micro pulse grid laser photocoagulation for macular can reduce the repeated injection times in BRVO. It will reduce the risk of repeated intravitreal injections. But the combined treatment can not reduce the repeated injection times in CRVO in6months. The long term effectiveness is expected to look further.5. Visual prognosis of RVO is closely related to clinical course, perfusion extent of retina and basement visual. Patients whose suffering time under6months and basement visual superior to0.1will get a better visual prognosis. The basement and prognostic visual does not depend on retinal thickness pre-treatment.