ABSTRACT

Purpose:

Review of patients with bad results after ME treatments in RVO and try to understand if some first line treatment are better -or worse.

Material & Methods:

Both BRVO and CRVO were included in this retrospective study. (2007-2017). 345 patients included (179 BRVO and 166 CRVO). All patients had complete check-up with VA, Fundus, TO, OCT and Fluorescein angiography (before and after treatment(s)). First line treatment was anti-VEGF IVT or corticosteroids (Dexamethasone Ozurdex) IVT or Vitrectomy with ILM peeeling or Combined treatments. Second and following treatments varied depending on results with time.

Results:

51 patients (33 CRVO and 18 BRVO) had severe visual acuity decrease, often very quickly after the 1st line treatment. 17 patients had Dexamethasone IVT, 14 Ranibizumab IVT, 5 Bevacizumab IVT , 5 Ranibizumab IVT + Bethamethasone Subtenon, 2 Bevacizumab IVT + Bethamethasone Subtenon, 3 Bevacizumab IVT + Triamcinolone Subtenon, 1 Ranibizumab IVT+ Triamcinolone Subtenon, 1 Aflibercept IVT, 1 ILM peeling + Dexamethasone IVT, 1 ILM peeling + Ranibizumab IVT and 1 ILM peeling. Main causes of severe visual loss were neovascular glaucoma if macular or peripheral ischemia was observed or central macular atrophy – often with fibrosis association – if initial huge macular edema existed.

Discussion:

Regarding all our cases with RVO, central fibrosis aspect associated with severe visual loss could be due to a CNV secondary to RVO. These CNV should habe been initially under detected because of a huge ME. Lot of these patients had 1st line cortico-steroid Dexamethasone IVT. We think that anti-VEGF IVT 1st line treatment could prevent this risk and improve VA results for these particular cases.

Conclusion:

Our retrospective study for patients with ME in RVO confirmed our intuition: We do not recommand Dexamethasone IVT for 1st line treatment in ME in RVO for our patients. We strongly advise our colleagues to analyze their bad results in RVO in order to see if they’ll conclude the same.


CONTACT DETAILS

 

Frédéric HAMON*, Rita SOYEUR
Centre Helios Ophthalmologie
St Jean de Luz
France
Email : hamonpro@gmail.com
Cell Phone: +33662046330
Work Phone: +33559518660