http://www.evrs.eu/medias/2010/congress/Branch-Retinal-Vein-Occlusion-Central-Retinal-Vein-Occlusion.flv

Ivan Fiser, Martina Rubesova (Prague, Czech Republic)

Advantages:

In most cases of persisting CME after BRVO we use vitrectomy with ILM peeling which has a good effect in more than 60 % of eyes but. In some patients we start with Avastin that brings a repeated benefit but later recurrences of CME happen. Laser coagulation in edematous retina is difficult. We are trying to find a system of consecutive procedures that can improve and stabilize the finding.

Methods:

A group of 21 eyes with CME after BRVO that did not regress spontaneously was treated using above mentioned methods and their combinations. We will show that ILM peeling itself helps in two thirds of eyes but opens several questions in the remaining third: 1. Can the late RPE and/or neuroretina atrophy with vision worsening (2 eyes) be explained by the ischemia itself? 2. What are the reasons for the recurrence of CME (3 eyes) or primary failure (2 eyes)? 3. If Avastin is used in combination therapy, should it be injected before vitrectomy or after? 4. Is laser beneficial in stabilizing the macula?

Effectiveness / Safety:

There are suggestions resulting from our experience that it is good to start with Avastin or TMC for edema regression, then proceed to ILM peeling for Muller cells stimulation and finally treat the retina gently with laser to the ischemic areas to prevent from VEGF production and recurrence of CME.

Take home message:

CME after BRVO is a complex disease sometimes requiring a combined treatment consisting of anti-VEGF, vitrectomy with ILM peeling and gentle laser coagulation.