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Purpose:

To assess the efficacy of the three monthly injections of ranibizumab for the treatment of macular oedema (MO) secondary to branch retinal vein occlusion (BRVO) in comparison with combined treatment (intravitreal injection of ranibizumab followed by grid laser treatment).

Methods:

Subjects were 19 patients (19 eyes) with unilateral vision loss attributable to macular oedema following BRVO. Duration of disease at the start of treatment ranged from 4 weeks to 4 months (in average 2.1 months). The patients were randomized into two groups: Group A (n=8) received three monthly intravitreal injections of ranibizumab (0.5 mg / 0.05 ml). Group B (n=11) received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment after 4 weeks following injection. Mainly clinical evaluation included measurement of best corrected visual acuity (BCVA) and central macular thickness (CMT) by means of optical coherence tomography (OCT) before the treatment and at 1, 2, 3 and 6 months after starting the treatment.

Results:

In Group A the patients had mean pre-treatment BCVA of 0.24± 0.04 (P <0.01); at 1 month mean BCVA was 0.49± 0.04 (P <0.01); at 2 month – 0.57± 0.04 (P <0.01); at 3 month – 0.71±0.03 (P <0.01); at 6 months – 0.69± 0.05 (P <0.01). In Group B the patients had mean pre-treatment BCVA of 0.27± 0.03 (P <0.02); at 1 month mean BCVA was 0.47± 0.04 (P <0.01); at 2 month – 0.54± 0.04 (P <0.01); at 3 month – 0.58± 0.05 (P <0.02); at 6 months – 0.68± 0.03 (P <0.01). In Group A the mean OCT CMT decreased from 383µm (range 359 – 471) to 259 µm (range 238 – 280) in 1 month after the first intravitreal injection of ranibizumab, in 2 months after initiation of treatment mean CMT was 233 µm (range 218 – 266), in 3 months after initiation of treatment CMT maintained at 229 µm (range 218 – 254); in 6 months CMT remained stable in 6 patients (75%), the remaining 2 patients showed growth of macular oedema and this became an indication for grid laser treatment or repeat injections of ranibizumab. In Group B the mean OCT CMT decreased from 395 µm (range 337 – 482) to 249 µm (range 229 – 277) in 1 month after intravitreal injection of ranibizumab and at that time grid laser coagulation was carried out, in 2 months after initiation of treatment mean CMT was 237 µm (range 226 – 265); in 3 months after initiation of treatment CMT maintained at 231 µm (range 225 – 261); in 6 months CMT remained stable in 7 patients (64%), the remaining 4 patients showed growth of macular oedema. Improving of visual acuity and reduction of MO were more significant and stable in group of patients that received three monthly intravitreal ranibizumab injection, and a significant number of patients in this group did not need laser treatment till sixth month of observation.

Conclusion:

The three monthly ranibizumab achieves a significant improvement of visual function and persistent reduction of MO secondary to BRVO, and all this indicates the three monthly ranibizumab as reasonable and promising method of treatment.

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