Matthew S. Benz, MD (Houston, TX),* David M. Brown, MD (Houston, TX),* Richard H. Fish, MD (Houston, TX),* Rosa Y. Kim, MD (Houston, TX),* Andrew Strickler, MS (Houston, TX), Tien P. Wong, MD (Houston, TX)*

PURPOSE:

Patients with ischemic central retinal vein occlusion have a high rate of developing anterior segment neovascularization and neovascular glaucoma and often have a dismal visual outcome. The RAVE (Rubeosis Anti-VEGF) study is an ongoing 1-year, FDA Phase I openlabel clinical trialdesigned to test the safety and efficacy of nine monthly intravitreal injections of 0.5 mg ranibizumab (Lucentis) in ischemic central retinal vein occlusion.

METHODS:

Enrolled patients receive nine monthly intravitreal injections of ranibizumab. Patients are followed by visual acuity, examination, OCT, FA, ERG, gonioscopy, and tonometry. The primary outcome in the study is the need for pan-retinal photocoagulation. Secondary outcome measures are changes in visual acuity and changes on OCT-measured central macular thickness. Entry criteria include ischmic CRVO of less than 3 months best-corrected ETDRS visual acuity < 20/200, 0.9 log unit RAPD, loss of 12e isopter on Goldman visual field, and reduction of B-wave on ERG. Exclusion criteria include anterior segment
neovascularization and any previous retina laser, intravitreal injection, or vitrectomy.

RESULTS:

Five patients have enrolled in the first phase of the trial. Four of the five patients have completed at least two-months follow-up. There have been no significant ocular or systemic adverse events. Basline visual acuity ranged from 20/320 to counting fingers (median 20/500). At the two-month time point, visual acuity ranged from 20/50 to 20/500 (median 20/400). Baseline mean central macular thickness by OCT was 304 microns (range 196-547). At the two-month time point, mean central macular thickness was 172 microns (range 160-183). Baseline mean pre-injection IOP was 12.8 mm Hg (range 10-17). Mean preinjection IOP at the twomonth time point was 13 (range 10-17). No patient developed anterior segment neovascularization on slitlamp examination or gonioscopy. No patient needed panretinal photocoagulation.

CONCLUSION:

The improvement seen in this small prospective trial may imply the macular edema present in ischemic CRVO is mediated in large part by VEGF. While the intermediate results of ranibizumab in ischemic CRVO are encouraging, we await longer-term follow-up to determine if neovascularization develops at a later time point. Further study of ranibizumab in patients with ischemic CRVO is warranted.
* Financial interest disclosed