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      Antagonism of vascular endothelial growth factor for macular edema caused by retinal vein occlusions: two-year outcomes.

      Ophthalmology
      Angiogenesis Inhibitors, administration & dosage, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Fluorescein Angiography, Follow-Up Studies, Humans, Intravitreal Injections, Macular Edema, drug therapy, etiology, physiopathology, Prospective Studies, Recurrence, Retinal Vein Occlusion, complications, Retreatment, Tomography, Optical Coherence, Treatment Outcome, Vascular Endothelial Growth Factor A, antagonists & inhibitors, Visual Acuity, physiology

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          Abstract

          To determine the long-term effects of intraocular antagonism of vascular endothelial growth factor (VEGF) in patients with macular edema caused by retinal vein occlusions (RVOs). Prospective randomized trial. Twenty patients with macular edema caused by branch RVOs (BRVOs) and 20 patients with central RVOs (CRVOs). After the month 3 primary end point, patients were seen every 2 months and received injections of an anti-VEGF agent as needed for recurrent edema. Mean change from baseline best-corrected visual acuity (BCVA) at month 24 with assessment of other parameters of visual function and center subfield thickness (foveal thickness [FTH]). For 17 patients with BRVO who completed 2 years of follow-up, the mean improvement from baseline in BCVA at month 24 was 17.8 letters compared with 15.6 letters at month 3. Improvement by at least 6, 3, or 2 lines occurred in 18%, 59%, and 76% of patients, respectively. The Snellen equivalent BCVA at month 24 was 20/40 or better in 10 patients. With an average of 2 injections of ranibizumab during year 2, the mean FTH at month 24 was 245.8 μm compared with 217.1 μm at month 3 and 481.5 μm at baseline. For 14 patients with CRVO who completed 2 years of follow-up, the mean improvement in BCVA at month 24 was 8.5 letters compared with 12.0 letters at month 3. Improvement by at least 6, 3, or 2 lines occurred in 14%, 21%, and 43% of patients, respectively. The Snellen equivalent BCVA at month 24 was 20/40 or better in 4 patients. With an average of 3.5 injections of ranibizumab in year 2, mean FTH at month 24 was 338 μm compared with 278 μm at month 3 and 533 μm at baseline. Duration of RVO >1 year at study entry and nonperfusion of perifoveal capillaries for 360 degrees correlated with reduced visual outcomes. Antagonism of VEGF provides substantial long-term benefit to patients with macular edema caused by RVO, but frequent injections are required in some patients with BRVO and most patients with CRVO. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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