Intravitreal Injection of Ranibizumab in Macular Edema Secondary to Retinal Vein Occlusion

 

Abstract

Aim: This study aimed to evaluate the safety and efficacy of intravitreal Ranibizumab 0.5mg in the treatment of macular edema secondary to retinal vein occlusion.

Patients & Methods: This was a prospective interventional analytical study included 39 eyes of 39 patients with retinal vein occlusion. Ophthalmic examination included assessment of visual acuity, measurement of intraocular pressure, and fundus examination. All patients were scanned using Swept source optical coherence tomography (3D DRI OCT Triton [plus], Topcon Corporation, Tokyo, Japan) to assess central macular thickness. The changes of visual acuity, IOP, and central macular thickness were assessed. Data were analyzed via Kolmogorov-Smirnov test and Wilcoxon signed rank.

Results: The mean age was 56.56 ± 9.6, 48.7% were male and 51.3% were females. Hypertension was detected in 69.2%, and hyperlipidemia in 2.6%. The mean best corrected visual acuity was 1.5 logMAR, 1.00 logMAR,1.00 logMAR, preoperative, fourth month, six months postoperative, respectively, (p<0.001). The mean central macular thickness was 675 μ, 306 u, 264 u, preoperative, fourth month, six months postoperative, respectively, (p< 0.001). The OP was 16.5 mmHg, 16.9 mmHg, 17.1 mmHg, preoperative, fourth month, six months postoperative, respectively, (p=0.423). There were no observed significant ocular adverse events such as ocular inflammation, sterile and infectious endophthalmitis, or sustained increase in intraocular pressure with the use of intravitreal ranizumab injections.

Conclusion: Intravitreal Ranibizumab injections as monotherapy have shown promising results with BCVA improvement and a decrease of central macular thickness in patients with macular edema secondary to retinal vein occlusion.

Keywords: Ranibizumab; Macular Thickness; OCT; Visual Acuity

Introduction

Retinal vein occlusion (RVO) is the most common retinal vascular disease after diabetic retinopathy [1]. Depending on the area of retinal venous drainage effectively occluded it is broadly classified as either central retinal vein occlusion (CRVO), hemispheric retinal vein occlusion , or branch retinal vein occlusion (BRVO) [2]. Although the exact etiology of RVO remains elusive, it is likely to follow a thrombotic event. In CRVO this may occur in the central retinal vein (CRV) at the lamina cribrosa or at a variable distance in its journey within the optic nerve posterior to the lamina cribrosa [2]. Hypoxia-induced expression of vascular endothelial growth factor (VEGF) is thought to be a trigger for macular edema. High intravitreal levels of VEGF have been found in patients with retinal vein occlusion [3]. Upregulation of VEGF is associated with breakdown of the blood-retina barrier with increased vascular permeability resulting in retinal edema, stimulation of endothelial cell growth, and neovascularization [4,5]. Macular edema leads to vision loss in many patients with either central or branch retinal vein occlusions (CRVO or BRVO). BRVO is the more common of the two presentations, accounting for approximately 80% of RVO [6].
Recently, there has been interest in the use of vascular endothelial growth factor (VEGF) inhibition in the treatment of RVO because of the observation of increased VEGF in the vitreous and aqueous of patients with these conditions [7].

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Visual Impairment and its Rehabilitation: A Review

 

Abstract

Visual impairment (VI) is a condition of reduced visual performance that cannot be remedied by refractive correction (spectacles or contact lenses), surgery or medical methods. Visual Impairment is a broader term that encompasses both Low vision and Blindness. The prevalence of visual impairment is estimated to be around 2.2 billion in the world as per World Health Organization (WHO). Causes of Visual Impairment differs significantly in different regions. Saying that, still cataract and refractive errors are main causes of visual impairment globally. Owing to its negative impact on the individual’s dailies, professional life, productive time, confidence, and self-respect, VI needs to be addressed timely and appropriately. Visual impairments do have profound consequences for the individual, however effective rehabilitation services can restore independence and therefore ameliorate these consequences and restore the individual’s quality of life.

Keywords: Visual Impairment; Blindness; low Vision; Rehabilitation; Optical Devices; Non-Optical Devices

Introduction

Impairment of any kind (sensorial or motor) is a bane for any human being. With visual impairment being one of the leading causes of sensorial impairment, it is necessary to acknowledge its prevalence, causes and methods to avoid them, if possible. Also, at the same time, it is important to understand that the term “visual impairment”, “blindness” and “Low vision” are not synonymous; rather visual impairment includes low vision as well as blindness. Simply, Visual impairment (VI) is a condition of reduced visual performance that cannot be remedied by refractive correction (spectacles or contact lenses), surgery or medical methods [1]. Various definitions of visual impairment have been given by various concerned authorities. International Statistical Classification of Diseases and Related Health Problems (ICD) defines visual impairment categories primarily on the basis of recommendations made by a World Health Organization (WHO) Study Group in 1972 [2] and defines as:

• low vision is defined as visual acuity of less than 6/18, but equal to or better than 3/60, or a corresponding visual field loss to less than 20 degrees in the better eye with best possible correction
• blindness is defined as visual acuity of less than 3/60, or a corresponding visual field loss to less than 10 degrees in the better eye with best possible correction.

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