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Updated: Apr 1, 2026
Optimization of the Retinal Vein Occlusion Mouse Model to Limit Variability
Published on: August 6, 2021
[Comparison of early management of central retinal vein occlusion with ranibizumab versus hemodilution]
M Graber1, A Glacet-Bernard1, C Fardeau2
1Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, hôpital Henri-Mondor, université Paris-Est Créteil, 40, avenue de Verdun, 94000 Créteil, France.
Insights
Early treatment of central retinal vein occlusion (CRVO) with hemodilution or intravitreal ranibizumab showed no significant differences in visual acuity or macular thickness. Hemodilution can be a first-line option, potentially avoiding anti-VEGF injections.
Area of Science:
- Ophthalmology
- Retinal Vascular Diseases
- Clinical Trials
Background:
- Central Retinal Vein Occlusion (CRVO) is a significant cause of vision loss.
- Early intervention is crucial for managing CRVO outcomes.
- Treatment options include hemodilution and anti-vascular endothelial growth factor (VEGF) therapy.
Purpose of the Study:
- To compare the efficacy of early CRVO treatment using hemodilution (HD), intravitreal (IVT) ranibizumab, or a combination (IVT+HD).
- To evaluate visual acuity and macular thickness changes over a 6-month follow-up period.
- To assess the tolerability of different treatment modalities.
Main Methods:
- A multicenter prospective randomized study included 44 patients with CRVO diagnosed within one month.
- Patients were assigned to HD, IVT ranibizumab, or combined IVT+HD treatment groups.
- Monthly assessments included best-corrected visual acuity (BCVA), optical coherence tomography (OCT) for macular thickness, and fluorescein angiography.
Main Results:
- No significant differences in BCVA or macular thickness were observed between the three groups after 6 months.
- The time from CRVO onset to treatment initiation (1-35 days) did not correlate with final visual outcomes.
- The mean number of IVT injections at 6 months was similar between the IVT and IVT+HD groups.
Conclusions:
- Early treatment of CRVO with HD, IVT ranibizumab, or both does not yield significant differences in visual acuity or macular thickness at 6 months.
- Hemodilution can be considered a first-line treatment, potentially delaying or avoiding IVT injections and their side effects.
- Intravitreal ranibizumab remains an effective option for CRVO management.
Purpose:
This study was designed to evaluate and compare the efficacy of early treatment of CRVO with either hemodilution by erythrocytopheresis or intravitreal (IVT) ranibizumab, or both.
Material And Methods:
A multicentric prospective randomized study including patients with CRVO for less than 1 month was designed. Patients were randomized into 3 treatment groups: hemodilution (HD group), 3 monthly intravitreal injections of ranibizumab followed by PRN treatment (IVT group), or combined treatment (IVT+HD group). A monthly evaluation during a 6-month follow-up included best-corrected visual acuity (BCVA) and macular thickness measurements with OCT. Fluorescein angiography was performed at baseline, month 2 and month 6. Local and systemic tolerability of the different treatments were also compared.
Results:
Forty-four CRVO patients were included between February 2010 and June 2013: 20 in the IVT group, 13 in the HD group and 11 in the HD+IVT group. The mean duration of CRVO at baseline was 10 days and 16 days at the time of treatment without any significant difference between groups. Retinal ischemia was present at baseline in 40% of eyes in each group. After a 6-month follow-up, no difference between the 3 groups was observed in BCVA (10.5 ETDRS letters, 14.6 and 14.1 in the IVT group, HD group and IVT+HD group respectively, P=0.726) or in macular thickness (398 μ, 440 μ and 379 μ respectively, P=0.465). The time until treatment from CRVO onset, ranging from 1 to 35 days, was not correlated to final outcomes. No significant difference in the mean number of IVT (3.2 in the IVT+HD group vs 3.7 in the IVT group) was observed at 6 months.
Conclusion:
No difference in BCVA nor in macular thickness was seen at M6 between the study groups. The duration of CRVO at the time of the initiation of the treatment was not correlated to better visual outcomes. Therefore, etiologic treatment with HD can still be proposed as a first-line treatment in young patients, which allows delaying or avoiding the IVT treatment and its potential side effects. Anti-VEGF IVT still remains an effective option in every case and can be started one month after the beginning of the CRVO.
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