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Intraoperative Anti-VEGF vs. Photocoagulation during Vitrectomy for Branch Retinal Vein Occlusion with Vitreous
Wei Lin1, Chuying Deng1, Zhong Lin1
1National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China.
Purpose:
To compare the effects of vitrectomy combined with intraoperative anti-VEGF therapy versus intraoperative sectoral retinal photocoagulation on the anatomical and functional outcomes of branch retinal vein occlusion (BRVO) complicated by vitreous hemorrhage (VH).
Design:
Randomized, parallel-group clinical trial.
Participants:
The study included 34 patients diagnosed with BRVO complicated by VH.
Methods:
Patients were randomly assigned to receive either intraoperative intravitreal injection of 0.5 mg ranibizumab (anti-VEGF group) or sectoral retinal photocoagulation (laser group) after vitrectomy. Postoperative assessments included best-corrected visual acuity (BCVA), visual field, and fluorescent angiography.
Main Outcome Measures:
Mean deviation (MD) of the visual field at 12 months and intergroup differences.
Results:
The average MD of the visual field in the anti-VEGF group was significantly lower than that in the laser group (-8.5 ± 4.6 dB vs. -15.1 ± 3.5 dB, P < 0.01) at 12 months. The BCVA was 0.20 ± 0.29 logarithms of the minimum angle of resolution (logMAR) and 0.26 ± 0.20 logMAR in the anti-VEGF and laser groups, respectively (P = 0.53). Recurrence VH occurred in 2 cases (1 case showed no regression of retinal neovascularization and one case exhibited the occurrence of venous macroaneurysm) of the anti-VEGF group, which was less compared to the laser group, which had a total of 4 cases with recurrent VH (1 case showed no regression of retinal neovascularization, while 3 cases exhibited venous macroaneurysms). However, these differences were not statistically significant (P = 0.39). Postoperative development of collateral vessels (CVs) was more evident in the anti-VEGF group, whereas laser treatment disrupted CVs in several cases.
Conclusions:
Intraoperative anti-VEGF therapy is a safe and effective alternative to sector retinal laser photocoagulation for patients with BRVO complicated by VH undergoing vitrectomy. This approach offers the advantage of preserving the visual field and avoiding CV damage associated with laser treatment.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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