30.
Vitrectomy vs. New Treatment Strategies in CRVO
Josep Callizo (Marburg)
Purpose: To evaluate different therapeutical options available for the treatment of central
retinal vein occlusion (CRVO) and its secondary macular edema.
Methods: In this retrospective study 89 patients with CRVO were included. The treatments
performed were repeated intravitreal injection of bevacizumab (30 patients), repeated intravitreal
injection of triamcinolone (19 patients), grid pattern laser photocoagulation (9 patients)
and vitrectomy with radial optic neurotomy (RON) (31 patients). Main outcome parameters
were optical coherence tomography measurements, visual acuity and retinal perfusion.
Results: The mean baseline visual acuity and central retinal thickness were 0,28±0,16 and
575±184μm (bevacizumab), 0,18±0,08 and 578±136μm (triamcinolone), 0,26±0,17 and
531±329μm (grid photocoagulation), 0,13±0,04 and 614±277μm (vitrectomy). The mean number
of bevacizumab injections was 3,2±1,8 and of trimacinolone was 2,1±1,7. Mean follow-up was 26,3 weeks.
A significant improvement (p<0.05) in visual acuity and central retinal thickness after bevacizumab and triamcinolone persisted
until 3 months after the last injection but the visual improvement lost significance one month later. A trend for vision
improvement without statistical significance was observed in eyes treated with grid pattern laser photocoagulation
(p=0.754). A significant visual improvement by the last control was observed only after vitrectomy (p=0.042). Only vitrectomy
with RON was able to improve the retinal perfusion.
Conclusion: None of the modalities achieved a clear functional improvement in the long-term. Vitrectomy with RON reached
an improvement of the retinal perfusion. The early functional benefit of intravitreal bevacizumab and trimacinolone were not
sustained without repeated injections. Regarding triamcinolone, transient benefits need to be balanced with a range of
potential adverse effects, such as development of cataract or glaucoma, which may increase after repeated injections. On
the other hand, the promising short-term efficacy and safety of intravitreal bevacizumab allow the presumption of its value.
Larger randomized controlled trials are needed to elucidate its best regimen of application.