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Anti-VEGF treatment and peripheral retinal nonperfusion in patients with central retinal vein occlusion

Authors Abri Aghdam K, Reznicek L, Soltan Sanjari M, Klingenstein A, Kernt M, Seidensticker F

Received 22 October 2016

Accepted for publication 10 January 2017

Published 15 February 2017 Volume 2017:11 Pages 331—336

DOI https://doi.org/10.2147/OPTH.S125486

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Kaveh Abri Aghdam,1,* Lukas Reznicek,2,* Mostafa Soltan Sanjari,1 Annemarie Klingenstein,2 Marcus Kernt,2 Florian Seidensticker2

1Department of Ophthalmology, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran; 2Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany

*These authors contributed equally to this work

Purpose: To evaluate the association between the size of peripheral retinal nonperfusion and the number of intravitreal ranibizumab injections in patients with treatment-naïve central retinal vein occlusion (CRVO).
Methods: Fifty-four patients with treatment-naïve CRVO and macular edema were included. Each patient underwent a full ophthalmologic examination including optical coherence tomography imaging and ultrawide-field fluorescein angiography. Monthly intravitreal ranibizumab injections were applied according to the recommendations of the German Ophthalmologic Society. Two ophthalmologists quantified the areas of peripheral retinal nonperfusion (group 1= less than five disc areas, group 2= more than five disc areas). Correlation analyses between the size of nonperfusion with best-corrected visual acuity, central subfield thickness, and the number of intravitreal injections were performed.
Results: Best-corrected visual acuity improved significantly after intravitreal injections (P<0.001, both groups). Final central subfield thickness after treatment did not significantly differ between both groups (P=0.92, P=0.96, respectively). Mean number of injections in group 1 and group 2 was 4.12±2.73 and 9.32±3.84, respectively (P<0.001). There was a significant positive correlation between areas of nonperfusion and the number of injections in each group. (R=0.97, P<0.001; R=0.94, P<0.001, respectively).
Conclusion: Peripheral retinal nonperfusion in patients with CRVO correlates significantly with the number of needed intravitreal ranibizumab injections. Ultrawide-field fluorescein angiography is a useful tool for detection of peripheral retinal ischemia, which may have direct implications in the diagnosis, follow-up, and treatment of these patients.

Keywords: angiography, central retinal vein occlusion, non-perfusion, retina, wide-field

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