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Anti-VEGF best option for managing macular edema caused by CRVO
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KAANAPALI, Hawaii — Monthly intravitreal injection of ranibizumab is the most effective treatment option for macular edema caused by central retinal vein occlusion, according to one speaker.
"The strongest evidence right now is with ranibizumab," Neil M. Bressler, MD, said at Retina 2011. "There are better short-term benefits and fewer risks as seen with triamcinolone."
Dr. Bressler recommended observing patients who are not bothered by their symptoms and treating those who refuse observation with Lucentis (ranibizumab, Genentech) injections for at least 6 months.
However, ranibizumab requires more injections than other drugs, and the need for injections after 12 months of treatment is still unknown, he said.
Dr. Bressler evaluated study results from three different clinical trials that were presented at Retina Congress 2009. Ranibizumab, dexamethasone intravitreal implant and intravitreal triamcinolone were found to be effective based on the primary outcomes of the studies.
According to Dr. Bressler, it would be ideal if physicians could determine the best treatment for their patients using results from a head-to-head clinical trial. Because no such studies exist, he compared the differences of the treatment groups vs. the sham control groups, with the primary outcome being a gain or loss of 15 letters or more at 6 months or 12 months.
Dr. Bressler also considered absolute difference, the number needed to treat, and factors such as treatment frequency and the risk of IOP increases.
- Disclosure: Dr. Bressler is the principal investigator of grants at Johns Hopkins University.
Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.