The effect of posterior vitreous detachment induced by intravitreal injections on macular edema with retinal vein occlusion Posterior vitreous and macular edema
Main Article Content
Introduction: To evaluate whether posterior vitreous detachment (PVD) improves treatment outcomes.
Methods:The medical records of treatment-naive patients followed up for a minimum of six months due to retinal vein occlusion between January 2007 and January 2016 were reviewed. Patients with initial PVD were excluded. Correlation analysis and binary logistic regression analysis were used to determine the relationship between categorical variables and treatment outcomes. A subgroup analysis (steroids vs anti-VEGFs) was also performed.
Results: The study included 95 eyes of 95 patients with macular edema due to retinal vein occlusion. Patients in both groups [central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)] were similar in terms of demographic data and showed similar improvement during the study. The patients who underwent intravitreal steroid injection (IVD or IVTA) were 12.35 times (95% CI: 4.03-37.85) more likely to develop PVD. The patients in steroid group had a statistically significantly high correlation with visual and anatomic improvements, especially after 5 months of follow-up. The median time of PVD was 5 months (2-11).
Conclusion: Commonly used drugs in intravitreal pharmacotherapy induce PVD, which plays an important role for the treatment of underlying macular edema.
intravitreal, macular edema, pharmacotherapy, vein occlusion, vitreous detachment
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
2-The Central Vein Occlusion Study Group. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. Ophthalmology 1995; 102:1425–33 DOI: 10.1016/s0161-6420(95)30849-4
3-The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol.1984;98(3):271–82
4- Ip MS, Scott IU, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M et al. SCORE Study Research Group. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5.
5-Heier JS, Clark WL, Boyer DS, Brown DM, Vitti R, Berliner AJ et al. Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: two-year results from the COPERNICUS study. Ophthalmology 2014;121(7):1414-20
6-Campochiaro PA, Clark WL, Boyer DS, Heier JS, Brown DM, Vitti R et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion: the 24-week results of the VIBRANT study. Ophthalmology.2015;122(3):538-44
7-Campochiaro PA, Sophie R, Pearlman J, Brown DM, Boyer DS, Heier JS et al. RETAIN Study Group. Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab: the RETAIN study Ophthalmology,2014;121:209–19
8- Jackson TL, Nicod E, Angelis A, Grimaccia F, Prevost AT, Simpson AR et al
Vitreous attachment in age-related macular degeneration, diabetic macular edema, and retinal vein occlusion: a systematic review and metaanalysis. Retina , 2013;33:1099–1108.
9- Bertelmann T, Goos C, Sekundo W, Schulze S, Mennel S. Is optical coherence tomography a useful tool to objectively detect actual posterior vitreous adhesion status? Case Rep Ophthalmol Med. 2016;2016:3953147.
10-Branch Vein Occlusion Study Group. Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein occlusion. A randomized clinical trial.Arch Ophthalmol.1986 ;104(1):34-41
11-Central Retinal Vein Occlusion Study Group. Natural history and clinical management of central retinal vein occlusion. Arch Ophthalmol.,1997;115: 486-91
12- Weber-Krause B, Eckardt U. Incidence of posterior vitreous detachment in eyes with and without age-related macular degeneration. An ultrasonic study. Ophthalmologe. 1996;93(6):660–665.
13- Geck U, Pustolla N, Baraki H, Atili A, Feltgen N, Hoerauf H. Posterior vitreous detachment following intravitreal drug injection. Graefes Arch Clin Exp Ophthalmol. 2013;251(7):1691–1695
14- Alpay A. Posterior vitreous detachment rate following intravitreal dexamethasone injection. Int J Ophthalmol. 2019;12(8):1298-1303. Published 2019 Aug 18. doi:10.18240/ijo.2019.08.10
15- Stalmans P, Benz MS, Gandorfer A, Kampik A, Girach A, Pakola S et al. MIVI-TRUST Study Group Enzymatic vitreolysis with ocriplasmin for vitreomacular traction and macular holes. N Engl J Med, 2012;367:606–615
16-Campochiaro PA, Brown DM, Awh CC, Lee SY, Gray S, Saroj N et al. Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology.2011;118(10):2041–49
17-Brown DM, Campochiaro PA, Bhisitkul RB, Ho AC, Gray S, Saroj N et al. Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology.2011;118(8):1594-602
18-Bakri SJ, Snyder MR, Reid JM, Pulido JS, Ezzat MK, Singh RJ et al. Pharmacokinetics of intravitreal ranibizumab (Lucentis). Ophthalmology. 2007;114(12):2179-82
19-Xu L, Lu T, Tuomi L, Jumbe N, Lu J, Eppler S et al. Pharmacokinetics of ranibizumab in patients with neovascular age-related macular degeneration: a population approach. Invest Ophthalmol Vis Sci. 2013;54(3):1616-24
20-Lucentis (ranibizumab) injection [prescribing information revised]
Genentech, Inc, South San Francisco, CA (2008).
Accessed June 10, 2008.
21-Yuan A, Ahmad BU, Xu D, Singh RP, Kaiser PK, Martin DF et al. Comparison of intravitreal ranibizumab and bevacizumab for the treatment of macular edema secondary to retinal vein occlusion. Int J Ophthalmol.2014;7(1):86-91
22-Iturralde D, Spaide RF, Meyerle CB, Klancnik JM, Tannuzzi LA, Fisher YL et al. Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina.2006;26(3):279-84
23- Haller JA, Bandello F, Belfort R Jr, Blumenkranz MS, Gillies M, Heier J et al. OZURDEX GENEVA Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117(6):1134-1146