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RANIBIZUMAB FOR MACULAR EDEMA AFTER BRANCH RETINAL VEIN OCCLUSION: One Initial Injection Versus Three Monthly Injections

Miwa, Yuko MD; Muraoka, Yuki MD, PhD; Osaka, Rie MD; Ooto, Sotaro MD, PhD; Murakami, Tomoaki MD, PhD; Suzuma, Kiyoshi MD, PhD; Takahashi, Ayako MD; Iida, Yuto MD; Yoshimura, Nagahisa MD, PhD; Tsujikawa, Akitaka MD, PhD

doi: 10.1097/IAE.0000000000001224
Original Study

Purpose: To compare the 12-month-efficacy of 1 initial intravitreal ranibizumab injection (IVR) followed by pro re nata (PRN) dosing with that of three initial monthly IVR followed by PRN dosing in patients with macular edema (ME) after branch retinal vein occlusion.

Design: Prospective, interventional study.

Methods: Of 81 eyes, 42 received 1 initial IVR injection (1+PRN group) and 39 eyes received 3 monthly IVRs (3+PRN). Pro re nata injections were performed when fovea exudative changes were evident.

Results: At Month 12, the visual acuity (VA) changes from baseline were −0.245 ± 0.227 and −0.287 ± 0.222, in the 1+PRN and 3+PRN groups, respectively; there were no significant difference between groups (P = 0.728). The stratified analysis showed that patients with better VA (baseline VA >20/40) had similar significant improvement in VA at Month 12 (P < 0.001) to that of those with poorer VA (≤20/40). Better VA at Month 12 was significantly associated with younger age, better baseline VA, and thinner baseline central foveal thickness (P = 0.003, < 0.001, and < 0.001, respectively). Mean total number of IVR injections in the 1+PRN and 3+PRN groups were 3.8 ± 1.8 and 4.6 ± 1.4, respectively (P = 0.060). In both groups, shorter durations to the first PRN injection were associated with greater total PRN injection number (1+PRN, P = 0.006; 3+PRN; group, P < 0.001).

Conclusion: In IVR treatment for ME after branch retinal vein occlusion, 1+PRN and 3+PRN regimens achieved similar 12-month functional outcomes. Patients with shorter durations to initial PRN injection may require more PRN treatments.

The authors treated macular edema after branch retinal vein occlusion using either a regimen of 1 initial or 3 monthly intravitreal ranibizumab injections, and compared the Month-12 visual outcomes between the 2 groups, after enrolling patients with relatively good baseline visual acuity that any previous studies did not examine well.

*Department of Ophthalmology and Visual Sciences, Graduate School of Medicine Kyoto University, Kyoto, Japan; and

Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki, Japan.

Reprint requests: Yuki Muraoka, MD, PhD, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: muraoka@kuhp.kyoto-u.ac.jp

Supported in part by the Japan Society for the Promotion of Science (JSPS), Tokyo, Japan (Grant-in-Aid for Scientific Research, no. 21592256), the Japan National Society for the Prevention of Blindness, Tokyo, Japan, Novartis Pharma K.K., Tokyo, Japan, and the Innovative Techno-Hub for Integrated Medical Bio-Imaging of the Project for Developing Innovation Systems, from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan. No additional external funding was received for this study.

None of the authors has proprietary interest in any product described in the article. Y. Muraoka: Bayer: grant support, Novartis Pharma K.K.: grant support; T. Murakami: Bayer: grant support, Novartis Pharma K.K.: grant support, Santen: grant support, and Senju: grant support; S. Ooto: Novartis Pharma K.K.: grant support, Bayer: grant support, Santen: grant support, and Senju: grant support; K. Suzuma: Novartis Pharma K.K.: grant support and Bayer: grant support; N. Yoshimura: Topcon Corporation: grant support, Nidek: grant support and consultant and Canon: grant support. A. Tsujikawa: Pfizer: grant support, Novartis Pharma K.K.: grant support, Bayer: grant support, Alcon: grant support, Santen: grant support, Senju: grant support, Nidek: grant support, and AMO Japan: grant support.

Conception and design of the study, Y. Miwa, Y. Muraoka, S. Ooto, T. Murakami, K. Suzuma, and A. Tsujikawa; analysis and interpretation, Y. Miwa, R. Osaka, and Y. Muraoka; writing of the article, Y. Miwa and Y. Muraoka; critical revision of the article, SM, T. Murakami, K. Suzuma, N. Yoshimura, and A. Tsujikawa; final approval of the article, Y. Miwa, Y. Muraoka, R. Osaka, S. Ooto, T. Murakami, K. Suzuma, A. Takahashi, Y. Iida, N. Yoshimura, and A. Tsujika; data collection, Y. Miwa, Y. Muraoka, R. Osaka, T. Murakami, S. Ooto, K. Suzuma, A. Takahashi, and Y. Iida.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

© 2017 by Ophthalmic Communications Society, Inc.