Combination of peripheral laser photocoagulation with intravitreal bevacizumab in naïve eyes with macular edema secondary to crvo: prospective randomized study

SIR, Increased vascular endothelial growth factor (VEGF) production has been reported in central retinal vein occlusion (CRVO), which could be due to peripheral retinal ischemia.1 Panretinal

laser photocoagulation (PLP) in peripheral retina has been shown to reduce the VEGF production.2 Here, we report 1-year results of a prospective randomized single-masked trial comparing

1.25 mg intravitreal bevacizumab pro-re-nata (PRN) monotherapy and PRN therapy in combination with PLP at 1 month in treatment of naive eyes with macular edema (ME) secondary to CRVO. Naive

eyes with center-involving ME secondary to CRVO of <9 months duration, minimum central subfield thickness (CST) of 250 _μ_m on spectral domain optical coherence tomography, and

best-corrected visual acuity of 24–73 letters were included. Subjects were randomized to either monotherapy or combination group. Through month 12, subjects were evaluated monthly and

treated with intravitreal injections on a PRN basis as per predefined retreatment criteria. Seven field fluorescein angiography and electroretinography (ISCEV standards) were performed at

baseline, month 6 and month 12. Wilcoxon signed-rank test was performed to evaluate changes in visual acuity and CST. Twenty-two eyes of 21 consecutive subjects were enrolled. Baseline

characteristics of both groups are shown as Table 1. Mean change in visual acuity in monotherapy and combination group at the last visit from baseline was 24.61 (_P_=0.001) and 25.49

(_P_=0.001) letters, respectively (_P_=0.32). Mean decrease in CST in monotherapy and combination group at the last visit from baseline was 515±202 (_P_=0.0002) and 642±224 (_P_=0.0003)

microns, respectively (_P_=0.3) (Figure 1). Mean number of injections in monotherapy and combination group was 6.0±3.17 and 6.7±3.59, respectively (_P_=0.33). There was no significant

difference in b/a ratio on ERG between two groups. Spaide3 reported outcome of 10 eyes, which underwent peripheral laser photocoagulation during the treatment with ranibizumab. He reported

no difference in the number of injections (3.4 _vs_ 3.1) 6 months before and after peripheral laser photocoagulation. Similar to our results, RETAIN and RELATE trials also reported no

benefits of PLP.4, 5 In conclusion, early PLP in eyes with CRVO neither shows additional benefits on functional outcome nor to reduce the number of injections during the 1-year follow-up.

STUDY GROUP INVESTIGATORS Divya Balakrishnan, Subhadra Jalali, Navakanth Bandi, Anand Partani, Sripathi Kamath, Devendra Venkatramani, Aditya Sudhalkar, Devendra Phalak, Padmaja K Rani,

Piyush Bansal, Rajeev Reddy, and Archana Bhargava. REFERENCES * Rehak M, Hollborn M, Iandiev I, Pannicke T, Karl A, Wurm A _et al_. Retinal gene expression and Müller cell responses after

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occlusion: the RELATE Trial. _Ophthalmology_ 2015; 122: 1426–1437. Article  Google Scholar  Download references AUTHOR INFORMATION Author notes * J Chhablani, R Narayanan, A Mathai and M

Tyagi: The members of CRVO-Laser study group are listed before the references. AUTHORS AND AFFILIATIONS * Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Kallam Anji Reddy

campus, LV Prasad Eye Institute, Hyderabad, India J Chhablani, R Narayanan, A Mathai & M Tyagi Authors * J Chhablani View author publications You can also search for this author inPubMed

 Google Scholar * R Narayanan View author publications You can also search for this author inPubMed Google Scholar * A Mathai View author publications You can also search for this author

inPubMed Google Scholar * M Tyagi View author publications You can also search for this author inPubMed Google Scholar CONSORTIA ON BEHALF OF CRVO-LASER STUDY GROUP CORRESPONDING AUTHOR

Correspondence to J Chhablani. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE

THIS ARTICLE Chhablani, J., Narayanan, R., Mathai, A. _et al._ Combination of peripheral laser photocoagulation with intravitreal bevacizumab in naïve eyes with macular edema secondary to

CRVO: prospective randomized study. _Eye_ 30, 1025–1027 (2016). https://doi.org/10.1038/eye.2016.51 Download citation * Published: 01 April 2016 * Issue Date: July 2016 * DOI:

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