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Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology.

Publication ,  Journal Article
Ehlers, JP; Kim, SJ; Yeh, S; Thorne, JE; Mruthyunjaya, P; Schoenberger, SD; Bakri, SJ
Published in: Ophthalmology
September 2017

PURPOSE: To evaluate the available evidence on the ocular safety and efficacy of current therapeutic alternatives for the management of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Literature searches were last conducted on January 31, 2017, in PubMed with no date restrictions and limited to articles published in English, and in the Cochrane Database without language limitations. The searches yielded 321 citations, of which 109 were reviewed in full text and 27 were deemed appropriate for inclusion in this assessment. The panel methodologist assigned ratings to the selected studies according to the level of evidence. RESULTS: Level I evidence was identified in 10 articles that addressed anti-vascular endothelial growth factor (VEGF) pharmacotherapies for ME, including intravitreal bevacizumab (5), aflibercept (2), and ranibizumab (4). Level I evidence was identified in 6 studies that examined intravitreal corticosteroids, including triamcinolone (4) and the dexamethasone implant (2). Level I evidence also was available for the role of macular grid laser photocoagulation (7) and scatter peripheral laser surgery (1). The inclusion of level II and level III studies was limited given the preponderance of level I studies. The number of studies on combination therapy is limited. CONCLUSIONS: Current level I evidence suggests that intravitreal pharmacotherapy with anti-VEGF agents is effective and safe for ME secondary to BRVO. Prolonged delay in treatment is associated with less improvement in visual acuity (VA). Level I evidence also indicates that intravitreal corticosteroids are effective and safe for the management of ME associated with BRVO; however, corticosteroids are associated with increased potential ocular side effects (e.g., elevated intraocular pressure, cataracts). Laser photocoagulation remains a safe and effective therapy, but VA results lag behind the results for anti-VEGF therapies.

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Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

September 2017

Volume

124

Issue

9

Start / End Page

1412 / 1423

Location

United States

Related Subject Headings

  • Visual Acuity
  • United States
  • Technology Assessment, Biomedical
  • Retinal Vein Occlusion
  • Ophthalmology & Optometry
  • Ophthalmology
  • Macular Edema
  • Intravitreal Injections
  • Humans
  • Drug Therapy, Combination
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ehlers, J. P., Kim, S. J., Yeh, S., Thorne, J. E., Mruthyunjaya, P., Schoenberger, S. D., & Bakri, S. J. (2017). Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology. Ophthalmology, 124(9), 1412–1423. https://doi.org/10.1016/j.ophtha.2017.03.060
Ehlers, Justis P., Stephen J. Kim, Steven Yeh, Jennifer E. Thorne, Prithvi Mruthyunjaya, Scott D. Schoenberger, and Sophie J. Bakri. “Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology.Ophthalmology 124, no. 9 (September 2017): 1412–23. https://doi.org/10.1016/j.ophtha.2017.03.060.
Ehlers JP, Kim SJ, Yeh S, Thorne JE, Mruthyunjaya P, Schoenberger SD, et al. Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology. Ophthalmology. 2017 Sep;124(9):1412–23.
Ehlers, Justis P., et al. “Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology.Ophthalmology, vol. 124, no. 9, Sept. 2017, pp. 1412–23. Pubmed, doi:10.1016/j.ophtha.2017.03.060.
Ehlers JP, Kim SJ, Yeh S, Thorne JE, Mruthyunjaya P, Schoenberger SD, Bakri SJ. Therapies for Macular Edema Associated with Branch Retinal Vein Occlusion: A Report by the American Academy of Ophthalmology. Ophthalmology. 2017 Sep;124(9):1412–1423.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

September 2017

Volume

124

Issue

9

Start / End Page

1412 / 1423

Location

United States

Related Subject Headings

  • Visual Acuity
  • United States
  • Technology Assessment, Biomedical
  • Retinal Vein Occlusion
  • Ophthalmology & Optometry
  • Ophthalmology
  • Macular Edema
  • Intravitreal Injections
  • Humans
  • Drug Therapy, Combination