The one-stage combined technology of treatment retinovascular macular edema «Macular double block»

    ABSTRACT

    The one-stage combined technology of treatment retinovascular macular edema «Macular double block»

    

    M.I. Ismailov, A.M. Agmadov

    

    1 The Department of Ophthalmology № 2 with the Course of Postgraduate Medical Advanced Training, the Dagestan State Medical Academy, Makhachkala;
2 The Eye Clinic «High Technology», Makhachkala

    

    Purpose. To increase the effectiveness of the macular edema treatment in non-ischemic occlusion of central retinal vein (CRV) branches in the early stages by means of a combined technology including micro-pulse sub-threshold laser photocoagulation and intravitreal injection of vascular endothelial growth factor (VEGF) inhibitors.

    Material and methods. The study included 79 patients (80 eyes) with macular edema that met the criteria of clinically significant macular edema (Early Treatment Diabetic Retinopathy Study), secondary to non-ischemic BRVO thrombosis. Patients were followed up within 1 year. All patients were divided into two groups: the main group – 40 individuals (40 eyes) and a comparative group – 39 individuals (40 eyes). All patients of the main group were treated according to a patented technique «macular double block». This combined method of treatment consisted of two consecutive stages of treatment. Initially the VEGF inhibitor (0.5mg) was injected intravitreally and then 30 minutes later the micro-pulse sub-threshold photocoagulation of the retina was carried out. In patients of the comparative group the VEGF inhibitor ranibizumab (Lucentis) was injected intravitreally in an amount of 0.5mg monthly within 3 months. In the study besides the standard ophthalmic examination there were used the computer perimetry according to the Macula threshold of 10° protocol (Oculus Twinfield), the fluorescent angiography of the retina (non-mydriatic digital fundus camera Kowa VX-10), the spectral optical coherence tomography (OCT) of the retina (Optovue RTVue-100).

    Results. At the end of treatment, the BCVA in patients of the main group increased by one or more lines in 90% (36 eyes) versus 77.5% (31 eyes) in patients of the comparative group. Macular thickness according to the data of the spectral OCT of the retina in eyes of the main group averaged 196 microns at the end of the study, in eyes of the comparative group – 219 microns. An increase of the light sensitivity of the central visual field was observed in both groups, starting from the 10th day after the beginning of the study. Moreover, in the main group the increase of light sensitivity of the central visual field was more pronounced from the outset and its curve of growth was in the first 2 months steeper. During the entire period of the study no relative or absolute scotoma was revealed in the area of laser exposure in the mode of the micro-pulse modulation by the author's method in patients of the main group.

    Conclusions. The developed technology of treatment allows to achieve a more complete recovery of the macula anatomy, in the early periods, and a greater visual acuity in comparison with the monotherapy by VEGF inhibitors (ranibizumab), with an equal safety and an atraumatic profile. This combined technology of treatment for retinovascular macular edema allows to reduce a quantity of intravitreal injections, compared with the intravitreal ranibizumab monotherapy.

    Key words: inhibitors of vascular endothelial growth factor, micro-pulse sub-threshold laser photocoagulation, macular edema.