Preliminary results of anti-vascular endothelial growth factor treatment for macular edema secondary to branch retinal vein occlusion in Lhasa Tibet_Chinese Journal of Ocular Fundus Diseases

Authors：

Sina Zhuoga ¹ , Deji Yangzong ¹ , An Fang ¹ , Yang Zhen ¹ , Xiao Dawa ¹ , Ciren Qiongda ¹ , Chen Xiaorong ¹ , Zhao Mingwei ² ,  Miao Heng ^1,2

1. Department of Ophthalmology, Tibet Autonomous Region People’s Hospital, Lhasa 850000, China;
2. Department of Ophthalmology & Clinical center of Optometry, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory Diagnosis and Therapy of Retina and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China;

Corresponding author：

Miao Heng, Email: sawyer_young@sina.com

Keywords：

Tibet; Anti-vascular endothelial growth factor drug treatment; Branch retinal vein occlusion; Macular edema

DOI：

10.3760/cma.j.cn511434-20220811-00447

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Objective To observe and evaluate the safety and efficacy of anti-vascular endothelial growth factor (VEGF) in the treatment of eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in Lhasa, Tibet. Methods A retrospective case series. From September 2018 to January 2022, a total of 41 patients (41 eyes) with BRVO-ME, who were diagnosed in Department of Ophthalmology of Tibet Autonomous Region People’s Hospital, were included in this study. There were 21 eyes in 21 males and 20 eyes in 20 females. The median age was 53 (31,75) years. There were 24 patients with hypertension (58.8%, 24/41). Best corrected visual acuity (BCVA), ocular pressure, fundus color photography and optical coherence tomography (OCT) were performed in all eyes. The BCVA was performed using the international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The foveal macular thickness (CMT) was measured by OCT. All eyes were treated with intravitreous injection of anti-VEGF drugs, once a month, among which 23 eyes (56.1%, 23/41) received intravitreous injection of ranibizumab (IVR), and 18 eyes (43.9%, 18/41) received intravitreous injection of conbercept (IVC), and were grouped accordingly. There was no significant difference in age (Z=－0.447), gender composition (Z=－0.485), logMAR BCVA (t=－1.591), intraocular pressure (t=－0.167) and CMT (t=－1.290) between two groups (P＞0.05). During the follow-up, the same devices and methods were used at baseline to perform relevant examinations, and the changes of BCVA, intraocular pressure, CMT and new cardiovascular and cerebrovascular events were compared between baseline and the last follow-up. logMAR BCVA, intraocular pressure and CMT were compared between baseline and last follow-up using Student t test. The comparison of injection times and follow-up time between IVR group and IVC group was conducted by Mann-Whitney U test. Results At baseline, logMAR BCVA, intraocular pressure, and CMT were 0.852±0.431, (12.5±2.5) mm Hg (1 mm Hg= 0.133 kPa), and (578.1±191.1) μm, respectively. At the last follow-up, the number of anti-VEGF drug treatments was (2.7±1.2) times; logMAR BCVA and CMT were 0.488±0.366 and (207.4±108.7) μm, respectively, with CMT > 250 μm in 14 eyes (34.1%, 14/41). Compared with baseline, BCVA (t=4.129) and CMT (t=－0.713) were significantly improved, with statistical significance (P＜0.001). The injection times of IVR group and IVC group were (2.6±0.9) and (3.0±1.5) times, respectively. There were no significant differences in the number of injection times (t=－1.275), logMAR BCVA (t=－0.492), intraocular pressure (t=0.351) and CMT (t=－1.783) between the two groups (P＞0.05). No new hypertension, cardiovascular and cerebrovascular events occurred in all patients during follow-up. At the last follow-up, there were no eye complications related to treatment modalities and drugs. Conclusion Short-term anti-VEGF treatment can improve the visual acuity of BRVO secondary ME patients and alleviate ME in Lhasa, Tibet. The safety and efficacy of ranibizumab and conbercept were similar.

Citation： Sina Zhuoga, Deji Yangzong, An Fang, Yang Zhen, Xiao Dawa, Ciren Qiongda, Chen Xiaorong, Zhao Mingwei, Miao Heng. Preliminary results of anti-vascular endothelial growth factor treatment for macular edema secondary to branch retinal vein occlusion in Lhasa Tibet. Chinese Journal of Ocular Fundus Diseases, 2023, 39(5): 375-380. doi: 10.3760/cma.j.cn511434-20220811-00447 Copy

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13.	吴鹏程, 张文芳, 律鹏, 等. 青海省玛沁县40岁以上世居藏族人群视网膜血管性疾病相关因素的流行病学调查[J]. 国际眼科杂志, 2014(7): 1288-1291. DOI: 10.3980/j.issn.1672-5123.2014.07.32.Wu PC, Zhang WF, Lyu P, et al. Epidemical survey of relative factors of retinal vessels disease of the native Tibetan among the people aged 40 and above in Maqin county, Qinghai province[J]. Int Eye Sci, 2014(7): 1288-1291. DOI: 10.3980/j.issn.1672-5123.2014.07.32.
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18.	Thomley ME, Gross CN, Preda-Naumescu A, et al. Real-world outcomes in patients with branch retinal vein occlusion- (BRVO-) related macular edema treated with anti-vegf injections alone versus anti-VEGF injections combined with focal laser[J/OL]. J Ophthalmol, 2021, 2021: 6641008[2021-05-19]. https://europepmc.org/article/MED/34104482. DOI: 10.1155/2021/6641008.
19.	Gale R, Pikoula M, Lee AY, et al. Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser[J]. Br J Ophthalmol, 2021, 105(4): 549-554. DOI: 10.1136/bjophthalmol-2020-315836.
20.	Avery RL, Castellarin AA, Steinle NC, et al. Systemic pharmacokinetics and pharmacodynamics of intravitreal aflibercept, bevacizumab, and ranibizumab[J]. Retina, 2017, 37(10): 1847-1858. DOI: 10.1097/IAE.0000000000001493.
21.	Billioti de Gage S, Bertrand M, Grimaldi S, et al. Risk of myocardial infarction, stroke, or death in new users of intravitreal aflibercept versus ranibizumab: a nationwide cohort study[J]. Ophthalmol Ther, 2022, 11(2): 587-602. DOI: 10.1007/s40123-021-00451-1.

1. Jaulim A, Ahmed B, Khanam T, et al. Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature[J]. Retina, 2013, 33(5): 901-910. DOI: 10.1097/IAE.0b013e3182870c15.
2. Hayreh SS. Photocoagulation for retinal vein occlusion[J/OL]. Prog Retin Eye Res, 2021, 85: 100964[2021-03-11]. https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(21)00025-2. DOI: 10.1016/j.preteyeres.2021.100964.
3. Song P, Xu Y, Zha M, et al. Global epidemiology of retinal vein occlusion: a systematic review and meta-analysis of prevalence, incidence, and risk factors[J/OL]. J Glob Health, 2019, 9(1): 010427[2019-06-01]. https://europepmc.org/article/MED/31131101. DOI: 10.7189/jogh.09.010427.
4. Mingji C, Onakpoya IJ, Perera R, et al. Relationship between altitude and the prevalence of hypertension in Tibet: a systematic review[J]. Heart, 2015, 101(13): 1054-1060. DOI: 10.1136/heartjnl-2014-307158.
5. Yang JY, You B, Wang Q, et al. Retinal vessel oxygen saturation in healthy subjects and early branch retinal vein occlusion[J]. Int J Ophthalmol, 2017, 10(2): 267-270. DOI: 10.18240/ijo.2017.02.14.
6. Mlinar T, Debevec T, Kapus J, et al. Retinal blood vessel diameters in children and adults exposed to a simulated altitude of 3, 000 m[J/OL]. Front Physiol, 2023, 14: 1026987[2023-02-28]. https://europepmc.org/article/MED/36926190. DOI:10.3389/fphys.2023.1026987.
7. Li Q, Guo Z, Liu F, et al. The effects of altitude-related hypoxia exposure on the multiscale dynamics of blood pressure fluctuation during sleep: the observation from a pilot study[J]. Nat Sci Sleep, 2021, 13: 1147-1155. DOI: 10.2147/NSS.S319031.
8. Baker J, Safarzadeh MA, Incognito AV, et al. Functional optical coherence tomography at altitude: retinal microvascular perfusion and retinal thickness at 3, 800 meters[J]. J Appl Physiol (1985), 2022, 133(3): 534-545. DOI: 10.1152/japplphysiol.00132.2022.
9. Abdel-Qadir H, Ethier JL, Lee DS, et al. Cardiovascular toxicity of angiogenesis inhibitors in treatment of malignancy: a systematic review and meta-analysis[J]. Cancer Treat Rev, 2017, 53: 120-127. DOI: 10.1016/j.ctrv.2016.12.002.
10. Mirrakhimov AE, Strohl KP. High-altitude pulmonary hypertension: an update on disease pathogenesis and management[J]. Open Cardiovasc Med J, 2016, 10: 19-27. DOI: 10.2174/1874192401610010019.
11. Algahtani FH, AlQahtany FS, Al-Shehri A, et al. Features and incidence of thromboembolic disease: a comparative study between high and low altitude dwellers in Saudi Arabia[J]. Saudi J Biol Sci, 2020, 27(6): 1632-1636. DOI: 10.1016/j.sjbs.2020.03.004.
12. Baertschi M, Dayhaw-Barker P, Flammer J. The effect of hypoxia on intra-ocular, mean arterial, retinal venous and ocular perfusion pressures[J]. Clin Hemorheol Microcirc, 2016, 63(3): 293-303. DOI: 10.3233/CH-152025.
13. 吴鹏程, 张文芳, 律鹏, 等. 青海省玛沁县40岁以上世居藏族人群视网膜血管性疾病相关因素的流行病学调查[J]. 国际眼科杂志, 2014(7): 1288-1291. DOI: 10.3980/j.issn.1672-5123.2014.07.32.Wu PC, Zhang WF, Lyu P, et al. Epidemical survey of relative factors of retinal vessels disease of the native Tibetan among the people aged 40 and above in Maqin county, Qinghai province[J]. Int Eye Sci, 2014(7): 1288-1291. DOI: 10.3980/j.issn.1672-5123.2014.07.32.
14. Gupta A, Singh S, Ahluwalia TS, et al. Retinal vein occlusion in high altitude[J]. High Alt Med Biol, 2011, 12(4): 393-397. DOI: 10.1089/ham.2010.1093.
15. Meier D, Collet TH, Locatelli I, et al. Does This patient have acute mountain sickness?: The rational clinical examination systematic review[J]. JAMA, 2017, 318(18): 1810-1819. DOI: 10.1001/jama.2017.16192.
16. Jonas JB, Mones J, Glacet-Bernard A, et al. Retinal vein occlusions[J]. Dev Ophthalmol, 2017, 58: 139-167. DOI: 10.1159/000455278.
17. Campochiaro PA, Heier JS, Feiner L, et al. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase Ⅲ study[J]. Ophthalmology, 2010, 117(6): 1102-1112. DOI: 10.1016/j.ophtha.2010.02.021.
18. Thomley ME, Gross CN, Preda-Naumescu A, et al. Real-world outcomes in patients with branch retinal vein occlusion- (BRVO-) related macular edema treated with anti-vegf injections alone versus anti-VEGF injections combined with focal laser[J/OL]. J Ophthalmol, 2021, 2021: 6641008[2021-05-19]. https://europepmc.org/article/MED/34104482. DOI: 10.1155/2021/6641008.
19. Gale R, Pikoula M, Lee AY, et al. Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser[J]. Br J Ophthalmol, 2021, 105(4): 549-554. DOI: 10.1136/bjophthalmol-2020-315836.
20. Avery RL, Castellarin AA, Steinle NC, et al. Systemic pharmacokinetics and pharmacodynamics of intravitreal aflibercept, bevacizumab, and ranibizumab[J]. Retina, 2017, 37(10): 1847-1858. DOI: 10.1097/IAE.0000000000001493.
21. Billioti de Gage S, Bertrand M, Grimaldi S, et al. Risk of myocardial infarction, stroke, or death in new users of intravitreal aflibercept versus ranibizumab: a nationwide cohort study[J]. Ophthalmol Ther, 2022, 11(2): 587-602. DOI: 10.1007/s40123-021-00451-1.

Chinese Journal of Ocular Fundus Diseases

Preliminary results of anti-vascular endothelial growth factor treatment for macular edema secondary to branch retinal vein occlusion in Lhasa Tibet

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