Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion

ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

摘要
目的：分析玻璃体内注射曲安奈德（intravitreal triamcinolone acetonide, IVTA）与玻璃体内注射贝伐珠单抗（intravitreal bevacizumab, IVB）对视网膜中央静脉阻塞（central retinal vein occlusion, CRVO）继发黄斑水肿患者眼前段新生血管（anterior segment neovascularization, ASN）及新生血管性青光眼（neovascular glaucoma, NVG）发生率的影响。
方法：本研究为一项前瞻性、随机、双盲、假治疗对照试验，共纳入35例视网膜中央静脉阻塞继发黄斑水肿患者，于研究前6个月内随机接受玻璃体内注射贝伐珠单抗、玻璃体内注射曲安奈德或假注射。主要结局指标为随访6个月时眼前段新生血管的发生率；次要结局指标为截至随访12个月时，最佳矫正视力（best-corrected visual acuity, BCVA）较基线的平均变化值，以及光学相干断层扫描（optical coherence tomography）测得的中心凹厚度（central foveal thickness, CFT）随时间的变化情况。
结果：在12个月的随访期间，共有8只眼（22.86%）发生眼前段新生血管，其中假注射组5只眼（62.50%）、曲安奈德组3只眼（37.50%），组间差异具有统计学意义（p=0.009）。仅在随访第1个月时，各组间最佳矫正视力差异具有统计学意义（p<0.05）；随访12个月内，各组间中心凹厚度无显著统计学差异（p<0.05）。另有1只眼虽经激光治疗，仍发生新生血管性青光眼并需手术干预。
结论：早期接受玻璃体内抗血管内皮生长因子治疗，可降低视网膜中央静脉阻塞后眼前段新生血管及新生血管性青光眼的发生率。