Hemiretinal vein occlusion with macular hemorrhage and edema treated with intravitreal bevacizumab

Figures & data

Figure 1 Initial presentation. Best corrected visual acuity 20/80. (A) Color fundus photograph demonstrates extensive, confluent inferior retinal hemorrhages with macular involvement. (B) Optical coherence tomography demonstrates intraretinal cysts and subretinal fluid. Central foveal thickness 696 microns (central 1 mm subfield). (C–E) Fluorescein angiography. (C) Early: 28 seconds, (D) 2.37 minutes, and (E) Late: 9.42 minutes, extensive blockage from hemorrhage and late hyperfluorescence.

Figure 2 Cirrus spectral domain optical coherence tomography progression. (A) Best corrected visual acuity 20/60, improved intraretinal and subretinal fluid (central foveal thickness 534 microns) after initial intravitreal bevacizumab injection four weeks earlier. (B) Best corrected visual acuity 20/70, central foveal thickness 682 microns. (C) Color fundus photograph six weeks after third intravitreal bevacizumab injection. Improved confluent macular hemorrhage. (D) Best corrected visual acuity 20/40, central foveal thickness 473 microns, corresponding optical coherence tomography to (C) visit.

Figure 3 Recent follow-up. Best corrected visual acuity 20/25. (A) Color fundus photograph demonstrates resolution of majority of confluent hemorrhages. (B) Optical coherence tomography demonstrates resolved fluid (central foveal thickness 261 microns) and presence of subfoveal inner and outer segment disruption.

Table 1 Branch retinal vein occlusion summary data^5,9,10

Treatment	Months	BCVA change^a	≥15 letters^a	CFT change
Triamcinolone 1 mg (SCORE)	12	+5.7	26%	−149 microns
Dexamethasone 0.7 mg (GENEVA)	6	+7.4	22%	−119 microns
Ranibizumab 0.5 mg (BRAVO)	12	+18.3	60%	−347 microns

Abbreviations: BCVA, best corrected visual acuity; CFT, central foveal thickness.

Table 2 Central retinal vein occlusion summary data^6,9,10

Treatment	Months	BCVA changea	≥15 lettersa	CFT change
Triamcinolone 1 mg (SCORE)	12	−1.2	27%	−196 microns
Dexamethasone 0.7 mg (GENEVA)	6	+0.1	22%	−119 microns
Ranibizumab 0.5 mg (CRUISE)	12	+13.9	51%	−462 microns

a Note: ETDRS letters.

Abbreviations: BCVA, change in best corrected visual acuity; CFT, change in central foveal thickness; EDTRS, Early Treatment for Diabetic Retinopathy Study.

Table 3 Outcomes in BCVA and CFT after 6 and 12 months of ranibizumab 0.5 mg treatment in BRAVO and CRUISE studies^5,6

Study	Mean change from baseline BCVAa 0.5 mg at 6 months versus sham	Mean change from baseline CFT, μm at 6 months versus sham	Mean change from baseline BCVAa 0.5 mg at 12 months versus sham	Mean change from baseline CFT, μm at 12 months versus sham
BRAVO	+18.3 versus +7.3	−345.2 versus −157.7	+18.3 versus +12.1	−374.4 versus −273.4
CRUISE	+14.9 versus +0.8	−452.3 versus −167.7	+13.9 versus +7.3	−462.1 versus −427.2

a Note: ETDRS letters. Patients were randomized 1:1:1 to receive sham injections or ranibizumab in one of two doses (0.3 or 0.5 mg) in both studies.

Abbreviations: BCVA, best corrected visual acuity; CFT, central foveal thickness; ETDRS, Early Treatment for Diabetic Retinopathy Study.

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