Retinal vein occlusion (RVO) affects 16 million people worldwide, usually the middle-aged or older. It is caused by thrombosis, the clogging of the retinal veins, which may occur in the four branch veins – branch vein retinal occlusion (BVRO), or in the central vein, which is formed by the combination of the four branch veins – central vein retinal occlusion (CVRO). Left untreated (or if treatment fails), persistant RVO can lead to macular edema (ME), the swelling of thickening of the macula caused by leaking blood vessels

Hrytsay, T.

SocioEconomic Challenges Journal (Sumy State University)

МІНІСТЕРСТВО ОСВІТИ І НАУКИ УКРАЇНИ 
СУМСЬКИЙ ДЕРЖАВНИЙ УНІВЕРСИТЕТ 
КАФЕДРА ІНОЗЕМНИХ МОВ 
ЛІНГВІСТИЧНИЙ НАВЧАЛЬНО-МЕТОДИЧНИЙ ЦЕНТР 
 
 
 
 
 
МАТЕРІАЛИ 
VIII МІЖВУЗІВСЬКОЇ НАУКОВО-ПРАКТИЧНОЇ 
КОНФЕРЕНЦІЇ 
ЛІНГВІСТИЧНОГО НАВЧАЛЬНО-МЕТОДИЧНОГО ЦЕНТРУ 
КАФЕДРИ ІНОЗЕМНИХ МОВ 
 
“TO LIVE IN A SAFER WORLD” 
 
 
(Суми, 28 березня 2014 року) 
 
 
 
The eighth scientific practical student`s, postgraduate’s and teacher’s 
LSNC conference 
 
 
 
 
118 
 
TREATING MACULAR EDEMA FOLLOWING RVO 
T. Hrytsay, Sumy State University, LS-204 
N.Horobchenko, EL Adviser 
 
Retinal vein occlusion (RVO) affects 16 million people 
worldwide, usually the middle-aged or older. It is caused by 
thrombosis, the clogging of the retinal veins, which may occur in the 
four branch veins – branch vein retinal occlusion (BVRO), or in the 
central vein, which is formed by the combination of the four branch 
veins – central vein retinal occlusion (CVRO). Left untreated (or if 
treatment fails), persistant RVO can lead to macular edema (ME), the 
swelling of thickening of the macula caused by leaking blood 
vessels. 
The standart care was grid laser photocoagulation for ME and 
non-ischemic BRVO and observation of macular edema in the case 
of CRVO. Today, care differs: implantable and injectable drug-based 
options are available, notably a dexamethasone intravitreal implant 
(Allergan’s Ozurdex) and inhibitors of vascular endothelial grows 
factor (VEGF), including an antibody and a fusion protein. Recently, 
pars plana vitrectomy has also been shown to be effective for 
improving macular thickness, volume, and sensitivity in patients with 
ME secondary to ischemic CRVO. 
Dexamethasone is a potent, water-soluble corticosteroid with 
many therapeutic indications, mostly anti-inflammatory. The 
intravitreal dexamethasone-containing implant comprises micronized 
dexamethasone within a biodegradable copolymer of lactic and 
glycolic acids. The implant is inserted into the eye through a small 
pars plana puncture using a customized applicator system and it 
releases dexamethasone over a period of months.  
It has been demonstrated that high concentrations of 
dexamethasone are sustained in the retina and vitreous during the 
first 2 months after the injection, and lower concentrations are 
sustained up to 6 months. Ozurdex has been proven effective, 
approved by the regulatory agencies in the United States and Europe, 
and is currently used in clinical practice for the treatment of ME 
associated with RVO and noninfectious posterior uveitis. It has also 
119 
 
been demonstrated to be effective for the treatment of diabetic ME in 
vitrectomized eyes. 
All published studies of Ozurdex focused on its short-term 
efficacy and safety, following patients for 6 or 12 months only. 
Information regarding the response to multiple treatments, the 
optimal retreatment interval, and long-term follow-up is lacking. The 
purpose of this study is to evaluate the long-term visual prognosis 
and complications of patients who received Ozurdex injections for 
the treatment of ME in RVO. 
VEGF inhibitors such as ranibizumab revealed a beneficial 
effect on visual function and reduced central macular thickness in 
eyes with BRVO and CRVO. However, with respect to the shorter 
half-life of ranibizumab, numerous injections are required to achieve 
and maintain this therapeutic effect. This is also valid for 
bevacizumab which is injected every 6 weeks for 12 months with a 
significant improvement of visual acuity (VA) and reduction of 
macular edema. 
A pre-treatment with a VEGF inhibitor may have an impact 
on the time until a recurrence of macular edema following the first 
Ozurdex implantation is seen. However, it appeared that the time to 
recurrence could not be prolonged. Recurrences occurred after a 
period of 3.2 and 3.8 months. Interestingly, the number of 
recurrences (and subsequent retreatments) in patients receiving a 
monotherapy with the dexamethasone implant was lower in BRVO 
compared with CRVO patients, which may be well explained by the 
more favorable natural course of macular edema associated with 
BRVO. 
In conclusion, combined treatment using Avastin 
(bevacizumab) and Ozurdex showed slightly better functional 
outcome for CRVO patients. Increased intraocular pressure and 
cataract progression was frequent and should be considered when an 
individual treatment is planned. 
 
 
 


Treating macular edema following RVO

Electronic Sumy State University Institutional Repository

МІНІСТЕРСТВО ОСВІТИ І НАУКИ УКРАЇНИ СУМСЬКИЙ ДЕРЖАВНИЙ УНІВЕРСИТЕТ КАФЕДРА ІНОЗЕМНИХ МОВ ЛІНГВІСТИЧНИЙ НАВЧАЛЬНО-МЕТОДИЧНИЙ ЦЕНТР      МАТЕРІАЛИ VIII МІЖВУЗІВСЬКОЇ НАУКОВО-ПРАКТИЧНОЇ КОНФЕРЕНЦІЇ ЛІНГВІСТИЧНОГО НАВЧАЛЬНО-МЕТОДИЧНОГО ЦЕНТРУ КАФЕДРИ ІНОЗЕМНИХ МОВ  “TO LIVE IN A SAFER WORLD”   (Суми, 28 березня 2014 року)    The eighth scientific practical student`s, postgraduate’s and teacher’s LSNC conference     118  TREATING MACULAR EDEMA FOLLOWING RVO T. Hrytsay, Sumy State University, LS-204 N.Horobchenko, EL Adviser  Retinal vein occlusion (RVO) affects 16 million people worldwide, usually the middle-aged or older. It is caused by thrombosis, the clogging of the retinal veins, which may occur in the four branch veins – branch vein retinal occlusion (BVRO), or in the central vein, which is formed by the combination of the four branch veins – central vein retinal occlusion (CVRO). Left untreated (or if treatment fails), persistant RVO can lead to macular edema (ME), the swelling of thickening of the macula caused by leaking blood vessels. The standart care was grid laser photocoagulation for ME and non-ischemic BRVO and observation of macular edema in the case of CRVO. Today, care differs: implantable and injectable drug-based options are available, notably a dexamethasone intravitreal implant (Allergan’s Ozurdex) and inhibitors of vascular endothelial grows factor (VEGF), including an antibody and a fusion protein. Recently, pars plana vitrectomy has also been shown to be effective for improving macular thickness, volume, and sensitivity in patients with ME secondary to ischemic CRVO. Dexamethasone is a potent, water-soluble corticosteroid with many therapeutic indications, mostly anti-inflammatory. The intravitreal dexamethasone-containing implant comprises micronized dexamethasone within a biodegradable copolymer of lactic and glycolic acids. The implant is inserted into the eye through a small pars plana puncture using a customized applicator system and it releases dexamethasone over a period of months.  It has been demonstrated that high concentrations of dexamethasone are sustained in the retina and vitreous during the first 2 months after the injection, and lower concentrations are sustained up to 6 months. Ozurdex has been proven effective, approved by the regulatory agencies in the United States and Europe, and is currently used in clinical practice for the treatment of ME associated with RVO and noninfectious posterior uveitis. It has also 119  been demonstrated to be effective for the treatment of diabetic ME in vitrectomized eyes. All published studies of Ozurdex focused on its short-term efficacy and safety, following patients for 6 or 12 months only. Information regarding the response to multiple treatments, the optimal retreatment interval, and long-term follow-up is lacking. The purpose of this study is to evaluate the long-term visual prognosis and complications of patients who received Ozurdex injections for the treatment of ME in RVO. VEGF inhibitors such as ranibizumab revealed a beneficial effect on visual function and reduced central macular thickness in eyes with BRVO and CRVO. However, with respect to the shorter half-life of ranibizumab, numerous injections are required to achieve and maintain this therapeutic effect. This is also valid for bevacizumab which is injected every 6 weeks for 12 months with a significant improvement of visual acuity (VA) and reduction of macular edema. A pre-treatment with a VEGF inhibitor may have an impact on the time until a recurrence of macular edema following the first Ozurdex implantation is seen. However, it appeared that the time to recurrence could not be prolonged. Recurrences occurred after a period of 3.2 and 3.8 months. Interestingly, the number of recurrences (and subsequent retreatments) in patients receiving a monotherapy with the dexamethasone implant was lower in BRVO compared with CRVO patients, which may be well explained by the more favorable natural course of macular edema associated with BRVO. In conclusion, combined treatment using Avastin (bevacizumab) and Ozurdex showed slightly better functional outcome for CRVO patients. Increased intraocular pressure and cataract progression was frequent and should be considered when an individual treatment is planned.    

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Treating macular edema following RVO

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