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Clinical science
Topical bromfenac reduces the frequency of intravitreal bevacizumab in patients with branch retinal vein occlusion Masahiko Shimura, Kanako Yasuda Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan Correspondence to Dr Masahiko Shimura, Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, 1163 Tate-machi, Hachioji, Tokyo 193-0998, Japan; [email protected] Received 3 December 2013 Revised 13 May 2014 Accepted 9 August 2014 Published Online First 2 September 2014
ABSTRACT Background/aims To evaluate the effectiveness of topical bromfenac during treatment with intravitreal injections of bevacizumab (IVB) in eyes with macular oedema (ME) secondary to branch retinal vein occlusion (BRVO). Methods Prospective interventional case–control study. 48 eyes of 44 patients with ME-BRVO who received 1.25 mg/0.05 mL of IVB showed temporary regression of ME. Additional IVB were given when ME recurred. 24 eyes received topical bromfenac, and the other 24 eyes received topical saline as control, four times a day during the clinical course of 48 weeks. The clinical course of foveal thickness (FT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution visual acuity (VA), was monitored. The number of IVB was also recorded. Results There were no significant differences in FT, VA between the bromfenac-treated eyes and the control eyes at the initial and final examinations. The number of injections in bromfenac-treated eyes of 3.8±1.1 times was significantly less than in the control eyes of 4.8±1.2 times. Conclusions Although topical bromfenac during IVB therapy in eyes with ME secondary to BRVO did not affect the visual prognosis, it had the advantage of reducing the number of injections. Trial registration number UMIN 14929.
INTRODUCTION
To cite: Shimura M, Yasuda K. Br J Ophthalmol 2015;99:215–219.
Branch retinal vein occlusion (BRVO) is the second most frequent major retinal vascular disease after diabetic retinopathy. Macular oedema (ME) develops in ∼60% of eyes with a BRVO and is one of the major causes for visual loss in eyes with BRVO.1 An earlier study on the natural history of BRVO reported that only 14% of eyes with chronic ME secondary to BRVO retained a visual acuity (VA) of 20/40 or better, whereas 86% had a final VA of 20/50 or worse.2 Although the Branch Vein Occlusion Study recommended macular grid laser photocoagulation,3 later studies suggest that improvement of visual function by this treatment was limited.4 5 During the last decade, a number of additional treatments for ME secondary to BRVO have been investigated. Possible treatments for BRVO include grid-pattern laser photocoagulation, laser chorioretinal anastomosis, vitrectomy, arteriovenous sheathotomy and intravitreal injection of triamcinolone acetonide (IVTA) or antibodies targeted at vascular endothelial growth factor (VEGF).6
Recently, many studies revealed that intravitreal injections of bevacizumab (IVB), an anti-VEGF antibody, provided rapid and effective treatment of ME following BRVO, while multiple IVB were required to maintain reduction of ME.7–9 A more recent study reported that half of patients still required occasional injections for more than 4 years.10 Multiple intravitreal injections of an anti-VEGF antibody can cause adverse effects such as ocular pain, ischaemic retinopathy and endophthalmitis,11 in addition to causing financial problems due to the high cost of anti-VEGF drugs like ranibizumab.12 Thus, the number of injections of intravitreal anti-VEGF antibody should be limited. Topical bromfenac, a non-steroidal antiinflammatory drug (NSAID) in combination with anti-VEGF antibody therapy for age-related macular degeneration, showed a synergistic effect with improved anatomical, functional outcomes and the need for fewer intravitreal injections.13 14 In this study, the efficacy of topical bromfenac in reducing the number of IVB treatments for ME secondary to BRVO was investigated to determine the number of injections of IVB necessary to maintain the morphological resolution of ME and to evaluate the clinical course of visual function.
METHODS This prospective study was conducted in accordance with the Institutional Guidelines of NTT East Japan Tohoku Hospital Clinical Research Ethics Committee and was approved by the Institutional Review Board (nttthk #082008). The procedures conformed to the tenets of the World Medical Association’s Declaration of Helsinki. Informed consent was obtained from each patient after they were provided with information on the procedures to be performed.
Patient eligibility Patients with ME secondary to BRVO, age over 50 years old, a preclinical period from symptom onset to initial examination of
Clinical science
Topical bromfenac reduces the frequency of intravitreal bevacizumab in patients with branch retinal vein occlusion Masahiko Shimura, Kanako Yasuda Department of Ophthalmology, NTT East Japan Tohoku Hospital, Sendai, Japan Correspondence to Dr Masahiko Shimura, Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, 1163 Tate-machi, Hachioji, Tokyo 193-0998, Japan; [email protected] Received 3 December 2013 Revised 13 May 2014 Accepted 9 August 2014 Published Online First 2 September 2014
ABSTRACT Background/aims To evaluate the effectiveness of topical bromfenac during treatment with intravitreal injections of bevacizumab (IVB) in eyes with macular oedema (ME) secondary to branch retinal vein occlusion (BRVO). Methods Prospective interventional case–control study. 48 eyes of 44 patients with ME-BRVO who received 1.25 mg/0.05 mL of IVB showed temporary regression of ME. Additional IVB were given when ME recurred. 24 eyes received topical bromfenac, and the other 24 eyes received topical saline as control, four times a day during the clinical course of 48 weeks. The clinical course of foveal thickness (FT) as measured by optical coherence tomography, logarithm of the minimum angle of resolution visual acuity (VA), was monitored. The number of IVB was also recorded. Results There were no significant differences in FT, VA between the bromfenac-treated eyes and the control eyes at the initial and final examinations. The number of injections in bromfenac-treated eyes of 3.8±1.1 times was significantly less than in the control eyes of 4.8±1.2 times. Conclusions Although topical bromfenac during IVB therapy in eyes with ME secondary to BRVO did not affect the visual prognosis, it had the advantage of reducing the number of injections. Trial registration number UMIN 14929.
INTRODUCTION
To cite: Shimura M, Yasuda K. Br J Ophthalmol 2015;99:215–219.
Branch retinal vein occlusion (BRVO) is the second most frequent major retinal vascular disease after diabetic retinopathy. Macular oedema (ME) develops in ∼60% of eyes with a BRVO and is one of the major causes for visual loss in eyes with BRVO.1 An earlier study on the natural history of BRVO reported that only 14% of eyes with chronic ME secondary to BRVO retained a visual acuity (VA) of 20/40 or better, whereas 86% had a final VA of 20/50 or worse.2 Although the Branch Vein Occlusion Study recommended macular grid laser photocoagulation,3 later studies suggest that improvement of visual function by this treatment was limited.4 5 During the last decade, a number of additional treatments for ME secondary to BRVO have been investigated. Possible treatments for BRVO include grid-pattern laser photocoagulation, laser chorioretinal anastomosis, vitrectomy, arteriovenous sheathotomy and intravitreal injection of triamcinolone acetonide (IVTA) or antibodies targeted at vascular endothelial growth factor (VEGF).6
Recently, many studies revealed that intravitreal injections of bevacizumab (IVB), an anti-VEGF antibody, provided rapid and effective treatment of ME following BRVO, while multiple IVB were required to maintain reduction of ME.7–9 A more recent study reported that half of patients still required occasional injections for more than 4 years.10 Multiple intravitreal injections of an anti-VEGF antibody can cause adverse effects such as ocular pain, ischaemic retinopathy and endophthalmitis,11 in addition to causing financial problems due to the high cost of anti-VEGF drugs like ranibizumab.12 Thus, the number of injections of intravitreal anti-VEGF antibody should be limited. Topical bromfenac, a non-steroidal antiinflammatory drug (NSAID) in combination with anti-VEGF antibody therapy for age-related macular degeneration, showed a synergistic effect with improved anatomical, functional outcomes and the need for fewer intravitreal injections.13 14 In this study, the efficacy of topical bromfenac in reducing the number of IVB treatments for ME secondary to BRVO was investigated to determine the number of injections of IVB necessary to maintain the morphological resolution of ME and to evaluate the clinical course of visual function.
METHODS This prospective study was conducted in accordance with the Institutional Guidelines of NTT East Japan Tohoku Hospital Clinical Research Ethics Committee and was approved by the Institutional Review Board (nttthk #082008). The procedures conformed to the tenets of the World Medical Association’s Declaration of Helsinki. Informed consent was obtained from each patient after they were provided with information on the procedures to be performed.
Patient eligibility Patients with ME secondary to BRVO, age over 50 years old, a preclinical period from symptom onset to initial examination of
