#Pro re nata take as needed cd pro

The Comparison of Ranibizumab versus Dexamethasone in Central Retinal Vein Occlusion (COMRADE-C) and Branch Retinal Vein Occlusion (COMRADE-B) were the first prospective randomized head-to-head trials comparing the efficacy and safety of intravitreal ranibizumab 0.5 mg injections (Lucentis® Novartis Pharma AG, Basel, Switzerland, and Genentech Inc., South San Francisco, CA) and intravitreal dexamethasone 0.7 mg implant (OZURDEX®, Allergan Inc., Irvine, CA) in patients with macular edema secondary to RVO. 12– 14 However, evidence on the impact of retinal ischemia on the efficacy of available RVO treatment options remains limited. Recent American, British, and Canadian guidelines for the treatment of RVO suggest anti-VEGF as the first line of therapy in patients with presence of macular edema at the time of diagnosis. Laser therapy, either central and panretinal, is also routinely utilized in both BRVO and CRVO patients with ischemia or neovascularization. 10 In recent years, significant advances in the management of macular edema following RVO have been made, and several effective treatments are now licensed, including dexamethasone implant and anti-VEGF therapies. 10, 11 Risk of neovascularization is high if the nonperfused area is >30 disc area (DA) and time from occlusion is <1 month. 1, 7, 9 In fact, the size of the nonperfused area, as detected by fluorescein angiography (FA), is proportional to the risk of retinal and disc neovascularization. 7įurther, retinal ischemia is associated with anatomical changes such as the development of shunt vessels and neovascularization. 8 Compared with patients with less nonperfusion, patients with ischemia experience a greater decrease in mean foveal central subfield thickness (FCPT) and greater visual acuity (VA) gain in response to combination treatment with anti-vascular endothelial growth factor (VEGF) and dexamethasone implant. 6, 7 Nonischemic patients may maintain good vision, while those with ischemia more commonly endure severe visual loss, cotton-wool spots, and large confluent hemorrhages.

3– 5 The presence of retinal ischemia in RVO typically affects its clinical course and response to treatment. 1, 2 Depending on the degree of capillary drop-out, occlusion of the central retinal vein (CRVO), or branch retinal vein (BRVO), can be further subdivided into perfused (nonischemic) or nonperfused (ischemic) RVO. Retinal ischemia secondary to capillary closure, or nonperfusion, is a frequent complication of RVO. Central RVO patients treated with dexamethasone received more laser treatments over the 6 months than those treated with ranibizumab, while there was no difference in the frequency of laser therapy between the branch RVO treatment groups.Ĭonclusions: VA gain over six months in ranibizumab-treated RVO patients is not affected by ischemia, and is associated with less development of new ischemia during the first 6 months of treatment and equal or fewer laser treatments than dexamethasone implant. Ranibizumab was associated with less new ischemia than dexamethasone. The presence of CA and PNP had a significant impact on VA gain over 6 months in CRVO patients ( p < .0001), while there was no significant impact in BRVO.

Results: Visual acuity (VA) gains from baseline to month 6 were higher with ranibizumab than with dexamethasone in both patients with central ischemia and those with peripheral retinal nonperfusion, independent of the type of RVO (branch or central). non-ischemic patients based on the ischemia assessment at month 6 was carried out. Change over 6 months in retinal ischemia status (central avascular zone and peripheral nonperfusion ), mean best-corrected visual acuity (BCVA), the development of shunt vessels and neovascularization, and frequency of laser therapy were assessed in retinal vein occlusion (RVO) patients treated with either ranibizumab 0.5 mg PRN or single dexamethasone 0.7 mg implant, as per European labels, in the COMRADE-B (N = 244 ranibizumab, 126, dexamethasone, 118) or COMRADE-C (N = 243 ranibizumab, 124, dexamethasone, 119) trials. Methods: A post-hoc analysis of the Phase IIIb, 6-month, multicenter, double-masked, randomized, COMRADE-B and COMRADE-C trials.

#Pro re nata take as needed cd pro

Purpose: To compare ischemia-related clinical outcomes in patients treated with either ranibizumab pro re nata (PRN) or single dexamethasone implant in the Branch Retinal Vein Occlusion (COMRADE-B) or Central Retinal Vein Occlusion (COMRADE-C) trials.