Study (country) | Complication secondary to iCRVO | Study characteristics | BCVA (SD) converted to LogMAR units (Treatment vs. comparator) | CRT (SD) in μm and/or NV (treatment vs. comparator) | Post-treatment complications (treatment vs. comparator) | Quality of evidence (GRADE)* |
---|---|---|---|---|---|---|
ANTI-VEGF TREATMENTS | ||||||
Korobelnik et al. 2014 [17] (multinational) | ME | ▪ T: Intravitreal aflibercept injection | ▪ Mean change in BCVA at: a | ▪ Mean reduction in CRT: a | ▪ During the 13-month study, NV development: 43 % vs. 43 % | NA |
o 13 months: +17.4 (16.1) vs. −8.0 (15.8) | o 494.6 (318.4) vs. 294.3 (258.6) | |||||
BCVA could not be converted to LogMAR units as the baseline BCVA was not available | ||||||
▪ C: Sham injection | ||||||
Brown et al. 2013 [19] (multinational) | ME | ▪ T: Intravitreal aflibercept injection | ▪ Proportion of eyes gaining ≥ 15 letters at: | Not given by ischemic status | ▪ Not given by ischemic status | NA |
o 6 months: 51.4 % vs. 4.3 % | ||||||
o 13 months: 48.6 % vs. 30.4 % | ||||||
▪ C: Sham injection | ||||||
Boyer et al. 2012 [18] (multinational) | ME | ▪ T: Intravitreal VEGF Trap-Eye (aflibercept) | ▪ Mean change in BCVA at: a | ▪ Mean reduction in CRT from baseline to: b | ▪ Not given by ischemic status | NA |
o 6 months: +17.8 vs. −2.3 | ||||||
BCVA could not be converted to LogMAR units as the baseline was BCVA was not available | o 6 months: 473.0 vs.309.4 | |||||
▪ C: Sham injection | ||||||
▪ Proportion of eyes gaining ≥ 15 letters at: | ||||||
o 6 months: 51.4 % vs. 4.3 % | ||||||
Wittstrom et al. 2012 [16] (Sweden) | NVG | ▪ T: Single intravitreal injection of bevacizumab combined with PRP | ▪ Mean baseline BCVA: | ▪ Median iris NV grade (range): | NA | ⊕ ⊕ ⊝⊝ low |
o 1.8 (0.61) vs. 2.0 (0.43) | o At baseline: 2 (0–4) vs. 1 (0–4) | |||||
▪ Mean BCVA at: | ||||||
o 1 week: 1.8 (0.59) vs. 2.2 (0.45) [p = 0.079] | o 1 week: 0 (0–1) vs. 0 (0–3) | |||||
o 2 months: 0 (0–1) vs. 0 (0–2) | ||||||
o 2 months: 1.8 (0.65) vs. 2.3 (0.46) [p = 0.136] | o 6 months: 0 (0–0) vs.0 (0–1) [for T: p = 0.001, for C: p = 0.005] | |||||
▪ C: PRP | o 6 months: 1.7 (0.71) vs. 2.3 (0.55) [p = 0.114] | |||||
▪ Median angle NV grade (range): | ||||||
o At baseline: 1.5 (0–4) vs. 1 (0–4) | ||||||
o At 1 week: 1 (0–3) vs. 0 (0–3) | ||||||
o At 2 months: 0 (0–3) vs. 0 (0–3) | ||||||
o At 6 months: 0 (0–3) vs.0 (0–3) [for T: p = 0.001, for C: p = 0.014] | ||||||
Campochiaro et al. 2008 [27] (USA) | ME | ▪ T: Ranibizumab 0.3 mg (3-monthly injections) | ▪ Mean baseline BCVA: | ▪ Mean baseline CRT: | NA | ⊕ ⊕ ⊕⊝ moderate |
o 0.78 (1.04–0.07) vs. 0.64 (0.96–0.34) | o 346 (88) vs. 297 (126) | |||||
▪ Mean BCVA at: | ▪ Mean CRT at: | |||||
o 3 months: 0.44 vs. 0.56 | o 3 months: 25 vs. 35 (eliminating 93 % vs. 89 % of the edema, respectively) | |||||
▪ C: Ranibizumab 0.5 mg (3 monthly injections) | ||||||
STEROID TREATMENTS | ||||||
Asano et al. 2007 [20] (Japan) | Ischemic CME or ME | ▪ T: Sub-tenon triamcinolone injection | ▪ Mean baseline BCVA: | ▪ Mean baseline CRT: | NA | ⊕ ⊕ ⊝⊝ low |
o 2 weeks before injection: 0.501 (0.229) vs. 0.510 (0.141) | ||||||
▪ C: No sub-tenon triamcinolone injection | ▪ Mean BCVA at: | o At 2 weeks before injection: 439 (148) vs. 436 (133) | ||||
o 1 month: 0.463 (0.359) vs. 0.510 (0.169) | ▪ Mean CRT at: | |||||
o 2 months: 0.488 (0.262) vs. 0.501 (0.330) | o 1 month: 315 (142) vs. 443 (150) | |||||
o 3 months: 0.499 (0.296) vs. 0.501 (0.212) | ||||||
o 4 months: 0.510 (0.203) vs. 0.511 (0.289) | o 2 months: 442 (143) vs. 467 (152) | |||||
o 3 months: 457 (123) vs. 466 (139) | ||||||
o 4 months: 449 (150) vs. 459 (128) | ||||||
Ramezani et al. 2006 [21] (Iran) | NV preventive effect | ▪ T: Intravitreal triamcinolone | ▪ Mean change in BCVA from baseline to: | ▪ Mean change in CRT from baseline to: | Not given by ischemic status | ⊕⊝⊝⊝ very low |
o 1 month: −0.40 (0.17) vs. −0.00 (0.12) | ||||||
o 2 months: −273 (108) vs. −115 (71) | ||||||
▪ C: Sham subconjunctival injection | ||||||
Jonas et al. 2005 [26] (Germany) | CME | ▪ T: Triamcinolone acetonide intravitreal injection (about 20 mg) | ▪ Mean baseline BCVA of ischemic patients in treatment arm: | NA | NA | NA |
o 1.79 (0.51) | ||||||
▪ Mean change in BCVA of ischemic patients in treatment arm: | ||||||
▪ C: No treatment (results were not given by ischemic status) | o From baseline to best post-operative VA: 1.57 (0.64) [p = 0.10] | |||||
PROCEDURAL TREATMENTS | ||||||
Tabatabaii et al. 2008 [23] (Iran) | ME, none of the eyes had NV | ▪ T: Pars plana vitrectomy with RON | ▪ Mean BCVA: | NA | Post-operation | NA |
▪ Iris NV, VH, and increased intraocular pressure in the early post-operative period: 11 % | ||||||
o Post-operation at 3.6 months vs. pre-operation: 1.32 (0.4–1.9) vs. 1.75 (1.5–1.9) [p < 0.01] | ||||||
▪ C: Pre-operation | ||||||
▪ Complicated by retinal detachment requiring pars plana vitrectomy and silicone injection: 5.5 % | ||||||
▪ Development of NV and VH that needed reoperation: 11 % | ||||||
Parodi et al. 2007 [22] (Italy and USA) | Anterior-segment NV | ▪ T: Conventional PRP (performed promptly when two clock hours of iris NV, any angle NV, or both were identified) | ▪ Mean baseline BCVA: | ▪ Iris NV (clock hours): | ▪ At follow-up, rate of NVG development: 5 % in T and C1 groups, and 11 % in C2 [p = 0.713] | ⊕ ⊕ ⊕ ⊕ high |
o 1.18 (0.16) vs. 1.19 (0.18) vs. 1.18 (0.15) | o At baseline:3.26 (1.96) [T] vs. 2.95(1.90)[C1] vs. 3.50 (1.97) [C2] | |||||
▪ Mean BCVA at: | ||||||
o 12 months: 1.23 (0.15) [T] vs. 1.20 (0.18) [C1] vs. 1.15 (0.16) [C2] [p = 0.28] | ||||||
o 1 month: 1.05 (1.12) vs. 3.15 (2.08) vs. 0.27 (0.46) | ||||||
▪ C1: Selective PRP (performed only in selected cases showing progression of iris NV, angle NV, or both during weekly follow-up) | o 6 months: 0.47 (1.07) vs. 3.05 (2.21) vs. 1.77 (1.11) | |||||
o 12 months: 0.52 (2.29) vs. 2.55 (3.05) vs. 2.27 (2.37) | ||||||
▪ C2: Photodynamic therapy with verteporfin (directed at the iris NV and angle NV) | ||||||
▪ Angle NV (clock hours): | ||||||
o At baseline:1.94 (1.12) [T] vs. 1.85 (1.34) [C1] vs. 2.38 (1.88) [C2] | ||||||
o 1 month: 0.68 (0.88) vs. 2.15 (1.81) vs. 0.00 (0.00) | ||||||
o 6 months: 0.52 (1.64) vs. 2.15 (1.89) vs. 0.83 (1.24) | ||||||
o 12 months: 0.57 (2.52) vs. 1.50 (2.64) vs. 1.27 (2.49) | ||||||
Feltgen et al. 2007 [24] (Germany) | Not mentioned | ▪ T: Retinal endovascular lysis | ▪ Mean pre-operative BCVA immediately before surgery: | NA | ▪ Rate of post-operative complication development: | NA |
▪ C: Pre-operation | o +1.2 (SEM +1.6/ minus +1.745) (range, +2.6 to +0.70) (N.B: +2.6 = light perception) | |||||
o NV: 46 % | ||||||
o Retinal detachment: 23 % | ||||||
▪ Mean post-operative BCVA at: | ||||||
o Cataract: 31 % | ||||||
▪ Rate of intra-operative complications: | ||||||
o 6 weeks: +1.31 (SEM plus +1.62/ minus +1.80) (range, +2.6 to +0.4) | ||||||
o Serious retinal detachment: 8 % | ||||||
o 3 months: +1.37 (SEM plus +1.72/ minus +1.85) (range, +2.6 to +0.52) | o VH: 31 % | |||||
▪ To treat these complications, 13 eyes required 22 additional procedures | ||||||
o 6 months: +1.46 (SEM plus +1.66/ minus +1.89) (range, +2.9 to +0.4) (N.B: +2.9 = Blindness) | ||||||
o 12 months: +1.40 (SEM plus 1.58/ minus +1.80) (range, +2.9 to +0.4) | ||||||
[None of these differences were significant] | ||||||
Mirshahi et al. 2005 [25] (Iran) | Prevention of NV | ▪ T: Surgical induction of chorioretinal venous anastomosis | ▪ Mean BCVA at time period from the onset of occlusion to the time of referral: | NA | ▪ Three (30 %) of 10 patients in the treatment arm needed further operations for: | NA |
o 2.5 vs. 1.5 [p < 0.001] | ||||||
▪ C: No surgery | ▪ Change in BCVA after the occurrence of occlusion: | o Cataract: 33.3 % | ||||
o Vitreous cavity hemorrhage: 33.3 % | ||||||
o 8 months: gained 0.94 vs. lost 0.57 [p < 0.001] | ||||||
o Retinal detachment: 33.3 % | ||||||
o NV: 0 % | ||||||
▪ In the control group, 7 (39 %) of 18 patients developed NV: | ||||||
o NVG: 57 % | ||||||
o Disc NV: 29 % | ||||||
o Iris NV: 14 % | ||||||
MISCELLANEOUS TREATMENTS | ||||||
Hayreh et al. 2011 [28] (USA) | Not mentioned | ▪ T: Aspirin | ▪ Baseline BCVA (n = 38 vs. 45 eyes) (p = 0.905) | NA | NA | NA |
▪ C: No aspirin or anticoagulant | ||||||
o Better than 0.5: 0 (0 %) vs. 0 (0 %) | ||||||
o 0.5–0.7: 1 (3 %) vs. 0 (0 %) | ||||||
o 1.0–1.3: 7 (18 %) vs. 11 (24 %) | ||||||
o CF or worse: 30 (79 %) vs. 34 (76 %) | ||||||
▪ Improved BCVA −0.5 or worse at: | ||||||
o 3 months (n = 26 vs. 32): 2 (8 %) vs. 4 (12 %) | ||||||
o 6 months (n = 22 vs. 29): 3 (14 %) vs. 5 (17 %) | ||||||
o 9 months (n = 18 vs. 32): 3 (17 %) vs. 5 (16 %) | ||||||
o 15 months (n = 16 vs. 21): 5 (31 %) vs. 5 (24 %) | ||||||
o 2–5 years (n = 9 vs. 17): 2 (22 %) vs. 4 (24 %) | ||||||
▪ Worsened BCVA −0.5 or worse at: | ||||||
o 3 months (n = 26 vs. 32): 5 (19 %) vs. 4 (12 %) | ||||||
o 6 months (n = 22 vs. 29):4 (18 %) vs. 6 (21 %) | ||||||
o 9 months (n = 18 vs. 32): 2 (11 %) vs. 8 (25 %) | ||||||
o 15 months (n = 16 vs. 21): 4 (25 %) vs. 5 (24 %) | ||||||
o 2–5 years (n = 9 vs. 17): 3 (33 %) vs. 5 (29 %) |