🔬 Laser Trials
- CVOS (1994)
- Macular edema: Grid laser reduced angiographic edema but did not improve vision.
- Neovascularization: Panretinal photocoagulation (PRP) should be deferred until NVI/NVA appears.
- BVOS (1984)
- Macular edema: In BRVO with >3 months edema and VA ≤20/40, grid laser improved vision.
- Neovascularization: Scatter laser reduced risk of vitreous hemorrhage; treat only when NV develops.
💊 Corticosteroid Trials
- SCORE (2008)
- BRVO: Triamcinolone gave early VA gains but not sustained; higher cataract/IOP risk.
- CRVO: Steroid improved VA but with significant cataract/ocular hypertension risk.
- GENEVA (2008)
- Dexamethasone implant improved VA at ~60 days, but effect waned by 6 months; ~16% risk of IOP rise.
- COMRADE C (2014)
- Ranibizumab was superior to dexamethasone (16 vs 9 letters gained at 6 months).
💉 Anti‑VEGF Registration Trials
- BRAVO (2008, BRVO): Ranibizumab monthly → +16–18 letters vs +7 with sham.
- CRUISE (2008, CRVO): Ranibizumab monthly → +13–15 letters vs <1 with sham.
- VIBRANT (2012, BRVO): Aflibercept monthly → 53% gained ≥15 letters vs 28% with laser.
- GALILEO/COPERNICUS (2010, CRVO): Aflibercept monthly → 56% gained ≥15 letters vs 12% with sham.
⚖️ Head‑to‑Head Pharmacologic Trials
- SCORE2 (2016, CRVO/HRVO): Bevacizumab noninferior to aflibercept (both +18 letters).
- CRAVE (2015): Bevacizumab ≈ Ranibizumab (both improved VA and reduced thickness).
- LEAVO (2016, CRVO):
- Ranibizumab: +12.5 letters
- Aflibercept: +15.1 letters
- Bevacizumab: +9.8 letters → inferior to the others.
- MARVEL (2015, BRVO): Bevacizumab ≈ Ranibizumab (similar VA gains ~16–18 letters).
📌 Key Clinical Lessons
- Laser: Limited role—use scatter laser for NV, grid laser only in select BRVO cases.
- Steroids: Effective but limited by cataract and IOP risks.
- Anti‑VEGF: Clear first‑line therapy; ranibizumab and aflibercept consistently superior to sham and laser.
- Comparisons: Bevacizumab is cost‑effective but may be slightly less effective than aflibercept/ranibizumab in CRVO (LEAVO).
1. What was the main finding of the CVOS trial regarding grid laser treatment for macular edema in CRVO?
2. Which trial demonstrated that ranibizumab was superior to dexamethasone for CRVO?
3. In the BRAVO trial, what was the average visual acuity gain with monthly ranibizumab 0.5 mg for BRVO?
4. Which anti‑VEGF agent showed noninferiority to aflibercept in the SCORE2 trial for CRVO?
5. What was the main conclusion of the VIBRANT trial comparing aflibercept to laser for BRVO?
6. Which trial showed that grid laser improved vision in BRVO patients with >3 months of edema and VA ≤20/40?
7. What percentage of eyes treated with aflibercept in the GALILEO/COPERNICUS trials gained ≥15 letters?
8. Which trial compared bevacizumab and ranibizumab for BRVO and found similar visual acuity gains?
9. In the LEAVO trial (CRVO), which agent had the lowest mean visual acuity gain at 100 weeks?
10. In the GENEVA study, when was peak visual improvement observed after a dexamethasone implant for RVO?
