덱사메타손과 베바시주맙에 반응없는 분지정맥폐쇄에 동반된 황반부종환자에서 라니비주맙치료 1예

Ranibizumab for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion Resistant to Dexamethasone and Bevacizumab

Purpose: To report a case of intravitreal ranibizumab for refractory macular edema secondary to branch retinal vein occlusion resistant to dexamethasone implant and bevacizumab. Case summary: A-65-year old female patient was hospitalized for visual disturbance and metamorphosia in the left eye. The patient had the symptom for 8 months however did not go through any treatment. In addition, she was admitted to the other hospital four months before as the onset of symptom and had the intravitreal bevacizumab injection for the diagnosis of branch retinal vein occlusion. Her best corrected visual acuity was 1.0 in the right eye and 0.3 in the left eye on the first examine. Retinal edema including macular edema, cotton wool spot, retinal hemorrhage were observed in the left eye. Fluorescein angiopraphy showed fluorescein leakage around the branch retinal vein in the late phase and macular edema with cystic change in the optical coherence tomography. Intravitreal dexamethasone implant injection was performed first. Four months after the treatment, macular edema was worse and the visual acuity was not improved. Four times more intravitreal bevacizumab injection was performed. After 11 months of treatments, the subretinal fluid disappeared, but macular edema with cystic change was rather worse. Furthermore, ranibizumab injection was performed three times. Macular edema disappeared 16 months after the start of treatment and corrected visual improved to 0.6 in the left eye. Conclusions: Intravitreal ranibizumab injection appeared to be an effective option for the treatment of macular edema secondary to branch retinal vein occlusion resistant to dexamethasone implant and bevacizumab.