Combined Intravitreal Injection of Bevacizumab and a ROCK Inhibitor (Fasudil) for Refractory Macular Edema Secondary to Retinal Vein Occlusion: A Pilot Study
Sahba Fekri1 *, Ramin Nourinia10 , Babak Rahimi-Ardabili10 , Arash Daneshtalab10 , Hamideh Sabbaghi10 , Hamid Ahmadieh10 , Bahareh Kheiri10
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract: To investigate the adjunctive effect of an intravitreal ROCK inhibitor (fasudil) in combination with intravitreal bevacizumab (IVB) on refractory macular edema secondary to retinal vein occlusion (RVO).
Methods: In this prospective interventional case series, 17 eyes of 17 patients (10 men, 7 women) with refractory RVO-related macular edema underwent three consecutive intravitreal injections of bevacizumab plus fasudil. Monthly evaluation was continued up to 12 months and IVB injection was performed if needed during the follow-up. Changes in the best corrected visual acuity (BCVA) was the primary outcome measure. The secondary outcome measures included central macular thickness (CMT) changes and any adverse events.
Results: BCVA significantly improved (mean change: -0.15 LogMAR; P=0.017) after 3 consecutive intravitreal injections of fasudil in combination with bevacizumab. CMT significantly decreased (mean change: -206 µm; P=0.028). The anatomical and functional improvement was maintained during the 12 month follow-up. No adverse effects were observed.
Conclusion: Intravitreal ROCK inhibitors may break the resistance to anti-VEGF therapy and improve the RVO induced macular edema via affecting the VEGF independent pathways.
