Keep your friends close, but your anti-VEGF injections closer… The BRAVO and CRUISE trials looked to find the best course of treatment for macular edema in the setting of branch and central retinal vein occlusions. Prior to this, laser therapy had proven to be ineffective and patients were simply observed with little hope in visual improvement. In the BRAVO and CRUISE trials, patients with macular edema following BRVO (n=397) and CRVO (n=392) were randomized to receive monthly intravitreal injections of 0.3 or 0.5 mg of ranibizumab or sham injections.
The importance of this study was showing that anti-VEGF injections were effective in treating macular edema following retinal vein occlusions leading to marked improvement in visual acuity while still maintaining a very low risk of complications.
- For BRVO, an increase in at least 15 letters in BCVA at 6 months was seen in 55.2% (0.3 mg) and 61.2% (0.5 mg) of patients compared to only 28.8% in the placebo arm; for CRVO, the respective groups yielding 46.2% (0.3 mg), 47.7% (0.5 mg), and 16.9% (placebo).
- Central foveal thickness at 6 months following BRVO/CRVO had decreased by a mean of 337/434 mircons (0.3 mg) and 345/452 microns (0.5 mg) in the ranibizumab groups compared to 158/168 mircons in the placebo group.
- The BRAVO trial saw more placebo patients (54.5%) receive rescue grid laser compared with the 0.3 mg (18.7%) and 0.5 mg (19.8%) ranibizumab groups.