Rapid Resolution of Macular Edema Associated with Central Retinal Vein Occlusion Using Ranibizumab After Failure with Multiple Bevacizumab Injections

Purpose: To report improvement in cystoid macular edema from central retinal vein occlusion with one injection of ranibizumab after failure with seven injections of bevacizumab.

Methods: Case report.

Results: A 74-year-old female developed persistent blurred vision for three months. Ocular examination revealed macular edema secondary to nonischemic central retinal vein occlusion. The patient was treated with intravitreal bevacizumab (1.25  mg in 0.05 mL). She received seven injections (every 5-6 weeks). Vision fluctuated between 20/30 and 20/60 with minimal variation in central foveal thickness (449-574 μm). However, weeks after one injection of ranibizumab the patient's vision improved to 20/20 with near resolution of macular edema (CFT = 343 μm).

Conclusions: Patients with no response to bevacizumab injections can show a rapid and large improvement with ranibizumab. This underscores the important differences between these two medications. Further study is required to determine if these initial effects of ranibizumab can be maintained.