Journal List > J Korean Ophthalmol Soc > v.54(7) > 1009420

Hyun, Min, and Woohyok: Macular Edema Following Branch Retinal Vein Occlusion: A Comparison of Natural Course and Treatment with Intravitreal Bevacizumab Injection

Abstract

Purpose

To assess long-term comparisions of intravitreal bevacizumab injection (IVB group) with natural course (Natural course group) in patients with macular edema after branch retinal vein occlusion (BRVO).

Methods

Fifty-seven patients were included in this retrospective study and were followed-up for at least 12 months. Patients in the Natural course group (27 eyes of 27 patients) were enrolled before February 2007, and patients in the IVB group (30 eyes of 30 patients) underwent intravitreal bevacizumab injection as-needed after February 2007. The main effi-cacy outcome was reported as the mean change from baseline best corrected visual acuity (BCVA), and all patients were measured at the initial visit and after 1, 3, 6, and 12 months. Retreatment criteria included central subfield macular thick-ness (CSMT) greater than 300 μ m or increased CSMT of at least 100 μ m between visits.

Results

There were no statistically significant differences in age or initial BCVA between the 2 groups. Mean changes of BCVA at initial visit and at 3 and 12 months were 0.61 ± 0.48, 0.44 ± 0.46 and 0.34 ± 0.40 in the Natural course group and 0.67 ± 0.40, 0.31 ± 0.26 and 0.27 ± 0.25 in the IVB group, respectively. Improvement in BCVA was observed in both groups at 12 months, although the IVB group improved significantly more at 3 months and not at 12 months ( p = 0.018, p = 0.187, respectively).

Conclusions

More frequent bevacizumab injection schedule appears necessary to achieve better long-term visual out-come for patients with macular edema following BRVO.

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Figure 1.
BCVA changes in each group. Vertical solid bars and vertical dotted bars are standard deviation of the IVB group and natural course group, respectively. There was a stat-istically signi fi cant group difference at month 3 (* p = 0.018). Intravitreal bevacizumab injections within 7 days from first diagnosed day; Observation without any treatment.
jkos-54-1054f1.tif
Figure 2.
Graph showing changes in central subfield macular thickness (CSMT) after intravitreal bevacizumab injection. The CSMT in the IVB group decreased at month 3, 6, and 12, and it was statistically different from baseline ( p = 0.002, p < 0.001, p = 0.001, respectively). CSMT = central subfield mac-ular thickness.
jkos-54-1054f2.tif
Table 1.
Demographic and clinical characteristics of each group
Groups Natural course group* IVB group p-value
Baseline characteristics
Number of eyes 27 30
Gender (male : female) 3:24 11:19 0.03§
Eye (right : left) 11:16 13:17 0.85Π
Age (years) 60.0 ± 11.3 61.7 ± 10.2 0.56#
Systemic disease Diabetes mellitus 4 (15%) 1 (3%) 0.04#
Hypertension 14 (52%) 16 (55%) 0.91#
Duration of symptoms (days) 34.1 ± 36.8 23.6 ± 24.4 0.23#
BCVA (log MAR) 0.61 ± 0.48 0.67 ± 0.40 0.33#

BCVA = best corrected visual acuity.

* Observation without any treatment

Intravitreal bevacizumab injections within 7 days from first diagnosed day

Between-group comparison was evaluated by

§ Fisher's exact probability test

Π Chi square test

# Mann-Whitney U test.

Table 2.
Changes in BCVA in each groups
BCVA Baseline Months 3 Months 6 Months 9 Months 12
IVB group* 0.67 ± 0.40 0.43 ± 0.34 0.31 ± 0.34 0.32 ± 0.22 0.27 ± 0.25
Mean changes from baseline (log MAR) -0.24 ± 0.29 -0.37 ± 0.28 -0.36 ± 0.34 -0.40 ± 0.31
p < 0.001 p < 0.001 p < 0.001 p < 0.001
Natural course group 0.61 ± 0.48 0.63 ± 0.53 0.44 ± 0.46 0.40 ± 0.43 0.35 ± 0.40
Mean changes from baseline (log MAR) 0.02 ± 0.41 -0.17 ± 0.44 -0.21 ± 0.42 -0.27 ± 0.46
p = 1.00 p = 0.065 p = 0.016 p = 0.011

Values are presented as mean ± SD. p-value was evaluated by Wilcoxon signed-rank test. BCVA = best corrected visual acuity.

* Intravitreal bevacizumab injections within 7 days from first diagnosed day

Observation without any treatment.

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