Journal List > J Korean Ophthalmol Soc > v.58(10) > 1010647

Kim and Choi: Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion

Abstract

Purpose

To compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO).

Methods

This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up.

Results

The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 µm to 311.3 ± 178.5 µm and in the macular BRVO group from 442.4 ± 155.8 µm to 297.2 ± 145.7 µm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021).

Conclusions

The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.

References

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Figure 1.
Patient's fundus photograph. (A) Fundus photograph of the right eye with superior temporal major branch retinal vein occlusion (BRVO). (B) Fundus photograph of the right eye with macular BRVO.
jkos-58-1138f1.tif
Figure 2.
Changes of best-corrected visual acuity in logarithm of the minimal angle of resolution in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). Although there was a significant improvement during the follow-up period in both major and macular BRVO groups, there was no statistical difference between major and macular BRVO groups in regard to visual outcome.
jkos-58-1138f2.tif
Figure 3.
Changes in central foveal thickness in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). The central foveal thickness was significantly improved after treatment in both groups. However, there was no difference at 12 months between major and macular BRVO groups.
jkos-58-1138f3.tif
Table 1.
Baseline clinical characteristics of patients with retinal vein occlusion
  Total (n = 58) Major BRVO (n = 39) Macular BRVO (n = 19) p-value
Age (years ± SD) 59.2 ± 6.4 59.6 ± 7.4 58.4 ± 8.6 0.651*
  (range 40–81)      
Gender (n, %)        
 Male 25 (43.1) 16 (41.0) 9 (47.4) 0.647
 Female 33 (56.9) 23 (59.0) 10 (52.6)  
Duration from onset (days ± SD) 27.5 ± 14.4 27.8 ± 18.8 26.8 ± 19.5 0.542*
  (range 1–120)      
Systemic condition (n, %)        
 Arterial hypertension 42 (72.4) 28 (71.7) 14 (73.7) 0.441
 DM 7 (12.1) 4 (10.3) 3 (15.8) 0.398§
Mean of Baseline BCVA (logMAR) (Snellen equivalent) 0.64 ± 0.39 0.66 ± 0.47 0.60 ± 0.41 0.269*
  (range CF–20/25) (20/87) (20/91) (20/79)  
Baseline BCVA (logMAR) (n, %)       0.946§
 <0.40 (20/40) 12 (20.7) 8 (20.5) 4 (21.1)  
 0.40 (20/40) to 1.0 (20/200) 26 (44.8) 17 (43.6) 9 (47.4)  
 >1.0 (20/200) 20 (35.5) 14 (35.9) 6 (31.5)  
FAG finding       0.755
 Ischemic type 24 (58.5%) 16 (59.3%) 8 (57.1%)  
 Perfused type 17 (41.5%) 11 (40.7%) 6 (42.9%)  
Mean baseline central macular thickness ± SD (μ m) 479.6 ± 188.1 498.5 ± 194.3 442.4 ± 155.8 0.214*
Macular edema type (n, %)       0.028§
 Combined with serous retinal detachment 24 (41.4) 20 (51.3) 4 (21.1)  
 Without serous retinal detachment 34 (58.6) 19 (48.7) 15 (78.9)  

Values are presented as mean ± SD unless otherwise indicated.

BRVO = branch retinal vein occlusion; SD = standard deviation; DM = diabetes mellitus; BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; CF = counting finger; FAG = fluorescein angiography.

* p-value by t-test

p-value by Chi-square test

FA was available for 41 eyes (70.7%) among all included eyes. More than 5 disc areas of non-perfusion on the FA image was defined as non-perfused

§ p-value by Fisher's exact test.

Table 2.
12 months results after anti-vascular endothelial growth factor treatment for branch retinal vein occlusion
  Major BRVO (n = 39) Macular BRVO (n = 19) p-value
logMAR at 12 months (Snellen equivalent) 0.34 ± 0.28 (20/43) 0.30 ± 0.22 (20/39) 0.672*
Mean logMAR change from baseline –0.32 –0.30 0.366*
BCVA changes (n, %)      
Improved more than 3 lines (improved ≥ logMAR 0.3) 17 (43.6) 6 (31.5) 0.624
Mean central foveal thickness at 12 months (μ m) 311.3 ± 178.5 297.2 ± 145.7 0.254*
Mean central foveal thickness changes from baseline (μ m) –187.2 –145.2 0.182*
Number of bevacizumab injections 3.5 ± 1.4 2.6 ± 1.6 0.021*
 Baseline BCVA ≤ 20/100 (n = 20) 3.7 ± 1.5 2.8 ± 1.4 0.043*
 Baseline BCVA > 20/100 (n = 38) 3.4 ± 1.7 2.3 ± 1.5 0.017*

Values are presented as mean ± SD unless otherwise indicated.

BRVO = branch retinal vein occlusion; logMAR = logarithm of the minimum angle of resolution; BCVA = best corrected visual acuity.

* p-value by t-test

p-value by Chi-square test.

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