Journal List > J Korean Ophthalmol Soc > v.51(3) > 1008758

Song and Park: Short-term Effects of Intravitreal Bevacizumab Injection and Macular Edema Patterns in Branch Retinal Vein Occlusion

Abstract

Purpose

We attempt to distinguish the patterns of macular edema due to branch retinal vein occlusion (BRVO) and to find correlations between the 24 hour short-term and three month long-term therapeutic effects of an intravitreal bevacizumab injection.

Methods

Forty-four eyes in 44 patients with macular edema due to BRVO underwent an intravitreal bevacizumab injection. Ophthalmoscopic examinations, fluorescein angiographic evaluations, and optical coherence tomography (OCT) examinations performed made before the injections, after 24 hours, and at one, two and three month follow-ups. OCT yielded three patterns of macular edema: diffuse macular edema, cystoid macular edema, and serous retinal detachment.

Results

Macular edema significantly improved 24 hours after the injections. The change in central macular thickness after 24 hours had a statistically significant correlation with the three month central macular thickness (Pearson correlation, r=0.757 p=0.011). Cystoid macular edema showed better improvement than the others after 24 hours, but no differences after three months.

Conclusions

OCT treatment 24 hours after an intravitreal bevacizumab injection was found to be highly correlated to the long term prognosis. It is therefore useful in determining therapy and predicting the progress of macular edema in patients with BRVO.

References

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Figure 1.
Classification of macular edema in branch retinal vein occlusion patients: Type 1, diffuse macular edema. Type 2, cystoid macular edema. Type 3, serous retinal detachment.
jkos-51-379f1.tif
Figure 2.
Correlation analysis of the visual acuity improvement at 24 hours after intravitreal bevacizumab injections with at 3 months (Pearson correlation, r=0.665; p=0.174).
jkos-51-379f2.tif
Figure 3.
Correlation analysis of the central macular thickness improvement at 24 hours after intravitreal bevacizumab injections with at 3 months. Strong correlation is observed (Pearson correlation, r=0.757; p=0.011).
jkos-51-379f3.tif
Figure 4.
Inter-correlations between the improvement of 24 hours after intravitreal bevacizumab injection according to the OCT patterns of macular edema, in branch retinal vein occlusion patients. Cystoid macular edema showed better improvement than the others at 24 hoursb (p=student t-test; n=number of eyes); DME= diffuse macular edema (Type 1); CME=cystoid macular edema (Type 2); SRD=serous retinal detachment (Type 3).
jkos-51-379f4.tif
Table 1.
Baseline characteristics of branch retinal vein occlusion patients
Variable Total
Age (years, mean± SD*) 62±10
No. of eyes (%) 44 (100%)
Sex (male: female) 19: 25
Mean follow up time (days) 91
IOP (mmHg, mean± SD) 15.4±2.2
Duration of symptom (days, mean± SD) 22±18
Preoperative BCVA (LogMAR, mean± SD) 0.76±0.43
Preoperative CMT (μm, mean± SD) 578.0±65.0

* SD=standard deviation

BCVA=best corrected visual acuity

CMT=central macular thickness.

Table 2.
Visual acuity and central macular thickness of eyes with macular edema from baseline through 3 months, in branch retinal vein occlusion patients treated with bevacizumab
Variable Baseline 24 hours 1month 2months 3months
BCVA (LogMAR, mean± SD*) 0.76±0.43 0.62±0.38 0.36±0.36 0.35±0.33 0.33±0.37
   p value§   0.079 <0.001 <0.001 <0.001
CMT (μm, mean± SD) 578.0±65.0 460.5±77.7 311.1±80.3 289.3±84.2 268.5±108.1
   p value§   <0.001 <0.001 <0.001 <0.001

* SD=standard deviation

BCVA=best corrected visual acuity

CMT=central macular thickness

§ p=paired t-test.

Table 3.
Baseline characteristics with different macular edema types in branch retinal vein occlusion patients
Variable DME CME§ SRD p-value#
No. of eyes (%) 13 (30%) 19 (43%) 12 (27%)  
Age (years, mean± SD*) 59±8 60±9 68±15 0.312
Mean follow up time (days) 90 88 96 0.387
IOP (mmHg, mean± SD) 16.0±1.2 15.0±2.2 15.3±4.1 0.268
Duration of symptom (days, mean± SD) 34±16 19±19 13±5 0.032
Preoperative BCVA (LogMAR, mean± SD) 0.85±0.63 0.75±0.33 0.67±0.29 0.209
Preoperative CMT (μm, mean± SD) 532.0±119.5 630.4±102.4 518.1±110.5 0.116

* SD=standard deviation

BCVA=best corrected visual acuity

DME=diffuse macular edema

§ CME=cystoid macular edema

SRD=serous retinal detachment

# p=one-way ANOVA.

Table 4.
Visual acuity and central macular thickness of eyes with macular edema from baseline after 24 hours and 3 months, according to different macular edema types in branch retinal vein occlusion patients treated with bevacizumab
Variable Baseline 24 hours 3months
Diffuse macular edema      
   BCVA (LogMAR, mean± SD*) 0.85±0.63 0.60±0.53 0.37±0.44
       (p§=0.059) (p§<0.001)
   CMT (μm, mean± SD) 532.0±119.5 432.8±45.0 284.6±60.3
       (p§<0.001) (p§<0.001)
Cystoid macular edema      
   BCVA (LogMAR, mean± SD) 0.75±0.33 0.59±0.32 0.30±0.32
       (p§=0.057) (p§<0.001)
   CMT (μm, mean± SD) 630.4±102.4 450.8±60.2 260.3±103.8
    (p§<0.001) (p§<0.001)
Serous retinal detachment      
   BCVA (LogMAR, mean± SD) 0.67±0.32 0.69±0.37 0.33±0.16
       (p§=0.160) (p§<0.001)
   CMT (μm, mean± SD) 518.1±110.5 490.1±104.4 264.0±107.4
       (p§<0.001) (p§<0.001)

* SD=standard deviation

BCVA=best corrected visual acuity

CMT=central macular thickness

§ p=paired t-test.

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