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

Young Bin Song; Sung Pyo Park

doi:10.3341/jkos.2010.51.3.379

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

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

Original Article

J Korean Ophthalmol Soc 2010;51(3):379-385.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.3.379

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

Young Bin Song, MD, Sung Pyo Park, MD, PhD

Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

Address reprint requests to Sung Pyo Park, MD, PhD Department of Ophthalmology, Kangdong Sacred heart Hospital, Hallym University College of Medicine #445 Gil-1-dong, Gangdong-gu, Seoul 134-701, Korea Tel: 82-2-2224-2274, Fax: 82-2-470-2088, E-mail: sungpyo@hananet.net

Received 8 June 2009 Accepted 17 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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Keywords: 24 hours follow-up, Bevacizumab, Branched retinal vein occlusion, Macular edema, Ocular coherence tomography

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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.

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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).

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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).

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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).

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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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