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Abstract
Purpose
The authors evaluated the 2-year clinical results of intravitreal bevacizumab injection in retinal vein occlusion (RVO).
Methods
Thirty-two eyes of 32 patients treated with an intravitreal bevacizumab injection of 1.25 mg (0.05 ml) for RVO (branch RVO: 22 eyes, central RVO: 10 eyes), repeated 3 times at a 6-week interval and were available for a follow-up period of at least 2 years were retrospectively reviewed. Best-corrected visual acuity (BCVA) before treatment and 6, 12, and 24 months after 3 serial injections, was recorded. The optical coherence tomography (OCT) results were analyzed to identify prognostic factors for recurrent macular edema that needed reinjection.
Results
Two years after the treatment, mean BCVA was significantly improved (p = 0.000). Out of 32 eyes, 16 (branch RVO: 8 eyes; central RVO: 8 eyes) needed reinjection because of recurrent macular edema. In central RVO, a significantly high reinjection rate was shown in serous retinal detachment (SRD) compared with cystoid macular edema (CME) as identified in OCT findings (p = 0.049). Additionally, in branch RVO, a high reinjection rate was shown in SRD, although statistically not significant (p = 0.375).
References
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Figure 1.
Classification of macular edema based on optical coherence tomography in retinal vein occlusion. (A) Cystoid macular edema. Multiple and various size of ovoid area of low reflecitivity represent intraretinal cystoids-like cavities. (B) Serous retinal detachment. There was subretinal fluid accumulation with detached retina.
Figure 2.
Change in best-corrected visual acuity (BCVA, log MAR) after intravitreal bevacizumab injection in retinal vein occlusion (All = BRVO+CRVO), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO). It shows general improvement of visual acuity after 6, 12, 24 month of injection. In RVO, the mean baseline BCVA was 0.64 ± 0.32 and the final BCVA was 0.32 ± 0.30, a difference that was statistically significant (p < 0.05). It showed similar results in BRVO and CRVO.
Figure 3.
Reinjection rate and number accoring to the OCT patterns of macular edema. (A) Retinal vein occlusion (BRVO+CRVO). In cystoid macular edema (CME), 33.0% of eyes developed recurrent macular edema that needed reinjection. In serous retinal detachment (SRD), 64.7% of eyes took reinjection. Mean number of reinjection was 0.87 ± 1.60 in cystoid macular edema, 1.76 ± 2.17 in serous retinal detachment. (B) Branch retinal vein occlusion. The reinjection rate was 27.3% in CME and 45.5% in SRD. Mean number of reinjection was 0.73 ± 1.56 in CME, 1.00 ± 1.55 in SRD. (C) Central retinal vein occlusion. Two eyes of 4 were needed reinjection in CME and all 6 eyes were needed reinjection in SRD type of CRVO patients. Mean reinjection number was also higher in SRD (3.17 ± 2.56) than CME (1.25 ± 1.90).
Figure 4.
Correlation analysis of the duration of symptom and initial best corrected visual acuity (BCVA) with number of reinjection. (A) In retinal vein occlusion patients (BRVO + CRVO), duration that onset of symptom to first treatment showed week correlation with number of reinjection (correlation coefficiency = 0.323, p-value = 0.071). Initial BCVA had no relation to number of reinjection (correlation coefficiency = 0.108, p-value = 0.684). (B) In branch retinal vein occlusion, duration of symptom or initinial BCVA were no correlation with number of reinjection. (C) In central retinal vein occlusion, duration of symptom was stastically significant correlation with number of reinjection. However, Initial BCVA was little correlation with number of reinjection.
Table 1.
Baseline characteristics of retinal vein occlusion patients
| Variable | BRVO* (n = 22) | CRVO† (n = 10) | All‡ (n = 32) |
|---|---|---|---|
| Age (mean ± SD§, yr) | 60.86 ± 7.66 | 58.40 ± 11.70 | 60.09 ± 8.99 |
| Sex (M:F) | 7:15 | 4:6 | 11:21 |
| Follow-up time (mean ± SD, mon) | 24.05 ± 2.57 | 22.60 ± 1.65 | 23.6 ± 2.4 |
| Preoperative BCVA (mean ± SD, log MAR) | 0.63 ± 0.26 | 0.67 ± 0.50 | 0.64 ± 0.32 |
| Duration of symptom (mean ± SD, wk) | 4.68 ± 4.05 | 4.55 ± 5.79 | 4.64 ± 4.56 |
Table 2.
Reinjection rate and mean number of reinjection in retinal vein occlusion, branch retinal vein occlusion, and central retinal vein occlusion
| | Reinjection rate | Mean number of reinjection (mean ± SD) |
|---|---|---|
| All* | 50% (16/32 eyes) | 1.34 ± 1.94 |
| BRVO† | 36% (8/22 eyes) | 0.86 ± 1.52 |
| CRVO‡ | 80% (8/10 eyes) | 2.40 ± 2.41 |
| p-value | 0.022 | 0.036 |
Table 3.
Baseline Characteristics and visual acuity improvement of eyes with different OCT types
| Variable | CME* | SRD† | p-value |
|---|---|---|---|
| No. of eyes (%) | 15 (47%) | 17 (53%) | |
| BRVO‡:CRVO§ | 11:4 | 11:6 | 0.599 |
| Age (mean ± SD, yr) | 59.40 ± 7.96 | 60.71 ± 10.01 | 0.689 |
| BRVO | 59.18 ± 7.56 | 62.54 ± 7.72 | 0.314 |
| CRVO | 60.00 ± 10.23 | 57.33 ± 13.43 | 0.746 |
| Follow-up time (mean ± SD, mon) | 24.27 ± 2.84 | 23.00 ± 1.80 | 0.138 |
| BRVO | 24.72 ± 3.00 | 23.36 ± 1.96 | 0.222 |
| CRVO | 23.00 ± 2.16 | 22.33 ± 1.36 | 0.562 |
| Duration of symptom (mean ± SD, wk) | 4.67 ± 3.92 | 4.61 ± 5.19 | 0.976 |
| BRVO | 5.55 ± 4.20 | 3.81 ± 3.89 | 0.329 |
| CRVO | 2.25 ± 1.50 | 6.08 ± 7.20 | 0.333 |
| Preoperative BCVA∏ (mean ± SD, log MAR) | 0.71 ± 0.33 | 0.59 ± 0.31 | 0.273 |
| BRVO | 0.71 ± 0.26 | 0.56 ± 0.23 | 0.155 |
| CRVO | 0.72 ± 0.52 | 0.65 ± 0.46 | 0.817 |
| Improvement of BCVA＃ (mean ± SD, log MAR) | 0.32 ± 0.27 | 0.32 ± 0.29 | 0.986 |
| BRVO | 0.34 ± 0.28 | 0.31 ± 0.25 | 0.762 |
| CRVO | 0.28 ± 0.27 | 0.34 ± 0.36 | 0.666 |
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