Electroretinographic Assessment of the Retinal Function during Intravitreal Bevacizumab Injections in Central Retinal Vein Occlusion

In Hwan Cho; Tae Kwann Park; Young-Hoon Ohn

doi:10.3341/jkos.2011.52.9.1055

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Cho, Park, and Ohn: Electroretinographic Assessment of the Retinal Function during Intravitreal Bevacizumab Injections in Central Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2011;52(9):1055-1062.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.9.1055

Electroretinographic Assessment of the Retinal Function during Intravitreal Bevacizumab Injections in Central Retinal Vein Occlusion

In Hwan Cho, MD, Tae Kwann Park, MD, PhD, Young-Hoon Ohn, MD, PhD

Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea

Address reprint requests to Tae Kwann Park, MD, PhD Department of Ophthalmology, Soonchunhyang University Bucheon Hospital #1174 Jung-dong, Wonmi-gu, Bucheon 420-767, Korea Tel: 82-32-621-5053, Fax: 82-32-621-5435, E-mail: genophilus@hanmail.net

Received 27 September 2010 Revised 13 March 2011 Accepted 5 June 2011

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

To investigate the changes of electroretinogram (ERG) at baseline and during the first 3 injections of intravitreal bevacizumab in central retinal vein occlusion (CRVO) patients.

Methods

Thirteen eyes of 13 CRVO patients who received 3 injections of intravitreal bevacizumab at 6-week intervals and who could be examined for visual acuity, optical coherence tomography and ERG at 4 weeks after each injection were included in the present study. In addition, the ERG results of the unaffected fellow eyes group at 4 weeks after each injection were compared with the CRVO eyes group.

Results

Amplitudes of rod b wave, a and b waves of maximal combined response and cone response, oscillatory potentials and 30-Hz flicker significantly decreased in the CRVO eyes group than the fellow eyes group at 4 weeks after each injection (p < 0.001). After injection, amplitudes of all the above-mentioned ERG parameters gradually increased during the 1st and the 2nd injection (p < 0.001). However, there was no significant difference at 4 weeks after the 2nd and 3rd injections (p > 0.05).

Conclusions

After intravitreal bevacizumab injection, macular functions significantly improved and amplitudes of all ERG parameters gradually increased in CRVO patients.

Keywords: Central retinal vein occlusion, Electroretinogram, Intravitreal bevacizumab injection

References

1. Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2000; 98:133–41. discussion. 141–3.

2. Mitchell P, Smith W, Chang A. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol. 1996; 114:1243–7.

3. Noma H, Funatsu H, Mimura T, et al. Vitreous levels of inter-leukin-6 and vascular endothelial growth factor in macular edema with central retinal vein occlusion. Ophthalmology. 2009; 116:87–93.

4. Guthoff R, Meigen T, Hennemann K, Schrader W. Comparison of bevacizumab and triamcinolone for treatment of macular edema secondary to central retinal vein occlusion–a matched-pairs analysis. Ophthalmologica. 2010; 224:126–32.

5. Spandau UH, Ihloff AK, Jonas JB. Intravitreal bevacizumab treatment of macular oedema due to central retinal vein occlusion. Acta Ophthalmol Scand. 2006; 84:555–6.

6. Iturralde D, Spaide RF, Meyerle CB, et al. Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina. 2006; 25:279–84.

7. Choi SW, Kim HW, Yun IH. Intravitreal bevacizumab treatment of macular edema in central retinal vein occlusion. J Korean Ophthalmol Soc. 2010; 51:707–15.

8. Oh JW, Yun IH. The usefulness of standard electroretinogram in classification of central retinal vein occlusion. J Korean Ophthalmol Soc. 2003; 44:1789–96.

9. Karpe G, Germanis M. The prognostic value of the electroretinogram in thrombosis of the retinal veins. Acta Ophthalmol Suppl. 1962; 70:202–29.

10. Breton ME, Quinn GE, Keene SS, et al. Electroretinogram parameters at presentation as predictors of rubeosis in central retinal vein occlusion patients. Ophthalmology. 1989; 96:1343–52.

11. Green WR, Chan CC, Hutchins GM, Terry JM. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases. Trans Am Ophthalmol Soc. 1981; 79:371–422.

12. Ota M, Tsujikawa A, Murakami T, et al. Association between integrity of foveal photoreceptor layer and visual acuity in branch retinal vein occlusion. Br J Ophthalmol. 2007; 91:1644–9.

13. Matsui Y, Katsumi O, Sakaue H, Hirose T. Electroretinogram b/a wave ratio improvement in central retinal vein obstruction. Br J Ophthalmol. 1994; 78:191–8.

14. Chen H, Wu D, Huang S, Yan H. The photopic negative response of the flash electroretinogram in retinal vein occlusion. Doc Ophthalmol. 2006; 113:53–9.

15. Shetty R, Pai SA, Vincent A, et al. Electrophysiological and structural assessment of the central retina following intravitreal injection of bevacizumab for treatment of macular edema. Doc Ophthalmol. 2008; 116:129–35.

16. Moschos MM, Moschos M. Intraocular bevacizumab for macular edema due to CRVO. A multifocal-ERG and OCT study. Doc Ophthalmol. 2008; 116:147–52.

Figure 1.

Boxplots show serial changes in ERG parameters (A-C, E-H) and graph shows changing of b-wave/ a-wave ratio (D) in CRVO eye group and fellow eye group. _^* Pre = baseline; _†1st = ERG was performed at 4 weeks after the 1st intravitreal bevacizumab injection; _‡2nd = ERG was performed at 4 weeks after the 2nd intravitreal bevacizumab injection; ^§3rd = ERG was performed at 4 weeks after the 3rd intravitreal bevacizumab injection; ∏ p < 0.001.

Figure 2.

Representative standard ERG traces recorded from CRVO eye of one 58-year-old male after intravitreal bevacizumab injection. Reference ERG wave shows the measurement of ERG parameters. The amplitudes of rod-b wave were measured from the baseline to the peak of the wave. The amplitudes of maximal com-bined-a wave and cone-a wave were measured from the baseline to the through of the wave. The amplitudes of maximal combined-b and cone-b wave were measured from the through of the a wave to the peak of the b wave. The sum of oscillatory potential amplitude was automatically calculated by ERG program. The 30 Hz flicker responses were obtained from average of wave amplitudes during 10 seconds and were automatically calculated by ERG program as well. ^* Pre = baseline; †1st = ERG was performed at 4 weeks after the 1st intravitreal bevacizumab injection; ^‡2nd = ERG was performed at 4 weeks after the 2nd intravitreal bevacizumab injection; ^§3rd = ERG was performed at 4 weeks after the 3rd intravitreal bevacizumab injection.

Table 1.

Background characteristics and changes in visual acuity (VA) and central foveal thickness (CFT) in thirteen patients with central retinal vein occlusion (CRVO)

Patient	Sex	Age	Disease	CRVO eyes	CRVO eyes (Pre^*)		CRVO eyes (1st^†)		CRVO eyes (2nd^‡)		CRVO eyes (3rd^§)
Patient	Sex	Age	Disease	CRVO eyes	VA (logMAR)^∏	CFT (μ m)^#	VA	CFT	VA	CFT	VA	CFT
1	F	81	CRVO^¶	Left	0.7	580	0.5	242	0.3	218	0.3	214
2	F	62	CRVO	Right	1.5	734	1.2	509	0.8	329	0.7	245
3	M	55	CRVO	Right	1.5	584	1.1	454	0.7	256	0.7	238
4	F	60	CRVO	Left	1.3	624	1	324	1	287	0.8	221
5	M	72	CRVO	Left	0.5	324	0.4	421	0.4	187	0.4	225
6	M	52	CRVO	Right	1.7	656	1.7	395	1.4	344	1	215
7	F	73	CRVO	Left	1.7	564	1.3	654	1	341	1	278
8	F	44	CRVO	Right	1.5	503	1.1	190	0.8	183	0.8	190
9	F	32	CRVO	Right	1.7	253	1.3	213	1	170	1	280
10	M	58	CRVO	Right	1.4	540	1.3	502	1.1	234	1	241
11	M	58	CRVO	Left	2	634	1.4	452	1	240	1	250
12	M	64	CRVO	Right	1.4	534	1	354	1	244	0.8	256
13	F	72	CRVO	Left	1.7	522	1.3	454	0.8	254	0.7	264
Average (mean ± SD)		60.2 ±13.0			1.4 ±0.4	542.5 ±129.7	1.1 ±0.4	397.2 ±131.5	0.8 ±0.2	252.8±58.4	0.7 ±0.2	239.8 ±26.4

^* Pre = baseline.

^† 1st = Ocular examination and OCT was performed at 4 weeks after the 1st intravitreal bevacizumab injection

^‡ 2nd = Ocular examination and OCT was performed at 4 weeks after the 2nd intravitreal bevacizumab injection

^§ 3rd = Ocular examination and OCT was performed at 4 weeks after the 3rd intravitreal bevacizumab injection

^∏ VA = best corrected visual acuity (logMAR).

^# CFT = central foveal thickness

^¶ CRVO = central retinal vein occlusion.

Table 2.

The changes in ERG parameters after intravitreal bevacizumab injection in CRVO eye group and fellow eye group

ERG parameters	Fellow eyes (Pre^*)		CRVO eyes (Pre)		Fellow eyes (1st^†)		CRVO eyes (1st)		Fellow eyes (2nd^‡)		CRVO eyes (2nd)		Fellow eyes (3rd^§)		CRVO eyes (3rd)
ERG parameters	Amp^∏	Imp^#	Amp	Imp	Amp	Imp	Amp	Imp	Amp	Imp	Amp	Imp	Amp	Imp	Amp	Imp
Rod-b wave (mean ± SD)	127.4±10.1	118.8±9.5	39.3±16.3	117.6±7.6	128.2±20.8	115.8±12.8	67.8±14.0^¶	118.4±5.6	133.3±25.7	117.4±13.1	84.5±11.5^¶	117.8±3.4	129.9±35.7	116.8±12.5	83.3±5.9	117.5±4.2
Maximal combined response (mean±SD)																
a-wave	85.3±8.4	20.1±2.7	39.7±10.7	21.5±1.6	92.5±15.4	22.1±2.8	58.0±6.8^¶	20.2±3.2	90.35±9.9	23.2±2.6	74.7±6.8^¶	21.9±2.2	87.5±15.5	22.9±142	72.6±7.4	21.0±4.2
b-wave	279.0±22.5	62.1±3.7	35.3±13.6	62.5±5.2	287.5±35.4	63.24±3.4	94.3±22.6^¶	62.1±3.3	271.4±39.5	60.3±5.8	163.7±20.1^¶	62.4±8.2	269.9±35.8	58.4±6.2	162.6±17.5	63.1±2.2
b/a ratio	3.3		0.9		3.2		1.6^¶		3.3		2.2^¶		3.2		2.2	
Sum of oscillatory potentials (mean±SD)	164.5±24.8		56.7±12.5		156.5±34.9		104.2±11.4^¶		159.8±14.5		133.2±5.6^¶		153.5±24.3		2.2131.3±7.6	
Cone response (mean±SD)																
a-wave	43.4±11.5	14.3±2.3	11.0±5.3	14.2±1.2	41.2±22.7	14.9±1.5	24.2±2.8^¶	14.1±2.3	45.2±13.5	14.7±3.5	37.0±7.3^¶	14.5±3.1	42.5±11.3	14.2±4.8	35.7±3.2	13.3±2.4
b-wave	105.0±19.4	36.2±10.8	36.4±5.4	36.4±3.7	98.9±21.6	35.8±2.9	53.6±11.8^¶	36.8±1.3	102.4±29.5	35.5±5.2	89±10.5^¶	37.1±2.3	104±12.1	37.5±4.1	86.4±8.8	36.4±2.1
30 Hz flicker	75.1±11.4	27.8±3.3	25.7±6.1	28.6±4.9	71.1±13.9	28.7±2.4	45.4±8.8^¶	28.4±2.9	71.6±21.9	29.4±10.9	63.2±7.5^¶	28.9±3.2	77.3±19.8	29.2±2.7	62.3±8.8	27.9±2.2

^* Pre = baseline

^† 1st = ERG was performed at 4 weeks after the 1st intravitreal bevacizumab injection

^‡ 2nd; ERG was performed at 4 weeks after the 2nd intravitreal bevacizumab injection

^§ 3rd = ERG was performed at 4 weeks after the 3rd intravitreal bevacizumab injection

^∏ Amp (μV) = mean±standard deviation of amplitude (microvolt)

^# Imp (ms) = mean±standard deviation of implicit time (millisecond)

^¶ p < 0.001.

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