Clinical Course after Intravitreal Bevacizumab Injection in Ischemic Central Retinal Vein Obstruction

Eun Seok Yoo; Young Ju Lew; Moon Jung Choi; Jung Il Han; Soo Jin Yoo; Dong Won Lee; Sung Won Cho; Chul Goo Kim; Tae Gon Lee; Jong Woo Kim; Jae Heung Lee

doi:10.3341/jkos.2011.52.10.1202

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Yoo, Lew, Choi, Han, Yoo, Lee, Cho, Kim, Lee, Kim, and Lee: Clinical Course after Intravitreal Bevacizumab Injection in Ischemic Central Retinal Vein Obstruction

Original Article

J Korean Ophthalmol Soc 2011;52(10):1202-1207.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.10.1202

Clinical Course after Intravitreal Bevacizumab Injection in Ischemic Central Retinal Vein Obstruction

Eun Seok Yoo, MD¹, Young Ju Lew, MD, PhD¹, Moon Jung Choi, MD¹, Jung Il Han, MD¹, Soo Jin Yoo, MD¹, Dong Won Lee, MD, PhD¹, Sung Won Cho, MD, PhD¹, Chul Goo Kim, MD¹, Tae Gon Lee, MD², Jong Woo Kim, MD, PhD¹, Jae Heung Lee, MD, PhD¹

¹Myung-Gok Eye Research Institute, Kim's Eye Hospital, Seoul, Korea

²Department of Ophthalmology, College of Medicine, Konyang University, Daejeon, Korea

Address reprint requests to Young Ju Lew, MD, PhD Kim's Eye Hospital #156 Yeongdeungpo-dong 4-ga, Yeongdeungpo-gu, Seoul 150-034, Korea Tel: 82-2-2639-7777, Fax: 82-2-2633-3976, E-mail: yjlew@kimeye.com

Received 7 February 2011 Accepted 4 April 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 determine the clinical outcome of intravitreal bevacizumab injection in patients with ischemic central retinal vein obstruction (CRVO).

Methods

The present study was conducted retrospectively on 56 eyes of 56 patients who were diagnosed with CRVO and classified according to ischemic and non-ischemic type and underwent an intravitreal bevacizumab injection. The present study measured changes in visual acuity and central macular thickness, neovascularization in the anterior segment, development of neovascular glaucoma and other clinical complications.

Results

The average number of bevacizumab injections in both groups was 2.07 and 1.62 in the ischemic type. No patients developed neovascular glaucoma in the non-ischemic type group, 14 of 26 eyes in the ischemic type group developed neovascular glaucoma and the mean time to diagnosis was 28.75 weeks. log MAR visual acuity of the ischemic type group prior to injection was 1.56 ± 0.65 on average which improved to 1.44 ± 0.97 (p = 0.45).

Conclusions

Intravitreal bevacizumab injection improves the condition of cystic macular edema clinically, but does not affect the development of neovascular glaucoma and improvement of visual acuity in ischemic type CRVO.

Keywords: Central retinal vein obstruction, Intravitreal bevacizumab injection, Neovacular glaucoma

References

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Figure 1.

A 52 year old man visited our clinic for visual disturbance. Best corrected visual acuity was 0.9 log MAR scale. FAG in the arterial and venous phase showed extensive hypoperfusion and blocked fluorescence at the post pole (A, B), and hypoperfusion with diffuse leakage in the late phase (C). Fundus photograph (D) showed multiple retinal hemorrhage and cotton wool spots along the major vascular arcade, OCT (E) showed diffuse cystoid macular edema before intravitreal bevacizumab injection (CMT: 522 μ m). 6 months after the injection, fundus photograph (F) showed that retinal hemorrhage and cotton wool spots had decreased, OCT (G) showed decreased macular edema after intravitreal bevacizumab injection (CMT: 174 μ m).

Figure 2.

This diagram shows the occurrence of neovascular glaucoma (NVG) in patients of ischemic central retinal vein obstruction, mean duration of neovascular glaucoma was 28.75 weeks, Ahmed valve implantation and panretinal photocoagulation was performed on 1 patient and 8 patients respectively.

Table 1.

Baseline dermographics of total patients

factor	Total patients (n = 56)	Non-ischemic CRVO^‡ (n = 30)	(n = 26) Ischemic CRVO^‡
Sex (M:F)	37:19	20:10	17:9
Age (mean ± SD, yr)	55.23 ± 11.38	50.67 ± 9.80	60.5 ± 10.93
Hypertension (yes:no)	40:16	26:4	14:12
Diabetes mellitus (yes:no)	7:49	2:28	5:21
BCVA^* (mean ± SD, log MAR)	1.05 ± 0.70	0.64 ± 0.39	1.56 ± 0.65
CMT^† (mean ± SD, μ m)	611.84 ± 259.33	590.50 ± 231.37	699.79 ± 305.67
Mean follow up periods (mon)	15.20	15.53	17.84
Mean times of bevacizumab injection	2.07	2.47	1.62

^* BCVA = best corrected visual acuity

^† CMT = central macular thickness

^‡ CRVO = central retinal vein obstruction.

Table 2.

Changes in best corrected visual acuity (log MAR)

	Non-ischemic CRVO^* (n = 30)		Ischemic CRVO^* (n = 26)
	BCVA^† (mean ± SD)	p-value^‡	BCVA^† (mean ± SD)	p-value^‡
Prior injection	0.64 ± 0.39		1.56 ± 0.65	
1 month after injection	0.59 ± 0.49	0.11	1.52 ± 0.22	0.53
6 months after injection	0.54 ± 0.55	0.12	1.49 ± 0.35	0.46
12 months after injection	0.45 ± 0.55	0.05	1.44 ± 0.93	0.45

^* CRVO = central retinal vein obstruction

^† BCVA = best corrected visual acuity

^‡ p-value by paired t-test.

Table 3.

Changes in central macular thickness

	Non-ischemic CRVO^* (n = 30)		Ischemic CRVO^* (n = 26)
	CMT^† (mean ± SD)	p-value^‡	CMT^† (mean ± SD)	p-value^†
Prior injection	590.50 ± 231.37		699.79 ± 305.67	
1 month after injection	475.10 ± 290.88	0.31	525.07 ± 374.66	0.19
6 months after injection	418.83 ± 147.22	0.44	479.88 ± 334.69	0.12
12 months after injection	375.12 ± 231.37	0.33	411.00 ± 338.83	0.01

^* CRVO = central retinal vein obstruction

^† CMT = central macular thickness (μ m)

^‡ p-value by paired t-test.

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