Macular Edema Following Branch Retinal Vein Occlusion: A Comparison of Natural Course and Treatment with Intravitreal Bevacizumab Injection

Ju Oh Hyun; Sagong Min; Chang Woohyok

doi:10.3341/jkos.2013.54.7.1054

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Hyun, Min, and Woohyok: Macular Edema Following Branch Retinal Vein Occlusion: A Comparison of Natural Course and Treatment with Intravitreal Bevacizumab Injection

Original Article

J Korean Ophthalmol Soc 2013;54(7):1054-1059.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1054

Macular Edema Following Branch Retinal Vein Occlusion: A Comparison of Natural Course and Treatment with Intravitreal Bevacizumab Injection

Ju Oh Hyun, MD, Sagong Min, MD, PhD, Chang Woohyok, MD, PhD

¹Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Woohyok Chang, MD, PhD Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea Tel: 82-53-620-3443, Fax: 82-53-620-5936 E-mail: changwh@ynu.ac.kr

* This study was presented as a poster at the 106th Annual Meeting of the Korean Ophthalmology Society 2011.

Received 26 October 201214 February 2013 Accepted 26 April 2013

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 assess long-term comparisions of intravitreal bevacizumab injection (IVB group) with natural course (Natural course group) in patients with macular edema after branch retinal vein occlusion (BRVO).

Methods

Fifty-seven patients were included in this retrospective study and were followed-up for at least 12 months. Patients in the Natural course group (27 eyes of 27 patients) were enrolled before February 2007, and patients in the IVB group (30 eyes of 30 patients) underwent intravitreal bevacizumab injection as-needed after February 2007. The main effi-cacy outcome was reported as the mean change from baseline best corrected visual acuity (BCVA), and all patients were measured at the initial visit and after 1, 3, 6, and 12 months. Retreatment criteria included central subfield macular thick-ness (CSMT) greater than 300 μ m or increased CSMT of at least 100 μ m between visits.

Results

There were no statistically significant differences in age or initial BCVA between the 2 groups. Mean changes of BCVA at initial visit and at 3 and 12 months were 0.61 ± 0.48, 0.44 ± 0.46 and 0.34 ± 0.40 in the Natural course group and 0.67 ± 0.40, 0.31 ± 0.26 and 0.27 ± 0.25 in the IVB group, respectively. Improvement in BCVA was observed in both groups at 12 months, although the IVB group improved significantly more at 3 months and not at 12 months ( p = 0.018, p = 0.187, respectively).

Conclusions

More frequent bevacizumab injection schedule appears necessary to achieve better long-term visual out-come for patients with macular edema following BRVO.

Keywords: Bevacizumab, Branch retinal vein occlusion, Macular edema, Natural history

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Figure 1.

BCVA changes in each group. Vertical solid bars and vertical dotted bars are standard deviation of the IVB group and natural course group, respectively. There was a stat-istically signi fi cant group difference at month 3 (^* p = 0.018). ^† Intravitreal bevacizumab injections within 7 days from first diagnosed day; ^‡ Observation without any treatment.

Figure 2.

Graph showing changes in central subfield macular thickness (CSMT) after intravitreal bevacizumab injection. The CSMT in the IVB group decreased at month 3, 6, and 12, and it was statistically different from baseline ( p = 0.002, p < 0.001, p = 0.001, respectively). CSMT = central subfield mac-ular thickness.

Table 1.

Demographic and clinical characteristics of each group

Groups		Natural course group^*	IVB group^†	p-value^‡
Baseline characteristics		Natural course group^*	IVB group^†	p-value^‡
Number of eyes		27	30
Gender (male : female)		3:24	11:19	0.03^§
Eye (right : left)		11:16	13:17	0.85^Π
Age (years)		60.0 ± 11.3	61.7 ± 10.2	0.56^#
Systemic disease	Diabetes mellitus	4 (15%)	1 (3%)	0.04^#
	Hypertension	14 (52%)	16 (55%)	0.91^#
Duration of symptoms (days)		34.1 ± 36.8	23.6 ± 24.4	0.23^#
BCVA (log MAR)		0.61 ± 0.48	0.67 ± 0.40	0.33^#

BCVA = best corrected visual acuity.

^* Observation without any treatment

^† Intravitreal bevacizumab injections within 7 days from first diagnosed day

^‡ Between-group comparison was evaluated by

^§ Fisher's exact probability test

^Π Chi square test

^# Mann-Whitney U test.

Table 2.

Changes in BCVA in each groups

BCVA	Baseline	Months 3	Months 6	Months 9	Months 12
IVB group^*	0.67 ± 0.40	0.43 ± 0.34	0.31 ± 0.34	0.32 ± 0.22	0.27 ± 0.25
Mean changes from baseline (log MAR)		-0.24 ± 0.29	-0.37 ± 0.28	-0.36 ± 0.34	-0.40 ± 0.31
		p < 0.001	p < 0.001	p < 0.001	p < 0.001
Natural course group^†	0.61 ± 0.48	0.63 ± 0.53	0.44 ± 0.46	0.40 ± 0.43	0.35 ± 0.40
Mean changes from baseline (log MAR)		0.02 ± 0.41	-0.17 ± 0.44	-0.21 ± 0.42	-0.27 ± 0.46
		p = 1.00	p = 0.065	p = 0.016	p = 0.011

Values are presented as mean ± SD. p-value was evaluated by Wilcoxon signed-rank test. BCVA = best corrected visual acuity.

^* Intravitreal bevacizumab injections within 7 days from first diagnosed day

^† Observation without any treatment.

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