Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema

Kyung Tae Kang; Yu Cheol Kim; Kwang Soo Kim

doi:10.3341/jkos.2015.56.10.1580

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Kang, Kim, and Kim: Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema

Original Article

J Korean Ophthalmol Soc 2015;56(10):1580-1585.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.10.1580

Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema

Kyung Tae Kang, M.D, Yu Cheol Kim, M.D, PhD, Kwang Soo Kim, M.D, PhD

Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Kwang Soo Kim, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-7706, Fax: 82-53-250-7705 E-mail: kimks@dsmc.or.kr

‗ The concept of this study was presented at the Association for Research in Vision and Ophthalmology, Orlando, Fla. USA, May 4-8, 2014.

Received 27 February 201520 May 2015 Accepted 21 July 2015

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 identify the factors related to repeatability of intravitreal bevacizumab injections in patients with macular edema sec-ondary to branch retinal vein occlusion (BRVO).

Methods

The present study included 26 patients with macular edema secondary to BRVO occurring within 1 month of diagnosis. Initial best corrected visual acuity, type of BRVO according to the involved vein branch, distance between fovea and occlusion vein, central macular thickness, type of macular edema, presence of macula hemorrhage, and presence of capillary nonperfusion were evaluated at the time of diagnosis. The patients received an intravitreal bevacizumab injection at the time of diagnosis and reinjections when macular edema and visual acuity were aggravated. According to the factors considered, the re-injection‐ free rate which was considered a survival rate was evaluated for 1 year after the first injection.

Results

The patients with initial visual acuity lower than log MAR 0.5 showed 52.6% survival rate within 1 year compared with 14.3% of the patients with visual acuity higher than log MAR 0.5 ( p < 0.01). The patients with occluded vein closer than a dis-tance of 2.5 disc diameters (DD) from the foveal center had a 57.1% survival rate and the patients with occluded vein farther than a distance of 2.5 DD from the foveal center had a 25.0% survival rate ( p = 0.04). Macular BRVO and major BRVO patients had 64.3% and 16.7% survival rates, respectively ( p = 0.01).

Conclusions

The patients with BRVO may have less chance of repetitive intravitreal bevacizumab injections due to macular edema when initial visual acuity is lower than log MAR 0.5, occluded vein is closer than 2.5 DD from the foveal center, and mac-ular branch is involved at the initial diagnosis. These factors can be utilized to predict the prognosis of BRVO patients and the probability of repetitive intravitreal bevacizumab injections.

Keywords: Bevacizumab, Branch retinal vein occlusion, Macular edema

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Table 1.

Baseline characteristics of single and multiple IVB groups

	Single IVB group (n = 11)	Multiple IVB group (n = 15)	p-value
Age (years)	63.00 ± 9.24	63.80 ± 8.50	0.78^*
Gender (male:female)	3:8	6:9	0.50^†
Mean visual acuity (log MAR units)	0.32 ± 0.26	0.50 ± 0.32	0.08^*
Diabetes mellitus (%)	2 (18.18)	1 (6.67)	0.36^†
Hypertenstion (%)	3 (27.27)	4 (26.67)	0.97^†
Central macular thickness (μ m)	484.36 ± 170.40	550.07 ± 193.51	0.21^*
Follow up period (days)	610.91 ± 239.75	775.73 ± 561.76	0.82^*

Values are presented as mean ± SD unless otherwise indicated. IVB = intravitreal bevacizumab injection.

^* Statistics by Mann-Whitney test;

^† Statistics by Chi-square test.

Table 2.

Survival rate according to initial visual acuity

	Total numbers	Single IVB group	Multiple IVB group	Survival rate^* (%)
Visual acuity > log MAR 0.5	7	1	6	14.3
Visual acuity ≤ log MAR 0.5	19	10	9	52.6

Total	26	11	15	42.3

IVB = intravitreal bevacizumab injection.

^* p < 0.01 by LogRank (Mantel-Cox) test.

Table 3.

Survival rate according to the distance between occluded vein and foveal center

	Total numbers	Single IVB group	Multiple IVB group	Survival rate^* (%)
Distance^† < 2.5 disc diameter	14	8	6	57.1
Distance^† ≥ 2.5 disc diameter	12	3	9	25.0

Total	26	11	15	42.3

IVB = intravitreal bevacizumab injection.

^* p = 0.04 by LogRank (Mantel-Cox) test; ^† Distance between occluded vein and foveal center.

Table 4.

Survival rate according to the type of BRVO

	Total numbers	Single IVB group	Multiple IVB group	Survival rate^* (%)
Major BRVO	12	2	10	16.7
Macular BRVO	14	9	5	64.3

Total	26	11	15	42.3

BRVO = branch retinal vein occlusion; IVB = intravitreal bevacizumab injection.

^* p = 0.01 by LogRank (Mantel-Cox) test.

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