Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion

Joo Yoen Kim; Kyoung Sub Choi

doi:10.3341/jkos.2017.58.10.1138

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Kim and Choi: Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2017;58(10):1138-1144.

Published online: 25 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.10.1138

Intravitreal Bevacizumab Injections for Macular Edema Secondary to Major and Macular Branch Retinal Vein Occlusion

Joo Yoen Kim, MD^1,², Kyoung Sub Choi, MD, PhD^2,

¹Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Address reprint requests to Kyoung Sub Choi, MD, PhD Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0590, Fax: 82-31-900-0343 E-mail: docchoi73@hanmail.net

Received 15 December 2016 Revised 18 April 2017 Accepted 24 September 2017

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 compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO).

Methods

This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up.

Results

The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 µm to 311.3 ± 178.5 µm and in the macular BRVO group from 442.4 ± 155.8 µm to 297.2 ± 145.7 µm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021).

Conclusions

The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.

Keywords: Anti-vascular endothelial growth factor, Bevacizumab, Branch retinal vein occlusion, Macular edema

References

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Figure 1.

Patient's fundus photograph. (A) Fundus photograph of the right eye with superior temporal major branch retinal vein occlusion (BRVO). (B) Fundus photograph of the right eye with macular BRVO.

Figure 2.

Changes of best-corrected visual acuity in logarithm of the minimal angle of resolution in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). Although there was a significant improvement during the follow-up period in both major and macular BRVO groups, there was no statistical difference between major and macular BRVO groups in regard to visual outcome.

Figure 3.

Changes in central foveal thickness in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). The central foveal thickness was significantly improved after treatment in both groups. However, there was no difference at 12 months between major and macular BRVO groups.

Table 1.

Baseline clinical characteristics of patients with retinal vein occlusion

	Total (n = 58)	Major BRVO (n = 39)	Macular BRVO (n = 19)	p-value
Age (years ± SD)	59.2 ± 6.4	59.6 ± 7.4	58.4 ± 8.6	0.651^*
	(range 40–81)
Gender (n, %)
Male	25 (43.1)	16 (41.0)	9 (47.4)	0.647^†
Female	33 (56.9)	23 (59.0)	10 (52.6)
Duration from onset (days ± SD)	27.5 ± 14.4	27.8 ± 18.8	26.8 ± 19.5	0.542^*
	(range 1–120)
Systemic condition (n, %)
Arterial hypertension	42 (72.4)	28 (71.7)	14 (73.7)	0.441^†
DM	7 (12.1)	4 (10.3)	3 (15.8)	0.398^§
Mean of Baseline BCVA (logMAR) (Snellen equivalent)	0.64 ± 0.39	0.66 ± 0.47	0.60 ± 0.41	0.269^*
	(range CF–20/25) (20/87)	(20/91)	(20/79)
Baseline BCVA (logMAR) (n, %)				0.946^§
<0.40 (20/40)	12 (20.7)	8 (20.5)	4 (21.1)
0.40 (20/40) to 1.0 (20/200)	26 (44.8)	17 (43.6)	9 (47.4)
>1.0 (20/200)	20 (35.5)	14 (35.9)	6 (31.5)
FAG finding^‡				0.755^†
Ischemic type	24 (58.5%)	16 (59.3%)	8 (57.1%)
Perfused type	17 (41.5%)	11 (40.7%)	6 (42.9%)
Mean baseline central macular thickness ± SD (μ m)	479.6 ± 188.1	498.5 ± 194.3	442.4 ± 155.8	0.214^*
Macular edema type (n, %)				0.028^§
Combined with serous retinal detachment	24 (41.4)	20 (51.3)	4 (21.1)
Without serous retinal detachment	34 (58.6)	19 (48.7)	15 (78.9)

Values are presented as mean ± SD unless otherwise indicated.

BRVO = branch retinal vein occlusion; SD = standard deviation; DM = diabetes mellitus; BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; CF = counting finger; FAG = fluorescein angiography.

^* p-value by t-test

^† p-value by Chi-square test

^‡ FA was available for 41 eyes (70.7%) among all included eyes. More than 5 disc areas of non-perfusion on the FA image was defined as non-perfused

^§ p-value by Fisher's exact test.

Table 2.

12 months results after anti-vascular endothelial growth factor treatment for branch retinal vein occlusion

	Major BRVO (n = 39)	Macular BRVO (n = 19)	p-value
logMAR at 12 months (Snellen equivalent)	0.34 ± 0.28 (20/43)	0.30 ± 0.22 (20/39)	0.672^*
Mean logMAR change from baseline	–0.32	–0.30	0.366^*
BCVA changes (n, %)
Improved more than 3 lines (improved ≥ logMAR 0.3)	17 (43.6)	6 (31.5)	0.624^†
Mean central foveal thickness at 12 months (μ m)	311.3 ± 178.5	297.2 ± 145.7	0.254^*
Mean central foveal thickness changes from baseline (μ m)	–187.2	–145.2	0.182^*
Number of bevacizumab injections	3.5 ± 1.4	2.6 ± 1.6	0.021^*
Baseline BCVA ≤ 20/100 (n = 20)	3.7 ± 1.5	2.8 ± 1.4	0.043^*
Baseline BCVA > 20/100 (n = 38)	3.4 ± 1.7	2.3 ± 1.5	0.017^*

Values are presented as mean ± SD unless otherwise indicated.

BRVO = branch retinal vein occlusion; logMAR = logarithm of the minimum angle of resolution; BCVA = best corrected visual acuity.

^* p-value by t-test

^† p-value by Chi-square test.

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