Factors Related to Refractory Macular Edema in Branch Retinal Vein Occlusion

Ji Hyun Park; Jung Min Park

doi:10.3341/jkos.2017.58.12.1367

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Park and Park: Factors Related to Refractory Macular Edema in Branch Retinal Vein Occlusion

Original Article

Journal of the Korean Ophthalmological Society 2017; 58(12): 1367-1375.

Published online: 14 December 2017

DOI: https://doi.org/10.3341/jkos.2017.58.12.1367

Factors Related to Refractory Macular Edema in Branch Retinal Vein Occlusion

Ji Hyun Park, MD, Jung Min Park, MD, PhD

Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea.

Address reprint requests to Jung Min Park, MD, PhD. Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 48972, Korea. Tel: 82-51-461-2540, Fax: 82-51-465-7470, pjm1438@hanmail.net

Received 8 June 2017 Revised 13 November 2017 Accepted 30 November 2017

The Korean Ophthalmological Society

(open-access):

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 evaluate the factors associated with refractory macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after three times of intravitreal bevacizumab (IVB) injections.

Methods

Ninety eyes of Ninety patients, who were retrospectively reviewed, were treated with IVB of 1.25 mg (0.05 mL) for ME secondary to BRVO, repeated three times at 4-week intervals and then followed-up for at least 4 months after the IVB. The patients were classified as refractory if there was an increase in the mean retinal thickness >150 µm when measured 1 month after the three injections. The patients were divided into two groups: a responsive group (46 eyes) and a refractory group (44 eyes).

Results

In univariate logistic regression analyses, age, diabetes mellitus, hypertension, visual acuity, maximal combined response b wave amplitude (Max B amp), maximal combined response B/A ratio (Max B/A), cone response b wave amplitude, subfoveal choroidal thickness (SFCT), and the number of hyperreflective foci (HF) were risk factors for refractory ME of BRVO (p = 0.045, p = 0.010, p = 0.037, p = 0.034, p = 0.003, p = 0.004, p = 0.001, p = 0.001 and p = 0.001, respectively). In backward multivariate logistic regression analyses, age, Max B amp, Max B/A, SFCT and number of HF were risk factors for refractory ME of BRVO (p = 0.024, p = 0.004, p = 0.047, p = 0.033 and p = 0.049, respectively).

Conclusions

Baseline age, Max B amp, Max B/A, SFCT and number of HF predicted the probability of refractory ME secondary to BRVO after IVB.

Keywords: Bevacizumab, Branch retinal vein occlusion, Electroretinogram, Hyperreflective foci, Subfoveal choroidal thickness

Figures and Tables

Figure 1

Horizontal sectional image of optical coherence tomography (OCT) in macular edema secodary to branch retinal vein occlusion. The OCT shows sparse exudates. Yellow arrow shows exudate smaller than 20 µm, blue arrows show exudates bigger than 40 µm and red arrows show exudates 20 µm to 40 µm, hyperreflective foci.

Table 1

Baseline characteristics of patients

Values are presented as mean ± SD or n (%) unless otherwise indicated. The patients were classified as refractory if there was an increase in the mean retinal thickness >150 µm when measured 1 month after the three injections. Baseline: At first visit. Group I: Responsive group, Group II: Refractory group.

DM = diabetes mellitus; HTN = hypertension; VA = visual acuity; SE = spherical equivalents.

^*p < 0.05; ^†Mean ± standard deviation, Independent sample t-test p-value; ^‡Chi-square test p-value.

Table 2

Comparison of baseline parameters of standard ERG and mean retinal thickness

Values are presented as mean ± SD unless otherwise indicated. The patients were classified as refractory if there was an increase in the mean retinal thickness >150 µm when measured 1 month after the three injections. Baseline: At first visit. Group I: Responsive group, Group II: Refractory group.

ERG = electroretinogram; Rod B amp = rod response b wave amplitude; Rod B/A = rod response B/A ratio; Max B amp = maximal combined response b wave amplitude; Max B/A = maximal combined response B/A ratio; OPs = average of oscillatory potentials; Cone B amp = cone response b wave amplitude; 30 HZ amp = 30 HZ flicker response amplitude; MRT = mean retinal thickness.

^*p < 0.05; ^†Mean ± standard deviation, Independent sample t-test p-value.

Table 3

Comparison of subfoveal choroidal thickness, hyperreflective foci

Values are presented as mean ± SD unless otherwise indicated. The patients were classified as refractory if there was an increase in the mean retinal thickness >150 µm when measured 1 month after the three injections. Baseline: At first visit. IVB 3: When 1 month after 3 times of intravitreal bevacizumab injections. Group I: Responsive group, Group II: Refractory group.

SFCT = subfoveal choroidal thickness; No. of HF = number of hyperreflective foci; ELM = external limiting membrane; IS/OS = junction of inner and outer photoreceptor segments.

^*p < 0.05; ^†Mean ± standard deviation, Independent sample t-test p-value; ^‡Paired t-test p-value.

Table 4

Comparison of baseline hyperreflective foci, subretinal fluid

Values are presented as n (%) unless otherwise indicated. The patients were classified as refractory if there was an increase in the mean retinal thickness >150 µm when measured 1 month after the three injections. Baseline: At first visit. Group I: Responsive group, Group II: Refractory group.

No. of HF = number of hyperreflective foci; ELM = external limiting membrane; RPE = retinal pigment epithelium; NFL = nerve fiber layer; ONL = outer nuclear layer; No. of SRF = number of patients who have subretinal fluid; Yes = patients who have subretinal fluid; No = patients who don't have subretinal fluid.

^*p < 0.05; ^†Chi-square test p-value.

Table 5

Comparison of position of hyperreflective foci in group I, II

Values are presented as n (%) unless otherwise indicated. The patients were classified as refractory if there was an increase in the mean retinal thickness >150 µm when measured 1 month after the three injections. Baseline: At first visit. IVB 3: When 1 month after 3 times of intravitreal bevacizumab injections. Group I: Responsive group, Group II: Refractory group.

ELM = external limiting membrane; RPE = retinal pigment epithelium; NFL = nerve fiber layer; ONL = outer nuclear layer.

^*p < 0.05; ^†McNemar test p-value.

Table 6

Regression analyses of baseline characteristics for refractory macular edema secondary to branch retinal vein occlusion after 3 times of intravitreal bevacizumab injections

Baseline: At first visit.

OR = odds ratio; CI = confidence interval; DM = diabetes mellitus; HTN = hypertension; VA = visual acuity; SE = spherical equivalents; Rod B amp = rod response b wave amplitude; Rod B/A = rod response B/A ratio; Max B amp = maximal combined response b wave amplitude; Max B/A = maximal combined response B/A ratio; OPs = average of oscillatory potentials; Cone B amp = cone response b wave amplitude; 30 HZ amp = 30 HZ flicker response amplitude; MRT = mean retinal thickness; SFCT = subfoveal choroidal thickness; HF = hyperreflective foci; ORL = outer retinal layer (ELM-retinal pigment epithelium [RPE]); IRL = inner retinal layer (nerve fiber layer [NFL]-outer nuclear layer [ONL]); ELM = external limiting membrane; IS/OS = junction of inner and outer photoreceptor segments.

^*p < 0.05; ^†Multivariate logistic regression analysis with backward method.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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