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Cho, Park, and Yu: Long-term Efficacy of Vitrectomy for Macular Edema Secondary to Branch Retinal Vein Occlusion in Patients Treated with Intravitreal Injections
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(5): 546-553.

Published online: 15 May 2017

DOI: https://doi.org/10.3341/jkos.2017.58.5.546

Long-term Efficacy of Vitrectomy for Macular Edema Secondary to Branch Retinal Vein Occlusion in Patients Treated with Intravitreal Injections

In Hwan Cho, MD1, 2, 3, Un Chul Park, MD, PhD1, 3, Hyeong Gon Yu, MD, PhD1, 3

1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

2Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.

3Retinal Degeneration Research Lab, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.

Address reprint requests to Hyeong Gon Yu, MD, PhD. Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: 82-2-2072-2438, Fax: 82-2-741-3187, hgonyu@snu.ac.kr

Received 2 February 2017       Revised 29 March 2017       Accepted 25 April 2017

©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 long-term efficacy of pars plana vitrectomy (PPV) on refractory or recurrent macular edema due to branch retinal vein occlusion (BRVO) after intravitreal steroid or anti-vascular endothelial growth factor injections.

Methods

We retrospectively reviewed the medical records of patients with macular edema due to BRVO who underwent PPV after intravitreal triamcinolone acetonide or bevacizumab injections and followed-up for at least 12 months. The best corrected visual acuity (BCVA) and subfoveal macular thickness were measured at 1, 3, 6, 12 months postoperatively and were compared with the preoperative values. The patients received additional intravitreal injections if they had recurrence of macular edema after surgery. The frequency of intravitreal injections (per year) were compared pre- and postoperatively.

Results

A total of 41 eyes of 41 patients were included and the mean duration of follow up was 58.7 ± 30.0 (15 -124) months. The BCVA (logMAR) at 1, 3, 6, 12 months postoperatively, and last follow up was 0.52 ± 0.42, 0.46 ± 0.38, 0.41 ± 0.26, 0.50 ± 0.34, and 0.49 ± 0.37, respectively, which was significantly different from the preoperative values (0.90 ± 0.47, p < 0.001). The subfoveal macular thickness at 1, 3, 6, 12 months postoperatively, and last follow up was 342.72 ± 84.10 µm, 365.02 ± 110.73 µm, 359.45 ± 119.28 µm, 360.96 ± 124.33 µm, and 329.34 ± 119.69 µm, respectively, which was also significantly different (p < 0.001) from the preoperative values (484.9 ± 112.8 µm, p < 0.001). The frequency of intravitreal injections was significantly decreased after surgery (3.58 ± 2.05 times/year vs. 0.60 ± 0.83 times/year, p < 0.001).

Conclusions

Pars plana vitrectomy could improve BCVA, decrease subfoveal macular thickness, and decrease recurrence in BRVO patients with refractory or recurrent macular edema after intravitreal injection. PPV could be an effective treatment option for these patients.

Keywords: Branch retinal vein occlusion, Intravitreal injection, Pars plana vitrectomy

Figures and Tables

Figure 1

Changes in best corrected visual acuity and central subfoveal thickness. (A) Best corrected visual acuity (BCVA) was significantly improved than baseline at 1 month after first intravitreal injection. Preoperative BCVA was significantly worse than baseline. After pars plana vitrectomy, BCVA was significantly improved than baseline and preoperative values at all-time points (postoperative 1, 3, 6, 12 months and last follow up). (B) Central subfoveal thickness (CST) was significantly improved than baseline at 1 month after first intravitreal injection. After pars plana vitrectomy, CST was significantly improved than baseline and preoperative values at all-time points (postoperative 1, 3, 6, 12 months and last follow up). Final = last follow up; M = month(s); Pre-Op = preoperative; Post-Op = postoperative. *p < 0.05 when compared with baseline value; **p < 0.05 when compared with preoperative value.

jkos-58-546-g001
Table 1

Demographics and clinical characteristics of patients with macular edema secondary to branch retinal vein occlusion

jkos-58-546-i001

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated.

BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; Pre-Op = preoperative; Post-Op = postoperative; Dry macula = at least 6 months of no intraretinal cyst or subretinal fluid.

Table 2

Comparison between preoprerative intravitreal triamcinolone injection group and intravitreal triamcinolone & bevacizumab group

jkos-58-546-i002

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated.

BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; Pre-Op = preoperative; Post-Op = postoperative.

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