J Korean Ophthalmol Soc.  2015 Oct;56(10):1580-1585. 10.3341/jkos.2015.56.10.1580.

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

• Kang KT
• Kim YC
• Kim KS

• KMID: 2214418
• DOI: http://doi.org/10.3341/jkos.2015.56.10.1580

Abstract

PURPOSE
To identify the factors related to repeatability of intravitreal bevacizumab injections in patients with macular edema secondary 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 reinjection-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 distance 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 macular 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.

Keyword

Bevacizumab; Branch retinal vein occlusion; Macular edema

MeSH Terms

Capillaries
Diagnosis
Edema*
Hemorrhage
Humans
Macular Edema
Prognosis
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Survival Rate
Veins
Visual Acuity
Bevacizumab
Retinaldehyde

Reference

References

1. Mitchell P, Smith W, Chang A. Prevalence and associations of reti-nal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol. 1996; 114:1243–7.

2. Argon laser photocoagulation for macular edema in branch vein occlusion The Branch Vein Occlusion Study Group. Am J Ophthalmol. 1984; 98:271–82.

3. Kumagai K, Furukawa M, Ogino N. . Long-term outcomes of vitrectomy with or without arteriovenous sheathotomy in branch retinal vein occlusion. Retina. 2007; 27:49–54.

4. Parodi M, DI Stefano G, Ravalico G. Grid laser treatment for exu-dative retinal detachment secondary to ischemic branch retinal vein occlusion. Retina. 2008; 28:97–102.

5. Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev. 2004; 25:581–611.

6. Ishida S, Usui T, Yamashiro K. . VEGF 164 is proinflammatory in the diabetic retina. Invest Ophthalmol Vis Sci. 2003; 44:2155–62.

7. Funatsu H, Yamashita H, Noma H. . Aqueous humor levels of cytokines are related to vitreous levels and progression of diabetic retinopathy in diabetic patients. Graefes Arch Clin Exp Ophthalmol. 2005; 243:3–8.

8. Funk M, Kriechbaum K, Prager F. . Intraocular concentrations of growth factors and cytokines in retinal vein occlusion and the ef-fect of therapy with bevacizumab. Invest Ophthalmol Vis Sci. 2009; 50:1025–32.

9. Wu L, Martínez-Castellanos MA, Quiroz-Mercado H. . Twelve-month safety of intravitreal injections of bevacizumab (Avastin) : results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol. 2008; 246:81–7.

10. Kreutzer TC, Alge CS, Wolf AH. . Intravitreal Bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol. 2008; 92:351–5.

11. Rabena MD, Pieramici DJ, Castellarin AA. . Intravitreal bev-acizumab (Avastin) in the treatment of macular edema secondary to branch retinal vein occlusion. Retina. 2007; 27:419–25.

12. Matsumoto Y, Freund KB, Peiretti E. . Rebound macular ede-ma following bevacizumab (Avastin) therapy for retinal venous oc-clusive disease. Retina. 2007; 27:426–31.

13. Kondo M, Kondo N, Ito Y. . Intravitreal injection of bev-acizumab for macular edema secondary to branch retinal vein oc-clusion: results after 12 months and multiple regression analysis. Retina. 2009; 29:1242–8.

14. Hoeh AE, Ruppenstein M, Ach T, Dithmar S. OCT patterns of macular edema and response to bevacizumab therapy in retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2010; 248:1567–72.

15. Chung EJ, Hong YT, Lee SC. . Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2008; 246:1241–7.

16. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999; 127:688–93.

17. Lerche RC, Schaudig U, Scholz F. . Structural changes of the retina in retinal vein occlusion-imaging and quantification with op-tical coherence tomography. Ophthalmic Surg Lasers. 2001; 32:272–80.

18. Finkelstein D. Ischemic macular edema. Recognition and favor-able natural history in branch vein occlusion. Arch Ophthalmol. 1992; 110:1427–34.

19. Noma H, Minamoto A, Funatsu H. . Intravitreal levels of vas-cular endothelial growth factor and interleukin-6 are correlated with macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2006; 244:309–15.

20. Zhang H, Xia Y. Analysis of visual prognosis and correlative fac-tors in retinal vein occlusion. Zhonghua Yan Ke Za Zhi 2002; 38. 98–102.

21. Jaissle G, Leitritz M, Gelisken F. . One-year results after intra-vitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2009; 247:27–33.

22. Ach T, Hoeh AE, Schaal KB. . Predictive factors for changes in macular edema in intravitreal bevacizumab therapy of retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2010; 248:155–9.

23. Hoeh AE, Ruppenstein M, Ach T. . OCT patterns of macular edema and response to bevacizumab therapy in retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2010; 248:1567–72.

24. Gregori NZ, Rattan GH, Rosenfeld PJ. . Safety and efficacy of intravitreal bevacizumab (avastin) for the management of branch and hemiretinal vein occlusion. Retina. 2009; 29:913–25.

25. Yunoki T, Miyakoshi A, Nakamura T. . Treatment of macular edema due to branch retinal vein occlusion with single or multiple intravitreal injections of bevacizumab. Jpn J Ophthalmol. 2012; 56:159–64.

26. Noma H, Funatsu H, Yamasaki M. . Pathogenesis of macular edema with branch retinal vein occlusion and intraocular levels of vascular endothelial growth factor and interleukin-6. Am J Ophthalmol. 2005; 140:256–61.

27. Jang YS, Lee DW. Effects of intravitreal bevacizumab injection in 3 types of macular edema secondary to branch retinal vein occlusion. J Korean Ophthalmol Soc. 2012; 53:1112–7.

28. Sakamoto A, Tsujikawa A, Ota M. . Evaluation of potential visual acuity in eyes with macular oedema secondary to retinal vein occlusion. Clin Experiment Ophthalmol. 2009; 37:208–16.