J Korean Ophthalmol Soc.  2014 Feb;55(2):209-215. 10.3341/jkos.2014.55.2.209.

Effects of Macular Ischemia and Early Treatment on Visual Outcome in Branch Retinal Vein Occlusion

• Seo KH
• Yang JH
• Yu SY
• Kwak HW

• KMID: 2218413
• DOI: http://doi.org/10.3341/jkos.2014.55.2.209

Abstract

PURPOSE
To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branch retinal vein occlusion (BRVO).
METHODS
This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumab injection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least 4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6, 12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the first treatment, and the relationship of these with BCVA.
RESULTS
Mean BCVA (log MAR) was significantly improved from 0.67 +/- 0.43 at baseline to 0.30 +/- 0.30 at 48 months (p < 0.001). Four years after treatment, mean BCVA in the macular non-ischemic group was better than in the ischemic group, but this relationship did not hold for mean change in BCVA. There was a statistically significant (p < 0.05) difference between the early (< or =6 weeks) and late (>6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant (p < 0.05) difference between the early (< or =6 weeks) and late (>6 weeks) treatment groups with macular ischemia in BCVA after 48 months.
CONCLUSIONS
In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections, despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining and improving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.

Keyword

Bevacizumab; Branch retinal vein occlusion; Early treatment; Four-year results; Macular ischemia

MeSH Terms

Follow-Up Studies
Humans
Ischemia*
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Retrospective Studies
Tomography, Optical Coherence
Visual Acuity
Bevacizumab
Retinaldehyde

Figure

• 

  Figure 1. Changes in best-corrected visual acuity (BCVA, log MAR) and central retinal thickness (CRT, μm) after intravitreal bevacizumab injection in branch retinal vein occlusion (BRVO). It shows general improvement of visual acuity and CRT after 6, 12, 24, 36, 48 month of injection. Error bars are 95% confidence intervals. Statistical significance was calculated by Wilcoxon Signed-Rank Test. * p < 0.05.

• 

  Figure 2. (A) Changes in best-corrected visual acuity (BCVA, log MAR) after intravitreal bevacizumab injection in macular ischemic group and macular non-ischemic group. (B) Changes in BCVA after intravitreal bevacizumab injection in early treatment group (≤6 weeks) and late treatment group (>6 weeks). Statistical significance was calculated by Mann-Whitney Test. * p < 0.05.

• 

  Figure 3. Representative fluorescein angiograms taken at baseline and optical coherence tomography scans taken at baseline and 48 months after first intravitreal bevacizumab injection, from a patient without macular ischemia (A, B, C) and a patient with macular ischemia (D, E, F).

• 

  Figure 4. Changes in best-corrected visual acuity (BCVA, log MAR) after intravitreal bevacizumab injection in early (≤6 weeks) and late (>6 weeks) treatment group with macular ischemia. Statistical significance was calculated by Mann-Whitney Test. There is statistically significant (p < 0.05) difference between early treatment group and late treatment group in BCVA after 12, 24, 36, 48 months. Error bars are 95% confidence intervals.

Reference

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