J Korean Ophthalmol Soc.  2014 Mar;55(3):379-386. 10.3341/jkos.2014.55.3.379.

Intravitreal Bevacizumab Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion: Long-Term Results

• Ahn SM
• Lee SJ
• Park JM

• KMID: 2218266
• DOI: http://doi.org/10.3341/jkos.2014.55.3.379

Abstract

PURPOSE
To evaluate the long-term results of intravitreal bevacizumab injection for macular edema secondary to branch retinal vein occlusion (BRVO).
METHODS
Fifty-six eyes with macular edema secondary to BRVO were treated with intravitreal bevacizumab injection. They were classified into two groups, one group that received three initial intravitreal bevacizumab loadings at monthly intervals and a second group that received only one initial injection. In the two groups, additive injection was performed at recurrence. The best corrected visual acuity (BCVA), central macular thickness (CMT) and retinal ischemic change was analyzed for more than 12 months postoperatively.
RESULTS
After 12 months of follow-up, mean BCVA improved and mean CMT reduced significantly in both groups (p < 0.05). However, the range of BCVA improvement and CMT reduction was wider in the three-injection group than in the single-injection group. Fluorescein angiography revealed posterior retinal ischemic changes; bevacizumab didn't seem to aggravate the ischemic change. No drug-related ocular or systemic side effects were observed in the follow-up period after intravitreal bevacizumab treatment except subconjunctival hemorrhage and a mild increase of intraocular pressure.
CONCLUSIONS
In patients with macular edema secondary to BRVO, intravitreal bevacizumab injection was a safe and effective treatment, and a more significant visual improvement and reduction of macular edema was achieved after three initial loadings rather than after a single injection.

Keyword

Bevacizumab; Initial loading; Macular edema; Retinal ischemia; Retinal vein occlusion

MeSH Terms

Fluorescein Angiography
Follow-Up Studies
Hemorrhage
Humans
Intraocular Pressure
Macular Edema*
Recurrence
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Visual Acuity
Bevacizumab
Retinaldehyde

Figure

• 

  Figure 1. Measurement of posterior nonperfusion area in a FA photograph of a retina with BRVO. There are three concentric circles centered on the macula. The radius of the innermost circle corresponds to 1DD; the radius of the second circle, to 2DD. The inner field surrounding this second circle is the so-called field 2F in the ETDRS FA grading protocol. The area of posterior capillary nonperfusion in the field 2F is out-lined by the use of the area measurement tool of a digital system. Blocked fluorescence lesions because of retinal hem-orrhages were distinguished from nonperfusion by comparing the FA and fundus images. The area of nonperfusion is ex-pressed relative to the DA.

• 

  Figure 2. Change in best corrected visual acuity (BCVA) from baseline (BSL) to month 12. There is significant improvement in BCVA as compared with BSL values in both group A and B at every follow-up visit. But the outcomes of group A are superior to group B’s at every visit.

• 

  Figure 3. Change in central macular thickness (CMT) from baseline (BSL) to month 12. There is significant reduction in CMT as compared with BSL values in both group A and B at every follow-up visit. But the outcomes of group A are superior to group B’s at every visit except month 1 and 5.

• 

  Figure 4. The percentages of patients in each treatment group who showed an increase, decrease or no change from 0 in retinal nonperfusion between baseline and the month 12 end point.

Reference

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