Korean J Ophthalmol.  2017 Apr;31(2):95-101. 10.3341/kjo.2017.31.2.95.

Natural Short-term Course of Recurrent Macular Edema Following Intravitreal Bevacizumab Therapy in Branch Retinal Vein Occlusion

• Yoo SJ
• Kim JH
• Lee TG
• Kim JW
• Cho SW
• Han JI

• KMID: 2373464
• DOI: http://doi.org/10.3341/kjo.2017.31.2.95

Abstract

PURPOSE
To evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab.
METHODS
This retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later.
RESULTS
At the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively).
CONCLUSIONS
Unlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.

Keyword

Bevacizumab; Macular edema; Natural history; Recurrence; Retinal vein occlusion

MeSH Terms

Bevacizumab*
Curriculum*
Humans
Macular Edema*
Natural History
Observational Study
Recurrence
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Retrospective Studies
Visual Acuity
Bevacizumab
Retinaldehyde

Figure

• 

  Fig. 1 Changes in the logarithm of the minimum angle of resolution (logMAR), best-corrected visual acuity (BCVA, A) and central foveal thickness (CFT, B) in eyes with recurrent macular edema (ME) following branch retinal vein occlusion (BRVO). The solid line (closed circles) indicates data from eyes without treatment (untreated group, 19 eyes) and the dashed line (closed squares) indicates data from eyes treated with a single intravitreal bevacizumab (IVB) injection (treated group, 17 eyes). Differences in BCVA and CFT between the two groups were not statistically significant at the time of ME recurrence (p = 0.772 and p = 0.996, respectively). However, 3 months after ME recurrence, the treated group had significantly improved results compared to those of the untreated group for both BCVA (p = 0.034) and CFT (p < 0.001). “At diagnosis” indicates the time when BRVO with ME was first diagnosed. “After IVB” indicates the period before ME recurrence. “Recurrence” indicates the time at which ME recurrence was noted. “3 mon” indicates 3 months after ME recurrence. Statistical analyses were performed using repeated measures analysis of variances with a Bonferroni's correction and independent sample t-test. An asterisk indicates a statistically significant difference between the two groups.

• 

  Fig. 2 Optical coherence tomography findings in two eyes diagnosed with macular edema (ME) secondary to branch retinal vein occlusion. Both eyes received no therapy for recurred ME for 3 months. Case 1 (A-D): at diagnosis (A), ME resolved after 2 monthly intravitreal bevacizumab injection (B), ME recurred 9 months after the last treatment (C). Retinal thickness remained elevated and relatively unchanged during the 3-month follow-up period (D). Case 2 (E-H): at diagnosis (E), ME resolved after 2 monthly intravitreal bevacizumab injections (F), the ME recurred 7 months after the last treatment (G). Although ME slightly decreased during the 3-month follow-up period, macular thickness did not return to normal (H).

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