J Korean Ophthalmol Soc.  2017 May;58(5):546-553. 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

• Cho IH
• Park UC
• Yu HG

• KMID: 2378625
• DOI: http://doi.org/10.3341/jkos.2017.58.5.546

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.

Keyword

Branch retinal vein occlusion; Intravitreal injection; Pars plana vitrectomy

MeSH Terms

Bevacizumab
Endothelial Growth Factors
Follow-Up Studies
Humans
Intravitreal Injections*
Macular Edema*
Medical Records
Recurrence
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Retrospective Studies
Triamcinolone Acetonide
Visual Acuity
Vitrectomy*
Bevacizumab
Endothelial Growth Factors
Retinaldehyde
Triamcinolone Acetonide

Figure

• 

  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.

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