J Korean Ophthalmol Soc.  2017 Aug;58(8):937-946. 10.3341/jkos.2017.58.8.937.

Significance of Early Visual Responses to Bevacizumab for Macular Edema in Branch Retinal Vein Occlusion

• Ryu G
• Noh D
• Lee J
• Sagong M

• KMID: 2388182
• DOI: http://doi.org/10.3341/jkos.2017.58.8.937

Abstract

PURPOSE
To determine whether early visual acuity response to intravitreal bevacizumab in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) is associated with 12-month follow-up outcome.
METHODS
Sixty treatment-naïve patients (60 eyes) with ME secondary to BRVO treated with intravitreal bevacizumab (1.25 mg) were retrospectively included. Initially, all patients were injected monthly to achieve fluid resolution and followed up with a pro re nata regimen for at least 12 months. The relationship between early (month 1) and late (month 12) visual acuity response (mean change from baseline in best-corrected visual acuity [BCVA]; categorized improvement [<1, 1-3, or ≥3 logMAR lines in BCVA]) was explored.
RESULTS
The proportions of eyes with <1, 1-<3, and ≥3-line improvements at 1 month were 19 eyes (31.7%), 17 eyes (28.3%), and 24 eyes (40%), respectively. Within each of the three response categories, the mean BCVA change from baseline at 12 months and onward did not vary by more than 1 line from the observed mean BCVA improvement at 1 month. Inter-cohort differences across the three response categories in mean BCVA change from baseline were statistically significant at each time point. Early BCVA response at 1 month showed significant associations with ≥3 line improvement and BCVA response at 12 months in multiple logistic and linear regression analyses.
CONCLUSIONS
Early BCVA responses to bevacizumab are associated with subsequent responses over the entire 12-month duration of treatment.

Keyword

Bevacizumab; Branch retinal vein occlusion; Early response; Macular edema; Visual response

MeSH Terms

Bevacizumab*
Follow-Up Studies
Humans
Linear Models
Macular Edema*
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Retrospective Studies
Visual Acuity
Bevacizumab
Retinaldehyde

Figure

• 

  Figure 1. Mean best-corrected visual acuity (BCVA) changes from baseline over time, categorized by BCVA response at 1 month after the first bevacizumab injection. Within the groups, the mean BCVA changes from baseline did not vary by more than 1 line af-ter 1 month over the entire period. Inter-co-hort differences were significant at each time point. Post-hoc test (Tukey method) between group comparison. <1 line im-provement vs. ≥3 lines Improvement, p < 0.001, at each time point. 1-<3 line im-provement vs. ≥3 lines Improvement, p < 0.001, p = 0.016, p = 0.022, p = 0.011.

• 

  Figure 2. Frequency distribution of best-corrected visual acuity (BCVA) improvement, categorized by BCVA response at 1 month. (A) Within the subset of eyes with < 1 line BCVA improvement at 1 month, approx-imately one-third of eyes continued to show < 1 line BCVA improve-ment at each time point. (B) Within the subset of eyes with 1 -< 3 lines BCVA improvement at 1 month, most eyes showed ≥ 1 line BCVA improvement at each time point. (C) Within the subset of eyes with a pro-nounced initial BCVA response (≥ 3 lines improvement) at 1 month, most eyes maintained this response over the entire period.

• 

  Figure 3. Mean central macular thickness (CMT) over time, categorized by best-cor-rected visual acuity response at 1 month after the first bevacizumab injection. There were no inter-cohort differences in mean CMT at each time point (p = 0.061, p = 0.651, p = 0.600, p = 0.420, p = 0.353, at each time point).

• 

  Supplementary Figure 1. Structural changes of external limiting membrane (ELM) and ellipsoid zone (EZ) integrity over time, cate-gorized by best-corrected visual acuity (BCVA) response at 1 month. No significant difference in distribution of ELM and EZ re-storation amongh three groups at each time point. (A) ELM integrity over time in <1 line BCVA improvement group. (B) EZ in-tegrity over time in <1 line BCVA improvement group. (C) ELM integrity over time in 1-< 3 lines BCVA improvement group. (D) EZ integrity over time in 1-< 3 lines BCVA improvement group. (E) ELM integrity over time in ≥3 lines BCVA improvement group. (F) EZ integrity over time in ≥3 lines BCVA improvement group.

Reference

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