J Korean Ophthalmol Soc.  2022 Apr;63(4):370-379. 10.3341/jkos.2022.63.4.370.

Predictors of Dexamethasone Response of Residual Edema by Branch Retinal Vein Occlusion after Bevacizumab Injection

• Lee JB
• Kim HY
• Kim YY
• Lee GW

• KMID: 2528329
• DOI: http://doi.org/10.3341/jkos.2022.63.4.370

Abstract

Purpose
To predict the response to intravitreal dexamethasone (IVD) implant injection in cases where macular edema (ME) caused by branch retinal vein occlusion persists despite intravitreal bevacizumab injection.
Methods
Three consecutive (monthly) bevacizumab injections were given to treat ME caused by branched retinal vein occlusion (BRVO) 63 eyes that received additional dexamethasone or bevacizumab injection 1 month later to treat residual ME were retrospectively studied. Each injection group was divided into two subgroups according to ME disappearance status by 6 months after diagnosis. Initial central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and hyperreflective focus status were compared among the subgroups, as were the changes in these values.
Results
At the decision point, the dexamethasone good response subgroups exhibited thicker CRTs and smaller CRT changes than the dexamethasone partial response subgroups (all p < 0.05). The good dexamethasone response subgroup showed smaller SFCT changes, a thicker CRT, and smaller CRT changes than the bevacizumab good response subgroup (all p < 0.05) at the decision point. The cutoff values of the Youden index were 409 μm for the CRT and 62.5 μm for the CRT change (p = 0.002 and p = 0.011, respectively).
Conclusions
If ME persists after three bevacizumab injections, IVD more effectively reduces edema if the CRT is thick or if the CRT change is small.

Keyword

Bevacizumab, Branch retinal vein occlusion, Dexamethasone implant, Macular edema