Persistent metamorphopsia associated with branch retinal vein occlusion

Abstract

PurposeTo investigate longitudinal changes in metamorphopsia associated with branch retinal vein occlusion.MethodsIn this prospective observational case series, we included 32 eyes (32 patients) with branch retinal vein occlusion and acute macular edema. Eyes were treated as needed with intravitreal ranibizumab injections for 12 months. At baseline and 1, 6, and 12 months after initiating treatment, metamorphopsia was quantified using M-CHARTS. Retinal morphology was examined through optical coherence tomography.ResultsLogarithm of the minimum angle of resolution visual acuity progressively improved from 0.342 ± 0.304 (Snellen equivalent: 20/44) at baseline to 0.199 ± 0.259 (20/32) and 0.118 ± 0.195 (20/26) at 1 and 12 months, respectively (both P < 0.001). The M-CHARTS score significantly decreased from 0.63 ± 0.61 at baseline to 0.45 ± 0.50 at 1 month (P = 0.044), but no further improvement was achieved with 1 year of additional treatment (6 months: 0.47 ± 0.53 [P = 0.094] and 12 months: 0.50 ± 0.44 [P = 0.173]). Three (13.6%) of 22 eyes with baseline metamorphopsia had complete metamorphopsia resolution. At 12 months, the M-CHARTS score was correlated with baseline foveal thickness (r = 0.373, P = 0.035) and the baseline M-CHARTS score (r = 0.503, P = 0.003). A multiple regression analysis revealed that only the baseline M-CHARTS score was correlated with the 12-month M-CHARTS score (β = 0.460, P = 0.027).ConclusionsEyes with branch retinal vein occlusion often have persistent metamorphopsia, even when visual acuity and retinal morphology improve. Metamorphopsia at 12 months was correlated with metamorphopsia and foveal thickness at baseline.

Changes in metamorphopsia after the treat-and-extend regimen of anti-VEGF therapy for macular edema associated with branch retinal vein occlusion

“…A previous study demonstrated the mean number of injections within 12, 18, and 24 months was significantly higher in the TAE regimen than in the PRN regimen in the treatments for retinal vein occlusion patients [ 17 ]. In fact, the mean number of injections within 12 months (6.6 ± 1.7, median: 7 [IQR, 5–7]) in our TAE regimen was higher than the mean number of injections within 12 months (4.0 ± 1.8) reported in the previous study with the PRN regimen [ 8 ]. Further study is needed to optimize the TAE regimen in order to achieve a sustainable quality of vision for a longer time while lowering the patient, physician, and economic burden of BRVO-associated ME.…”

“…Some studies about changes in metamorphopsia after anti-VEGF therapy with PRN regimen for BRVO-ME using M-CHARTS showed that the scores were not significantly decreased in the short term up to 6 months after induction even with ME improvement [ 6 , 7 , 9 ]. Osaka et al reported significant improvement in M-CHARTS scores at 1 month; however, the score worsened with no significant improvement at 12 months compared to baseline, and the mean cumulative number of ME recurrences was 3 ± 1.8 [ 8 ]. In contrast, our data show the improvement of the metamorphopsia with significant decrease of the mean M-CHARTS score was maintained up to 12 months, and the mean cumulative numbers of ME recurrences was 1.5 ± 1.8 (median: 1 [IQR, 0–2]).…”

“…After anti-VEGF therapy for ME in BRVO, metamorphopsia improves in the short term (1 month) [ 7 , 8 ], but not in the midterm (6–12 months) despite ME improvement [ 8 , 9 ], and the long term (>12 months) outcome has not been reported. In previous reports, patients were treated with intravitreal injections of anti-VEGF agents using a pro re nata (PRN) regimen.…”

A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion

“… Naive 29 66.7 (8.2) 58.6 Retrospective, – 48 Lalinská et al [ 109 ] Czech Republic Ranibizumab 0.5 mg Three monthly injections then PRN regimen. Unclear 54 65 50 Retrospective, single-centre 12 Osaka et al [ 110 ] Japan Ranibizumab 0.5 mg Single injection then monthly PRN regimen Naive 32 68.1 (11.1) 53.13 Prospective, single-centre 12 Ozkaya et al [ 50 ] Turkey Ranibizumab 0.5 mg Three monthly injections then monthly PRN regimen. Naive 46 60.8 (8.7) 30.4 Retrospective, single-centre 24 Winterhalter et al [ 43 ] Germany Ranibizumab 0.5 mg Three monthly injections, then further sets of 3 monthly injections PRN if active disease.…”

Metamorphopsia in neurological practice

“…Он связан с повреждением фоторецепторов и/или других клеток сетчатки в области макулы и возникающим при этом нарушением переработки оптической информации, которая в норме начинается уже в содержащем фоторецепторы наружном слое сетчатки и продолжается во время проведения импульсов через ее средний и внутренний слои [15]. Периферическая метаморфопсия описана при такой патологии, как возрастзависимая дегенерация макулы, макулярный отек, центральная серозная хориоретинопатия, макулярный разрыв сетчатки (перфорация сетчатки, макулярное отверстие), идиопатическая эпиретинальная мембрана и другие нарушения в зоне контакта стекловидного тела и сетчатки, пигментная дегенерация и отслойка сетчатки [10,[13][14][15][16][17][18][19].…”