Risk factors of recurrence of macular oedema associated with branch retinal vein occlusion after intravitreal bevacizumab injection

Abstract

Patients with BRVO with non-perfusion of more than half of the 1 mm zone of the ETDRS circle or with an initial CRT >570 µm should be closely monitored for macular oedema recurrence within 6 months of IVB injection.

Predicting recurrences of macular edema due to branch retinal vein occlusion during anti-vascular endothelial growth factor therapy

“…Alternatively, hypoxia may have interrupted the recovery of vessels that were influenced at the time of occlusion due to insufficient nutrient and oxygen supply to the affected vascular cells. This interpretation of our results is consistent with a previous report using FA, which found that 35% of patients showed recurrence 6 months after a single injection of an anti-VEGF drug; the risk was increased if the patients had a non-perfused area in the deep capillary plexus within 1 mm of the fovea [14]. Notably, the previous study using FA had a limitation in the recording of clear images if the eyes had severe hemorrhage causing blockade of the signals [14].…”

“…This interpretation of our results is consistent with a previous report using FA, which found that 35% of patients showed recurrence 6 months after a single injection of an anti-VEGF drug; the risk was increased if the patients had a non-perfused area in the deep capillary plexus within 1 mm of the fovea [14]. Notably, the previous study using FA had a limitation in the recording of clear images if the eyes had severe hemorrhage causing blockade of the signals [14]. In contrast, the current study did not have this limitation; the inner retinal layers in the sectional OCT images could be evaluated regardless of the extent of hemorrhage and edema before treatment.…”

“…Previous studies have shown that decreased macular vessel density, as determined with optical coherence tomography angiography (OCTA) [11] and fluorescein angiography (FA) [14], is related to recurrence after anti-VEGF treatment. However, before treatment, it may be difficult to perform OCTA and FA because massive retinal hemorrhage and/or edema in patients with fresh BRVO can cause segmentation error and fluorescence blockade, respectively.…”

The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario

“…observed a positive correlation between baseline central RT value and macular edema recurrence in 63 patients receiving intravitreal bevacizumab injection for treating BRVO-related macular edema. [ 31 ] In contrast, Yasuda et al . [ 32 ] observed a strong correlation between a pretreatment low CFT value and post-treatment macular edema recurrence in patients with BRVO receiving intravitreal bevacizumab injection; however, this correlation was not statistically significant (odds ratio, 0.98; 95% confidence interval, 0.96–1.00, P = 0.063).…”

Recent advances in understanding and managing retinal vein occlusions

“…Several studies have evaluated predictors of macular edema recurrence and visual acuity in patients with BRVO. Recurrence of macular edema has been shown to be associated with the degree of non-perfusion of the central 1 mm ETDRS (Early Treatment Diabetic Retinopathy Study) circle or with an initial central retinal thickness of more than 570 48 . Disorganization of the retinal inner layers is a predictor of subsequent visual acuity improvement or decline following the first three monthly injections in patients with macular edema 49 .…”