Abstract
This study aims to investigate the changes in metamorphopsia after administering the treat-and-extend regimen of anti-vascular endothelial growth factor therapy for branch retinal vein occlusion-associated macular edema. We retrospectively examined 27 patients (27 eyes) with macula edema due to branch retinal vein occlusion who received intravitreal injections of anti-vascular endothelial growth factor agents using the treat-and-extend regimen for ≥18 months. We evaluated best-corrected visual acuity, central macular thickness, macular edema recurrence, and amount of metamorphopsia quantified by M-CHARTS. The best-corrected visual acuity (logarithm of minimum angle of resolution) and central macular thickness significantly improved at 18 months compared to baseline, the median value (interquartile range [IQR]), 0.30 (0.15–0.52) and 459 (373–542) μm at baseline, and 0 (-0.08–0.16) and 267 (232–306) μm at 18 months. The M-CHARTS score (the mean of vertical and horizontal scores) significantly decreased at 1, 6, and 12 months compared to baseline, but worsened at 18 month, the median value (IQR), 0.45 (0.250–0.925), 0.4 (0.15–0.70), 0.4 (0.150–0.625), 0.4 (0.225–0.550) and 0.45 (0.225–0.750) at baseline, 1 month, 6 months, 12 months and 18 months, respectively. The median cumulative number of macular edema recurrences was 2 (IQR, 0.5–3.0) at 18 months. Simple linear regression and multivariate analyses revealed that the change in the mean M-CHARTS score at 18 months was significantly correlated with the baseline score and the cumulative number of macular edema recurrences. Anti-vascular endothelial growth factor therapy using the treat-and-extend regimen improved metamorphopsia in branch retinal vein occlusion-related macular edema in the short to mid-term follow-up period, but not in the long term. Macular edema recurrence may be associated with persistent metamorphopsia.
Highlights
Branch retinal vein occlusion (BRVO) is one of the most common retinal vascular diseases
Randomized clinical trials regarding BRVO, such as BRIGHTER, VIBRANT, and BRAVO revealed that intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents substantially improved Macular edema (ME) and visual acuity (VA) [3,4,5]
The inclusion criteria were (1) symptomatic BRVO with retinal hemorrhage and edema involving the macula and (2) central macular thickness (CMT) greater than 300 μm measured by optical coherence tomography (OCT) at baseline
Summary
Branch retinal vein occlusion (BRVO) is one of the most common retinal vascular diseases. Macular edema (ME) secondary to BRVO is a major complication and decreases visual acuity (VA) [1, 2]. Randomized clinical trials regarding BRVO, such as BRIGHTER, VIBRANT, and BRAVO revealed that intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents substantially improved ME and VA [3,4,5]. BRVO patients often have decreased quality of vision due to symptomatic metamorphopsia, even after VA improvement and ME resolution [6,7,8,9]. It has been reported that improvement of metamorphopsia was more strongly associated with good vision-related quality of life than VA restoration in patients with an epiretinal membrane and a macular hole who underwent vitrectomy [10]. Clinicians need to strongly consider metamorphopsia improvement to increase the quality of life of patients with vitreoretinal disorders
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