Treatment responses for branch retinal vein occlusion predicted by semi-automated fluorescein angiography quantification

Pei-Wei Huang,Laura Liu,Yen-Po Chen,Cheng-Hsiu Wu,Ling Yeung,Wei-Chi Wu,Yih-Shiou Hwang,Kuan-Jen Chen,Chi-Chun Lai,Jerry Chien-Chieh Huang

doi:10.1186/s12886-022-02245-w

Abstract

BackgroundsBranch retinal vein occlusion (BRVO) is one of the most important causes of visual loss in retinal vascular diseases. The aim of this study is to predict the treatment response of anti-vascular endothelial growth factor (anti-VEGF) therapy in BRVO using semi-automated quantified fluorescein angiography (FA) features.MethodsThis retrospective case-control study enrolled patients with BRVO who are receiving anti-VEGF therapy and have been followed up for > 1 year. Those receiving < 5 anti-VEGF injections in the first year were classified as the responsive group, while those receiving ≥5 injections were the refractory group. The FA images were subjected to semi-automated pre-processing. Fluorescein leakages at the 5-min image were represented by mean gray value over parafoveal and perifoveal regions. FA leakages and central retinal thickness (CRT) on optical coherence tomography (OCT) were used for predicting the treatment response and compared using area under receiver operating characteristic curve (AUC).ResultsEighty-nine patients (56 males, 33 females, mean age 62.5 ± 10.9 years) with BRVO were enrolled. Of the 89 eyes, 47 (53%) were in the responsive group and 42 (47%) were in the refractory group. The refractory group had a significantly higher number of anti-VEGF injections in the first year (5.9 ± 1.6 versus 2.4 ± 1.2, p < 0.001) when compared with that of the responsive group. It had thicker pre-treatment CRT (p = 0.011), post-treatment best CRT (p < 0.001) and CRT at 1-year (p < 0.001). It also had a higher mean gray value over the parafoveal (p < 0.001) and the perifoveal (p < 0.001) regions. The mean gray value over perifoveal (AUC 0.846) and parafovel (AUC 0.818) had significantly larger AUC than that of the pre-treatment OCT (AUC 0.653; p = 0.005 and p = 0.016, respectively) when predicting treatment response.ConclusionThe refractory group had a more severe fluorescein leakage over the parafoveal and the perifoveal regions than the responsive group had. Semi-automated quantified FA leakage can be used as a biomarker for the prediction of anti-VEGF treatment response in macular edema due to BRVO.

Highlights

Branch retinal vein occlusion (BRVO) is one of the most important causes of visual loss in retinal vascular diseases [1]
Additional anti-vascular endothelial growth factor (VEGF) injections were administered in cases with recurrent or persistent macular edema - defined as central retinal thickness (CRT) ≥ 300 μm
A total of 89 eyes from 89 patients with BRVOrelated macular edema and receiving anti-VEGF treatment were included in this study

Summary

Introduction

Branch retinal vein occlusion (BRVO) is one of the most important causes of visual loss in retinal vascular diseases [1]. Anti-vascular endothelial growth factor (VEGF) has been used as the standard of care for macular edema secondary to BRVO and could significantly improve the. Some patients may suffer from recurrent or persistent macular edema and require repeated anti-VEGF injections [2, 3]. In the BRIGHTER study, the number of anti-VEGF injections varied from a few of injections to almost monthly injections spanning over 2 years [2]. During the 4-year follow-up of the RETAIN study, about 50% of patients had unresolved macular edema [3]. Switch to intravitreal steroid treatment or applying retinal photocoagulation may be beneficial for some patients [1, 13]

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