Visual acuity and foveal thickness after vitrectomy for macular edema associated with branch retinal vein occlusion: a case series

Hidetaka Noma,Katsunori Shimada,Tatsuya Mimura,Hideharu Funatsu,Shuichiro Eguchi

doi:10.1186/1471-2415-10-11

Hidetaka Noma, Katsunori Shimada + Show 3 more

Open Access

https://doi.org/10.1186/1471-2415-10-11

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Abstract

BackgroundThe mechanism by which vitrectomy improves macular edema in patients with branch retinal vein occlusion remains unclear, although intraocular levels of vascular endothelial growth factor have been suggested to influence the visual prognosis and macular edema.MethodsA series of 54 consecutive patients (54 eyes) with branch retinal vein occlusion was studied prospectively. All patients underwent pars plana vitrectomy for treatment of macular edema. Best corrected visual acuity and retinal thickness (examined by optical coherence tomography) were assessed before and after surgery. The level of vascular endothelial growth factor in vitreous fluid harvested at operation was determined. Patients were followed for at least 6 months postoperatively.ResultsBoth the visual acuity and the retinal thickness showed significant improvement at 6 months postoperatively (P = 0.0002 and P < 0.0001, respectively). The vitreous level of vascular endothelial growth factor was significantly higher in patients who showed less improvement of visual acuity compared with those who had a better visual prognosis (p = 0.0135). In contrast, a high vitreous level of vascular endothelial growth factor was associated with greater improvement of macular edema (p = 0.0064).ConclusionsThese results suggest that the vitreous level of vascular endothelial growth factor might influence the visual prognosis and the response of macular edema to vitrectomy in patients with branch retinal vein occlusion.

Highlights

The mechanism by which vitrectomy improves macular edema in patients with branch retinal vein occlusion remains unclear, intraocular levels of vascular endothelial growth factor have been suggested to influence the visual prognosis and macular edema
We recently reported that the vitreous level of vascular endothelial growth factor (VEGF) is elevated in Branch retinal vein occlusion (BRVO) patients with macular edema, and that vitreous VEGF levels are correlated with the non-perfused area of the retina and with the severity of macular edema[3,4]
The present study demonstrated that the vitreous level of VEGF was significantly higher in BRVO patients who showed less improvement of their best-corrected visual acuity after pars plana vitrectomy (PPV) (Figure 1)

Summary

Introduction

The mechanism by which vitrectomy improves macular edema in patients with branch retinal vein occlusion remains unclear, intraocular levels of vascular endothelial growth factor have been suggested to influence the visual prognosis and macular edema. We recently reported that the vitreous level of vascular endothelial growth factor (VEGF) is elevated in BRVO patients with macular edema, and that vitreous VEGF levels are correlated with the non-perfused area of the retina and with the severity of macular edema[3,4]. We recently reported that higher VEGF levels in the vitreous fluid were associated with more marked improvement of macular edema after PPV in patients with BRVO[7]. We evaluated the outcome of PPV for macular edema in patients with BRVO and examined the relations between VEGF in vitreous fluid, the final best corrected visual acuity, and the response of macular edema to PPV

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