Macular Edema In Branch Retinal Vein Occlusion Research Articles

Conbercept improves macular microcirculation and retinal blood supply in the treatment of nonischemic branch retinal vein occlusion macular edema.

To investigate the effect of conbercept on macular microvascular system and retinal blood supply in the treatment of nonischemic branch retinal vein occlusion macular edema (BRVO-ME). Patients were divided into three groups: group A (containing 12 nonischemic BRVO-ME eyes), group B (containing contralateral 12 healthy eyes), and group C (containing 30 cataract eyes to obtain normal aqueous humor cytokine levels). Group A received monthly intravitreal injections of conbercept for 3months. General data and best-corrected visual acuity (BCVA) were compared among the three groups. Optical coherence tomography angiography (OCTA) results (including central macular thickness [CMT], retinal vascular density and perfusion, and foveal avascular zone [FAZ]) at baseline were compared among groups A and B. Aqueous humor cytokine levels (including VEGF, IL-8, PDGF-AA, TNF-α, and ANGPTL-4) at baseline were compared between groups A and C. Moreover, BCVA, OCTA results, and aqueous humor cytokine levels of group A before and after conbercept treatment were compared. At baseline, group A had a significantly worse BCVA, lower retinal vascular density and perfusion, and numerically larger CMT and FAZ area comparing to the group B, and had a higher aqueous cytokine level (IL-8, VEGF, and ANGPTL-4) comparing to the group C (all ps < 0.05). After the injection of conbercept, group A presented a better BCVA (at initial diagnosis vs. after three conbercept injections: 1.16 ± 0.51 vs. 0.81 ± 0.30, logMAR, p < 0.05), higher retinal vascular density (11.56 ± 4.73 vs. 15.88 ± 2.31, mm-1 , p < 0.05) and perfusion (0.28 ± 0.12 vs. 0.39 ± 0.06, mm2 , p < 0.05), smaller CMT (504.92 ± 184.11 vs. 219.83 ± 46.63, mm2 , p < 0.05), as well as a lower levels of VEGF (before first injection vs. before third injection: 113.84 [70.81, 235.4] vs. 3.94 [3.56, 8.07], pg/ml, p < 0.05) and ANGPTL-4 (45,761 [7327.5, 81,402.5] vs. 25,015.5 [6690, 43,396], pg/ml, p < 0.05). However, the average FAZ area of group A expanded (at initial diagnosis vs. after three conbercept injections: 0.41 ± 0.14 vs. 0.62 ± 0.36, mm2 , p < 0.05). This study demonstrated that intraocular injection of conbercept could effectively improve macular microcirculation and increase retinal blood supply in the treatment of nonischemic BRVO-ME based on the combination of visual acuity, OCTA parameters, and aqueous humor cytokine assay results. However, further study with a larger sample size and longer observation period is still needed in the future.

Comparison of hyperreflective foci in macular edema secondary to multiple etiologies with spectral-domain optical coherence tomography: An observational study

BackgroundHyperreflective foci (HRF) features in macular edema associated with different etiologies may indicate the disease pathogenesis and help to choose proper treatment. The goal of this study is to investigate the retinal microstructural features of macular edema (ME) secondary to multiple etiologies with spectral-domain optical coherence tomography (SD-OCT) and analyze the origin of HRF in ME.MethodsThis was a retrospective study. SD-OCT images were reviewed to investigate macular microstructural features such as the number and distribution of HRF and hard exudates and the internal reflectivity of the cysts. The differences in microstructural features between groups and the correlations between the number of HRF and other parameters were analyzed.ResultsA total of 101 eyes with ME from 86 diabetic (diabetic macular edema, DME) patients, 51 eyes from 51 patients with ME secondary to branch retinal vein occlusion (branch retinal vein occlusion-macular edema, BRVO-ME), 59 eyes from 58 central retinal vein occlusion (central retinal vein occlusion-macular edema, CRVO-ME) patients, and 26 eyes from 22 uveitis (uveitic macular edema, UME) patients were included in this study. The number of HRF, the frequency of hard exudates and the enhanced internal reflectivity of the cysts were significantly different among the groups. The number of HRF in the DME group was significantly higher than that in the other groups (all P < 0.05). The frequency of hard exudates and enhanced internal reflectivity of the cysts in the DME group were significantly higher than ME secondary to other etiologies (all P < 0.001). Within the DME group, the number of HRF in the patients with hard exudates was significantly higher than that in the patients without hard exudates (P < 0.001).ConclusionHRF detected with SD-OCT were more frequent in DME patients than in BRVO-ME, CRVO-ME, or UME patients. The occurrence of HRF was correlated with the frequency of hard exudates. HRF may result from the deposition of macromolecular exudates in the retina, which is speculated to be a precursor of hard exudates.

Efficacy of intravitreal conbercept injection on short- and long-term macular edema in branch retinal vein occlusion

To observe the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) repeatedly after the intravitreal injection of conbercept (IVC) for treating cystoid macular edema (CME) in branch retinal vein occlusion (BRVO) and explore the relationship between the duration of CME and visual outcome. Subgroup analysis was performed to compare short-term (within 90d of CME onset) and long-term (over 90d of CME onset) macular edema in BRVO. After an initial IVC, a pro re nata (PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA. Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6mo after IVC. Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME. There were statistical significances between and within groups of the BCVAs at different time points (P<0.001). The interaction was found between group and time (P=0.006), indicating the difference in the speed of BCVA improvement between groups. In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group. There were significant differences between and with groups of the CFT at different time points (P<0.001). However, the interaction between group and time in relation to CFT had no significant differences (P=0.59). IVC treatment for CME following BRVO is effective and safe. The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO. The improvement of vision might be faster with early IVC treatment than with delayed treatment.

Hyperbaric Oxygen Therapy for Recalcitrant Macular Edema Following Branch Retinal Vein Occlusion

Cystoid macular edema (CME) is the most common cause of reduced vision in branch retinal vein occlusion (BRVO). The treatment protocols for macular edema in BRVO have changed considerably in the previous decade because of the increased popularity of the wide use of optical coherence tomography (OCT) and intravitreal drugs. Intravitreal injection of anti-vascular endothelial growth factors (anti-VEGF) and steroids result in the reduction of CME. However, the effect is transient, and multiple injections may be required. On repeated use, few patients become non-responders to these drugs. Nonetheless, anti-VEGF drugs may have potentially life-threatening complications because of systemic absorption. Intravitreal steroids may lead to severe ocular side effects such as cataract and glaucoma. Chances of endophthalmitis, retinal tear, and inflammation can occur with any of the intravitreal injections. We present a case of BRVO with recalcitrant CME following focal laser, multiple intravitreal anti-VEGF, and steroid injections. However, he had cardiovascular risk factors, so repeated anti-VEGF injections were not given. He was planned for hyperbaric oxygen therapy and showed favorable response. His visual acuity improved and macular edema reduced to more than half from baseline values on OCT.

Topographic patterns of retinal edema in eyes with branch retinal vein occlusion and their association with macular edema recurrence

In this study, we evaluated the topographic pattern of retinal edema in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) using a widefield retinal thickness map of optical coherence tomography and its association with ME recurrence. In 87 eyes with ME secondary to BRVO who were treated with anti-vascular endothelial growth factor (VEGF) injections and followed up for ≥ 1 years, 12 × 9 mm macular volume scans of swept-source optical coherence tomography (DRI-OCT Triton; Topcon Inc, Japan) were performed and retinal thickness maps were automatically generated at baseline and follow-up visits. Topographic patterns of retinal edema on the maps at baseline and 1 month after the first anti-vascular endothelial growth factor (VEGF) treatment were classified as extramacular (outside the ETDRS grid), macular (within the grid), and combined pattern and correlated with ME recurrences. Seventy-five of 87 (86.2%) eyes with BRVO ME showed combined edema at baseline. There were 4 topographic patterns of edema at 1 month following anti-VEGF injection as follows: no residual edema, extramacular only, macular only, and combined edema. In contrast to the baseline pattern, the pattern of retinal edema 1 month following anti-VEGF therapy showed significant association with 6-month recurrence, number of ME recurrences during a 1-year period, and time to first recurrence. (all P < 0.05) An automatically generated widefield retinal thickness map could be used to effectively visualize the topographic patterns of retinal edema in eyes with BRVO. The map can be used as a valuable tool for detection of retinal edema on widefield retinal areas and prediction of ME recurrence in eyes with BRVO.

Aqueous humor inflammatory cytokine levels and choroidal thickness in patients with macular edema associated with branch retinal vein occlusion.

We aimed to investigate the association between subfoveal choroidal thickness (SCT) and the level of aqueous humor (AH) inflammatory cytokines in patients with macular edema (ME) associated with branch retinal vein occlusion (BRVO). Twenty-eight eyes of 28 BRVO ME patients who underwent intravitreal injection treatment (ranibizumab, bevacizumab, or dexamethasone implant) were prospectively recruited. The concentrations of vascular endothelial growth factor (VEGF)-A and inflammatory cytokines were measured from AH samples. We analyzed clinical factors associated with visual gain or the degree of central macular thickness (CMT) decrease and the association between SCT and inflammatory cytokine levels. On multiple linear regression analysis, the AH interleukin (IL)-8 level was significantly associated with visual gain and CMT reduction at 6months. Age, systemic hypertension, and AH monocyte chemo-attractant protein 1 level showed a significant association with baseline SCT, and VEGF-A showed a significant association with baseline SCT ratio (BRVO eye SCT/fellow eye SCT). Those with thick SCT showed a higher level of AH soluble VEGF receptors 2 and IL-8 and showed better visual gain and greater CMT reduction at 2 and 6months compared to the thin SCT group. The level of AH inflammatory cytokines was significantly associated with the ischemic status of the retina, treatment outcomes, and SCT in BRVO ME patients. Thick baseline SCT might be a predictive sign for better treatment outcomes in BRVO ME patients which are thought to be related to a higher level of intraocular inflammatory cytokines in these patients.

EVALUATION OF MACULAR ISCHEMIA IN EYES WITH BRANCH RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study.

To quantitatively assess macular morphology and perfusion status using optical coherence tomography, and optical coherence tomography angiography in eyes with branch retinal vein occlusion when macular edema has completely resolved, and to investigate the impact on visual function. Thirty consecutive eyes with branch retinal vein occlusion-macular edema that resolved after treatment with intravitreal ranibizumab injections were included. Macular sensitivity was measured by microperimetry; defect length of foveal ellipsoid zone band was measured using optical coherence tomography; foveal avascular zone and parafoveal nonperfusion areas (NPA) were measured by optical coherence tomography angiography. The logarithm of minimum angle of resolution visual acuity was significantly associated with the defect length of the foveal ellipsoid zone band (P = 0.005), the parafoveal NPA in the superficial capillary plexus (P = 0.007), and the parafoveal NPA in the deep capillary plexus (P = 0.006). Macular sensitivity correlated with parafoveal thickness on the affected side (P = 0.034), the defect length of the foveal ellipsoid zone band (P = 0.048), parafoveal NPA in the superficial capillary plexus (P = 0.008), and parafoveal NPA in the deep capillary plexus (P = 0.012). Multivariate analysis where the only significant parameters in the univariate analyses were used as the independent variables showed that parafoveal NPA was most significantly associated with the logarithm of minimum angle of resolution visual acuity (β = 0.500, P = 0.005) and macular sensitivity (β = -0.480, P = 0.007). In eyes with branch retinal vein occlusion-macular edema resolved by intravitreal ranibizumab treatments, visual function was strongly associated with parafoveal NPA size.

Gap in Capillary Perfusion on Optical Coherence Tomography Angiography Associated With Persistent Macular Edema in Branch Retinal Vein Occlusion.

To evaluate correlations between persistent macular edema associated with branch retinal vein occlusion (BRVO) and the macular perfusion status in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) using optical coherence tomography angiography (OCTA). Retrospective, case-control study. Twenty patients with BRVO followed for 12 months or more were enrolled. Persistent macular edema was defined as central retinal thickness exceeding 300 μm that persisted or recurred less than 3 months after the final treatment. We compared two groups (i.e., seven eyes with persistent macular edema and 13 eyes without macular edema). The macular perfusion status was evaluated using OCTA. We defined a gap vessel as a residual vessel in the SCP that existed simultaneously with capillary loss in the DCP. The gap vessels were determined by subtracting the vessel images of the DCP from the images of the SCP using an image processing technique. In eyes with persistent macular edema, the area with gap vessels was significantly (P = 0.0013) larger than in eyes without macular edema (14.34% vs. 8.02%). Other factors evaluated (i.e., the area of the foveal avascular zone, superficial vessel density, and deep vessel density) did not differ significantly (P = 0.66, P = 0.23, P = 0.34, respectively) between the groups. The difference in capillary loss between the SCP and DCP can facilitate development of persistent macular edema in BRVO.

Microaneurysms cause refractory macular edema in branch retinal vein occlusion.

Intravitreal anti-vascular endothelial growth factor (VEGF) agents can treat macular edema (ME) in branch retinal vein occlusion (BRVO). However, refractory ME, the mechanism of which is not well elucidated, occurs frequently. Sixty-six eyes with ME secondary to BRVO were enrolled in this retrospective observational case-control study. Twenty eyes received a sub-Tenon’s capsule injection of triamcinolone acetonide (STTA), 22 eyes an intravitreal anti-VEGF injection (ranibizumab), 16 eyes were switched from STTA to ranibizumab, 4 eyes underwent vitrectomy, and 4 eyes were untreated. Multiple regression analysis and multivariate logistic regression analysis were conducted, respectively, to identify independent predictors of visual acuity (VA) prognosis and risk factors for refractory ME longer than 1 year. The mechanism of refractory ME and therapeutic approaches for identified risk factors also were investigated. Thirty-four (52%) eyes had refractory ME for over 1 year. Microaneurysms were identified as risk factors for refractory ME, leading to poor final VA. Ranibizumab suppressed microaneurysm formation and refractory ME, with early administration more effective. For already formed microaneurysms, laser photocoagulation reduced additional treatments. Microaneurysms may cause refractory ME in BRVO. Alternative therapy to suppress microaneurysms should be considered to prevent refractory ME in patients with BRVO.

Intravitreal bevacizumab injection with grid laser photocoagulation for macular oedema in branch retinal vein occlusion

AbstractPurpose To evaluate the effects of intravitreal bevacizumab (IVB) with grid laser photocoagulation for macular edema in branch retinal vein occlusion (BRVO).Methods This was a retrospective case series. Ten eyes in 10 patients with macular edema secondary to BRVO with at least 3 months of symptom duration were included. The mean follow‐up term was 70.2 ± 8.4 weeks. Patients underwent IVB at baseline and macular grid laser photocoagulation 1 week later. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were examined during the monthly follow‐up. If persistent or recurrent fluid collection appeared in optical coherence tomography (OCT) , additional IVB were performed. To evaluate differences between baseline and post‐treatment BCVA and CMT, Fisher exact test was performed.Results The mean baseline BCVA was 0.31±0.17 (mean±SD), and the mean CMT was 530±109 µm. The mean BCVA at 4, 12 and 24 weeks were 0.49±0.21 (p=0.030), 0.47±0.60 (p=0.038), and 0.41±0.85 (p=0.041), respectively. The mean CMT were 285±75 µm (p&lt;0.01), 304±120 µm (p&lt;0.01), and 325±145 µm (p=0.015). A mean 1.85 injections were administered and the second injection was done at a mean 3.52 months after baseline.Conclusion IVB and additional grid photocoagulation were effective for macular edema in BRVO, and the improvement maintained for 6 months.

Recurrence of macular edema associated with branch retinal vein occlusion after intravitreal bevacizumab

To study the recurrence of macular edema and the probability of retreatment with intravitreal bevacizumab (IVB) of eyes with macular edema associated with branch retinal vein occlusion (BRVO). In this retrospective study of an interventional case series, the temporal profile of visual acuity and retinal thickness after individual IVB, either initial or repeated, was investigated for eyes with acute BRVO associated with symptomatic macular edema. In a total of 95 IVB treatment sessions conducted on 37 eyes of 37 patients, 25 injections were completed with a follow-up period of 6 months or longer without any additional treatments. Fifty-eight IVB injections were followed by retreatment with IVB after an average interval of 119 days (range 42-308 days) since the preceding IVB injection. The remaining 12 injections were followed either by an insufficient follow-up period of less than 6 months or by laser treatment. Although retreatment with IVB because of recurrence of macular edema is common, in this study, the probability of retreatment with IVB was approximately 70% after each individual IVB injection, indicating that 4 injections is maximum for three-quarters of eyes with BRVO macular edema.

Intravitreal injection of bevacizumab combined with macular grid laser photocoagulation for macular edema in branch retinal vein occlusion

To evaluate the effects of combined therapy of intravitreal injections of bevacizumab (IVB) and additional macular grid laser photocoagulation for recurrent macular edema in branch retinal vein occlusion (BRVO). This was a retrospective interventional case series in which 44 eyes of 44 patients with macular edema due to BRVO were studied. The mean follow-up term was 77.2 ± 12.4 weeks. All patients underwent IVB as a primary therapy. After two to three IVB, 19 of the 44 eyes (43.2%) underwent laser photocoagulation in the macular edema area to prevent the recurrence of the edema. In the other 25 eyes (56.8%), macular edema was successfully treated with IVB only. Visual acuity and central macular thickness (CMT) were examined during the follow-up. The mean visual acuity and the mean CMT in both groups improved significantly after the IVB. Following macular grid laser photocoagulation for recurrent macular edema, the mean visual acuity was maintained for 24 weeks, however, the mean CMT increased significantly after 12 weeks. Additional grid laser photocoagulation for recurrent macular edema in BRVO after IVB maintained mean visual acuity with limited effects on the further recurrence of macular edema.

Intravitreal Bevacizumab Associated with Grid Laser Photocoagulation in Macular Edema Secondary to Branch Retinal Vein Occlusion

To evaluate intravitreal bevacizumab (IVB) combined with grid laser photocoagulation in macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Eight eyes (8 patients) with ME associated with BRVO with at least 3 months of evolution since symptom onset were included. All subjects underwent measurement of best-corrected visual acuity (BCVA) and imaging with spectral domain optical coherence tomography (SD-OCT) at baseline and 1, 3, 6, and 12 months. Intravitreal bevacizumab was administered at baseline and macular grid laser photocoagulation 1 month later. During follow-up, additional IVB was administered based on physician discretion if persistent or recurrent intraretinal fluid (cysts) was observed on SD-OCT. The mean BCVA and SD-OCT central subfield thickness (CST) values were determined at each time point. Fisher exact test was performed to assess differences between baseline and post-treatment BCVA and SD-OCT measurements. The mean baseline BCVA was 0.28±0.14 (mean±SD), and the mean CST was 479±137 µm. The mean BCVAs at 1, 3, 6, and 12 months were 0.47±0.18 (p=0.031), 0.56±0.50 (p=0.031), 0.65±0.60 (p=0.008), and 0.66±0.65 (p=0.016), respectively. The mean CST values at 1, 3, 6, and 12 months were 295±60 µm (p=0.008), 333±114 µm (p=0.070), 339±80 µm (p=0.008), and 335±109 µm (p=0.008). A mean 2.13 injections were administered; the second injection was administered a mean of 2.71 months after baseline. Combined treatment with IVB and macular grid photocoagulation provided good results and may be considered as an alternative therapy for ME in BRVO. Further studies are needed to assess these preliminary results.

Predictive factors for functional improvement after intravitreal bevacizumab therapy for macular edema due to branch retinal vein occlusion

BackgroundTo identify predictive factors for improvement of visual acuity and central retinal thickness by intravitreal bevacizumab for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO).MethodsTwo hundred and five eyes from 204 patients with ME secondary to BRVO were retrospectively included at six sites. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.05 ml). The mean follow-up was 36.8 ± 12.7 weeks (range, 18 to 54 weeks). Measurement of ETDRS best-corrected visual acuity (BCVA, in all eyes) and optical coherence tomography (OCT, in 87% of eyes) were performed at baseline and at follow-up examinations every 12 weeks. Using fluorescein angiography, the perfusion status of the macula at baseline could be assessed in 84% of the eyes. The main outcome measures were changes in BCVA and central retinal thickness (CRT). For analysis of predictive factors, the results at 24 weeks were used.ResultsThe median BCVA was 0.6 LogMAR at baseline and improved to 0.4 LogMAR at 24 and 48 weeks. This visual improvement was associated by a significant reduction in CRT, decreasing from a baseline of 454 μm to 267 μm and 248 μm after 24 and 48 weeks respectively. Eyes with ME and intact (perfused) or interrupted (ischemic) foveal capillary ring showed a 2-line increase of median BCVA [45 eyes (22%) and 128 eyes (62%) respectively]. However, the final median BCVA was significantly worse in eyes with ischemic ME (0.6 versus 0.3 logMAR in perfused ME). Other factors for visual improvement were absence of previous treatments of the ME, age younger than 60 years and low baseline BCVA (≥0.6 logMAR) (2, 3, and 2 median BCVA lines increase respectively). Furthermore, eyes with duration of the ME of less than 12 months responded with a 3-line increase of the median BCVA. Final CRT only showed minor differences between the subgroups. During the entire follow-up, retreatments were performed in 85% of the eyes, with a median number of injections of three (mean 3.2; range, 1 to 10) and a median time-interval between injections of 11.6 weeks (mean 14.6 weeks).ConclusionsIntravitreal injection of bevacizumab resulted in a significant improvement of BCVA and reduction of ME in BRVO. Baseline BCVA, patient’s age, and duration of BRVO were found to be of prognostic relevance for visual improvement. A less favorable outcome of the bevacizumab therapy in eyes with longstanding BRVO would advocate initiation of treatment within 12 months after onset.

Arteriovenous Sheathotomy for Persistent Macular Edema in Branch Retinal Vein Occlusion

PurposeTo evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion.MethodsTwenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared.ResultsThe mean preoperative BCVA (log MAR) were 0.79±0.29 and postoperative BCVA (log MAR) at 3 months was 0.57±0.33. And improvement of visual acuity ≥2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22±76.83 µm (510-737 µm) and postoperative fovea thickness was 217.60±47.33 µm (164-285 µm).ConclusionsVitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.

Triamcinolona intravítrea en el tratamiento de la oclusión de rama venosa retiniana

Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRVO.