Major Branch Retinal Vein Occlusion Research Articles

Clinical study of branch retinal vein occlusion (BRVO) in a tertiary eye care center

Branch Retinal Vein Occlusion (BRVO) is a common retinal vascular disorder which involves one of the branch retinal veins. The aim of the study is to analyse epidemiology, risk factors, clinical characteristics in the distribution of different types of BRVO and final visual outcome after treatment and six months follow up. This is a prospective study including 222 patients of BRVO was done from October-2018 to September-2020. Clinical evalution included, detailed history with systemic risk factors, visual acuity testing, Slit-lamp biomicroscopy, Intra occular pressure, detailed fundus evaluation, fundus fluorescein angiography, Optical Coherence Tomography and Gonioscopy. Laboratory test included complete blood count, Erythrocyte sedimention rate, fasting blood sugar, serum lipid profile. Treatment given, observation and follow up, intravitreal (lV) ranibizumab, IV triamcinolone and laser photo coagulation. Out of 222 BRVO patients, 207 (94.1%) were major BRVO (129(58.1%) were suprotemporal BRVO, 66(29.8%) were inferotemporal BRVO) and 15 (5.9%) were macular BRVO. Maximum number of patients 108 (48.6%) in the age group of 61-70 years. Male patients 126 (56.7%) more than females 96 (43.3%). Right eye 117 cases (52.7%) were involved slight more than the left eye 102 cases (45.9%). Blurring of vision 162 (72.9%) is the commonest symptom. Hypertensive patients 113 (50.9%) affected more followed by Diabetic 36 (16.2%) and cardiovascular disease 33 (14.9%). Mean Systolic blood pressure (SBP), Diastolic blood pressure (DBP), ESR & Fasting blood sugar (FBS) are higher in Macular BRVO, cholesterol level is higher in Major BRVO. Retinal haemorrhage was present in all cases. Macular edema was present in 87.4% of patients in whom OCT was done. At the end of six months after treatment in majority of patients i:e 85.1% had BCVA between 6/6-6/18. There was dramatical improvement of vision after receiving intravitreal Ranibizumab (P value 0.041).There is strong association of conventional risk factors with BRVO. Visual prognosis depends on initial status with careful monitoring for macular ischaemia, macular edema, development of neovascularization and subsequent neovascular glaucoma followed by appropriate therapy like IV Ranibizumab, IV Triamcinolone and laser photocoagulation etc wherever required. There is dramatical improvement of vision after receiving intravitreal Ranibizumab (P value 0.041).

Branch Retinal Vein Occlusion: A Case Report

To report a case of a major branch retinal vein occlusion (BRVO) in the superotemporal region with superior macular involvement and a review of its natural history. This is a retrospective case presentation of a 49-year-old African Caribbean female patient presented to Accident and Emergency with unilateral persistent acute history of reduced central vision of left eye for 10 days with no other associated symptoms. Treatment options included using scatter (pan-retinal) laser photocoagulation followed by intravitreal injections as the area of non-perfusion is >5-disc area. It is warranted to understand the risk factors associated with BRVO and to develop appropriate treatment and follow-up plans.

Characteristics of major and macular branch retinal vein occlusion

We compared the aqueous profiles, baseline characteristics, and clinical outcomes of 54 eyes with macular edema secondary to major branch retinal vein occlusion (BRVO) and macular BRVO. We also identified the characteristics of poor responders to anti-vascular endothelial growth factor (VEGF) injections. Aqueous inflammatory cytokine and VEGF concentrations were significantly higher in major BRVO. In optical coherence tomography, major BRVO had a higher proportion with subretinal fluid, disorganization of retinal inner layers, and ellipsoid zone disruption. Comparing the clinical outcomes, major BRVO required more intravitreal anti-VEGF injections and had a poorer visual prognosis in the first 12 months. A significantly higher proportion of patients with major BRVO required additional treatments after 6 months compared to macular BRVO. Patients who responded poorly to anti-VEGF had higher aqueous VEGF levels and central subfield thickness (CST) at baseline. In conclusion, major BRVO patients required more and longer treatments, and had worse visual prognoses. BRVO that responds poorly to anti-VEGF had greater CST and higher aqueous VEGF levels at baseline.

Association between capillary congestion and macular edema recurrence in chronic branch retinal vein occlusion through quantitative analysis of OCT angiography

This study aims to quantitatively investigate the optical coherence tomographic angiography (OCTA) findings of capillary congestion and its association with macular edema (ME) recurrence in chronic branch retinal vein occlusion (BRVO). We retrospectively reviewed the medical records of 115 consecutive patients with major ischemic BRVO who reached stable macula (without ME for two consecutive visits) at baseline (the first visit within the stable period). All patients were classified into a recurrence or non-recurrence groups depending on ME recurrence. Capillary congestion of deep capillary plexuses (DCP-C) and other abnormal capillary lesions were segmented, and their areas, vascular densities, and mean retinal thicknesses (MRT) were calculated. The main outcomes were differences between the two groups and risk factors for recurrence among baseline and OCTA parameters. A total of 76 eyes were included, of which 22 (28.9%) recurred. DCP-C existed in all eyes at baseline. MRT of DCP-C (p = 0.006) was greater in the recurrence group. Greater MRT of DCP-C (OR: 1.044; p = 0.002) and more frequent intravitreal injections (OR: 1.803; p < 0.001) were associated with a higher risk of relapsing ME. DCP-C may contribute to the anatomical stability of chronic BRVO and simultaneously be the source of ME.

Efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion

BackgroundThe objective of our study was to assess the efficacy of intravitreal Lucentis injection on major and macular branch retinal vein occlusion (BRVO).MethodsIn this retrospective analysis, 43 patients (major BRVO n = 24; macular BRVO, n = 19) were treated with intravitreal injection of Lucentis with a 1 + PRN regimen, which is diagnosed by fluorescein fundus angiography (FFA). “1 + PRN”, namely, one intravitreal injection of Lucentis at the baseline, and then continue or stop according to the condition of the patient. The following observation indexes were measured at baseline and follow-up (1–6 months): best corrected visual acuity (BCVA), foveal thickness (CFT), total retinal volume with macular diameter of 6 mm. During the follow-up, repeated injections were given according to patients’ demand, and the number of injections was recorded.ResultThe observation indexes of patients with BRVO were significantly improved after 6 months of Lucentis treatment in both major and macular groups, including BCVA, CFT and the retinal volume of the 6 mm-diameter macula. Interestingly, there were significant differences in the therapeutic effect between the two groups, and the macular group had better therapeutic effect than the major group with the less number of repeated injections.ConclusionsTo sum up, intravitreal injection of Lucentis was effective for both major and macular BRVO, and the efficacy in macular subtype group was better than that in major subtype group with the more obviously improvement and the less number of injections.

Angiographic Risk Features of Branch Retinal Vein Occlusion Onset as Determined by Optical Coherence Tomography Angiography.

PurposeExamine associations between the vasculature at arteriovenous (AV) crossings and the onset of branch retinal vein occlusion (BRVO).MethodsWe included 78 patients with major BRVO, 35 patients with macular BRVO, and 110 controls without BRVO and determined the vessel positions at AV crossings, where the first- or second-order branches of the retinal veins associate, using a viewing angle of 12 × 12 mm2 in optical coherence tomography angiography (OCTA).ResultsWe reviewed 1349 and 1276 AV crossings in BRVO patients and control subjects, respectively. The proportions of venous overcrossing were 26.5%, 28.6%, and 26.8% at non-causative crossings in BRVO eyes, non-BRVO fellow eyes, and unaffected control eyes, respectively; however, the rate of venous overcrossings at the causative crossings was 45.1%. In OCTA analyses, we divided the branches into macular- or non-macular veins. The rate of venous overcrossing was 52.5% at causative crossings in major BRVO but was 28.6% in macular BRVO. Odds ratios for whether venous overcrossing was a risk factor for BRVO were 3.09 (95% confidence interval [CI], 1.96–4.88) and 0.94 (95% CI, 0.44–2.00) for non-macular veins and macular veins, respectively. The patients with major BRVO caused by venous overcrossing were younger than patients for whom the cause was arterial overcrossing (P < 0.001). The onset of macular BRVO did not differ between crossing patterns at causative crossings (P = 0.60).ConclusionsIn eyes with BRVO, venous overcrossing was a common angiographic feature at causative crossings and might be a risk factor for major BRVO onset.

Branch Retinal Vein Occlusion: Treatment Outcomes According to the Retinal Nonperfusion Area, Clinical Subtype, and Crossing Pattern

This prospective study examined 58 eyes with branch retinal vein occlusion (BRVO) to investigate the effects of the nonperfusion area (NPA), clinical subtype, and crossing pattern on the 2-year outcomes of ranibizumab therapy for the macular edema (ME). All eyes received three initial monthly injections, followed by additional pro re nata (PRN) injections. The final best corrected visual acuity (BCVA) and ranibizumab injection number were not associated with the macular NPA or total NPA at baseline or month 12, and they showed no significant differences between the clinical subtypes. However, the incidence of neovascular changes was higher in the major BRVO group than in the macular BRVO group (P = 0.030). Twelve and 19 of the 34 eyes with major BRVO exhibited arterial overcrossing and venous overcrossing, respectively. At baseline, the total NPA did not differ according to the crossing pattern, however, the total NPA was significantly larger in the venous overcrossing group at month 12 (P = 0.047). At month 24, the incidence of neovascular changes was higher in the venous overcrossing group (P = 0.030). Following ranibizumab therapy for BRVO-associated ME, the clinical subtype and the arteriovenous crossing pattern may be associated with neovascular changes.

Short-term effect of intravitreal conbercept injection on major and macular branch retinal vein occlusion.

ObjectiveTo evaluate the effectiveness of intravitreal conbercept injection on major and macular branch retinal vein occlusion (BRVO).MethodsThis retrospective analysis involved 43 patients with BRVO (major BRVO n = 24; macular BRVO, n = 19) who were diagnosed by fluorescein fundus angiography (FFA) and injected with intravitreal conbercept. The following outcomes were measured at baseline and follow-up (1-6 months): best-corrected visual acuity (BCVA), central foveal thickness (CFT), total retinal volume in a 6-mm diameter section of the macula, choroidal thickness under the central fovea of the macula, relative area of retinal hemorrhage, complications, and times when repeated injection was performed.ResultsThere were significant differences between the two groups in terms of BCVA, CFT, and total retinal volume in a 6-mm diameter section of the macula at 6 months after treatment. Choroidal thickness under the central fovea of the macula and relative area of retinal hemorrhage showed no significant differences between the two groups at 6 months after treatment; however, they significantly differed from baseline measurements.ConclusionIn general, intravitreal injection of conbercept may have a better short-term effect in patients with macular BRVO than in patients with major BRVO.

Collateral vessels on optical coherence tomography angiography in eyes with branch retinal vein occlusion

AimsTo detect collateral vessels using optical coherence tomography angiography (OCTA) in eyes with branch retinal vein occlusion (BRVO) and to investigate the associations with visual outcomes and macular oedema.MethodsEyes with...

Intravitreal Ranibizumab and Aqueous Humor Factors/Cytokines in Major and Macular Branch Retinal Vein Occlusion

Aqueous humor levels of cytokines and growth/inflammatory factors were measured in 38 patients with macular edema who had major branch retinal vein occlusion (BRVO) or macular BRVO and were treated with intravitreal ranibizumab injection (IRI). Patients with recurrence of macular edema received further IRI as needed. Aqueous humor levels of vascular endothelial growth factor (VEGF), soluble VEGF receptor-1 (sVEGFR-1), and other cytokines/factors were measured. Compared with major BRVO, macular BRVO was associated with lower aqueous humor levels of sVEGFR-1, its ligands (VEGF and placental growth factor), and other growth/inflammatory factors (platelet-derived growth factor-AA, monocyte chemotactic protein-1, soluble intercellular adhesion molecule-1, interleukin-6, and interleukin-8). The mean number of IRI over 6 months was significantly lower in the macular BRVO group than in the major BRVO group. These findings suggest that macular BRVO requires fewer IRI than major BRVO and is associated with lower aqueous humor levels of various growth/inflammatory factors and cytokines.

Aqueous Angiopoietin-Like 4 Levels Correlate With Nonperfusion Area and Macular Edema in Branch Retinal Vein Occlusion.

To investigate whether macular edema (ME) due to branch retinal vein occlusion (BRVO) associates with retinal overexpression of angiopoietin-like 4 (ANGPTL4). The aqueous ANGPTL4 and vascular endothelial growth factor (VEGF) levels in patients with ME due to BRVO were measured, and the relationships between ANGPTL4 levels and the degree of retinal ischemia and edema were determined. The study and control groups consisted of all consecutive patients who were scheduled to undergo intravitreal bevacizumab injection for treatment-naïve BRVO with ME and senile cataract surgery, respectively. The study group was divided into the major BRVO and macular BRVO subgroups on the basis of the involved retinal area. The aqueous ANGPTL4 and VEGF levels were measured by enzyme-linked immunosorbent assay. In the patients with BRVO, capillary nonperfusion area by fluorescein angiography and central subfield macular thickness (CSMT) and total macular volume (TMV) by spectral-domain optical coherence tomography were determined. Patients with ME due to BRVO (50 eyes) had higher aqueous ANGPTL4 and VEGF levels than the controls (61 eyes) (both P < 0.001). The major BRVO had higher ANGPTL4 and VEGF levels than the macular BRVO (both P < 0.001). The aqueous ANGPTL4 levels of all BRVO patients correlated positively with nonperfusion area (r = 0.901, P < 0.001), CSMT (r = 0.574, P < 0.001), and TMV (r = 0.453, P = 0.001), even after adjustment for VEGF levels. The aqueous ANGPTL4 levels correlated significantly with phenotypes of BRVO with ME. This suggests that ANGPTL4 may be a candidate biomarker and treatment target in ischemia-induced retinopathies, including BRVO.

Definition and Classification of Retinal Vein Occlusion

Retinal vein occlusion is second most common retinal vascular disease after diabetic retinopathy. A main cause of the retinal vein occlusion is arterial disease when arterial stiffness affects neighboring vein. There are three main types of retinal vein occlusion: central retinal vein occlusion, hemicentral retinal vein occlusion and branch retinal vein occlusion. Central retinal vein occlusion and hemicentral retinal vein occlusion can be further divided into non-ischemic and ischemic types. Branch retinal vein occlusion can be further divided into major branch retinal vein occlusion and macular branch retinal vein occlusion based on the location of the occlusion. Retinal vein occlusion is a major cause of vision loss. Of the two main types of retinal vein occlusion, branch retinal vein occlusion, is 4- to 6-times more prevalent than central retinal vein occlusion. A common risk factor for retinal vein occlusion is advancing age, and additional risk factors include systemic conditions such as hypertension, arteriosclerosis, diabetes mellitus, hyperlipidemia, vascular cerebral stroke, blood hyperviscosity and thrombophilia. Ophthalmic risk factors for retinal vein occlusion are ocular hypertension and glaucoma, higher ocular perfusion pressure and changes in the retinal arteries.

Fundus changes in branch retinal vein occlusion.

To investigate systematically the retinal changes in branch retinal vein occlusion (BRVO) and their natural history. The study comprised 214 consecutive patients with BRVO (144 major BRVO and 72 macular BRVO eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Initially, retinal hemorrhages were moderate to severe in the perifovea and macula in at least 65% in major and 52% in macular BRVO; at the fovea, it was 51% in major and 36% in macular BRVO. Initially, macular edema was more marked in major BRVO than in macular BRVO (P = 0.007). Major BRVO had a significantly higher rate of development of serous macular detachment (P = 0.002), epiretinal membrane (P = 0.008), serous retinal detachment (P = 0.002), perivenous sheathing (P < 0.0001), optic disk pallor (P < 0.0001), and lipid deposit (P < 0.0001) compared with macular BRVO. Retinal and disk neovascularization was seen only in major BRVO. The time to resolution of BRVO was significantly longer for major BRVO compared with macular BRVO (P = 0.0002). Major and macular BRVOs are two distinct clinical entities. Initial and final fundus findings in the two types differ markedly.

Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema

Purpose: To identify the factors related to repeatability of intravitreal bevacizumab injections in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: The present study included 26 patients with macular edema secondary to BRVO occurring within 1 month of diagnosis. Initial best corrected visual acuity, type of BRVO according to the involved vein branch, distance between fovea and occlusion vein, central macular thickness, type of macular edema, presence of macula hemorrhage, and presence of capillary nonperfusion were evaluated at the time of diagnosis. The patients received an intravitreal bevacizumab injection at the time of diagnosis and reinjections when macular edema and visual acuity were aggravated. According to the factors considered, the reinjection‐free rate which was considered a survival rate was evaluated for 1 year after the first injection. Results: The patients with initial visual acuity lower than log MAR 0.5 showed 52.6% survival rate within 1 year compared with 14.3% of the patients with visual acuity higher than log MAR 0.5 (p < 0.01). The patients with occluded vein closer than a distance of 2.5 disc diameters (DD) from the foveal center had a 57.1% survival rate and the patients with occluded vein farther than a distance of 2.5 DD from the foveal center had a 25.0% survival rate (p = 0.04). Macular BRVO and major BRVO patients had 64.3% and 16.7% survival rates, respectively (p = 0.01). Conclusions: The patients with BRVO may have less chance of repetitive intravitreal bevacizumab injections due to macular edema when initial visual acuity is lower than log MAR 0.5, occluded vein is closer than 2.5 DD from the foveal center, and macular branch is involved at the initial diagnosis. These factors can be utilized to predict the prognosis of BRVO patients and the probability of repetitive intravitreal bevacizumab injections. J Korean Ophthalmol Soc 2015;56(10):1580-1585

Ocular vascular occlusive disorders: natural history of visual outcome.

Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO - much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen within 7 days of onset, central VF defect improved in 47% and peripheral VF in 52%, and in transient BRAO central and peripheral VFs were normal at follow-up. My studies showed that AION, CRVO, BRVO, CRAO and BRAO, each consist of multiple distinct clinical sub-categories with different visual outcome. Contrary to the prevalent impression, these studies on the natural history of visual outcome have shown that there is a statistically significant spontaneous visual improvement in each category. The factors which influence the visual outcome in various ocular vascular occlusive disorders are discussed.

Branch Retinal Vein Occlusion

Understanding the natural history of visual outcome in branch retinal vein occlusion (BRVO) is fundamental to its management. To investigate the natural history of visual outcome in major and macular BRVO. Observational cohort study at a university-based referral practice from 1973 until 1999. The study comprised 216 consecutive eyes with BRVO (144 eyes with major and 72 eyes with macular BRVO) seen within 3 months of onset. At first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation. Ophthalmic evaluation at initial and follow-up visits included recording best-corrected visual acuity (VA) using the Snellen VA chart and visual fields with a Goldmann perimeter. Best-corrected VA and visual field outcome on follow-up. The median time to macular edema resolution was 21 months in those with major BRVO and 18 months in those with macular BRVO. Overall, for eyes with initial VA of 20/60 or better, VA improved or remained stable in 75% (95% CI, 63%-86%) for major BRVO and 86% (95% CI, 73%-95%) for macular BRVO. In those with initial VA of 20/70 or worse, VA improved in 69% (95% CI, 56%-80%) for major BRVO and in 53% (95% CI, 27%-79%) for macular BRVO, with median final VA of 20/60 for both BRVO types. Major and macular BRVOs are 2 distinct clinical entities, and initial visual status and final visual outcome in the 2 types are quite different. Overall, on resolution of macular edema, our study suggests that in both major and macular BRVO, VA and visual fields improved to a variable degree in the majority of eyes without any treatment.

Inflammatory Factors in Major and Macular Branch Retinal Vein Occlusion

Concentrations of inflammatory factors were measured in 40 patients with macular edema due to major branch retinal vein occlusion (BRVO) or macular BRVO who were treated by pars plana vitrectomy. Vitreous fluid levels of vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor (PEDF) were determined. Visual acuity and central macular thickness were significantly improved at 6 months in both groups. Vitreous fluid levels of VEGF and sICAM-1 were higher in the major BRVO group than the macular BRVO group, while the PEDF level was lower in the major group than the macular group. The mean visual acuity and central macular thickness at 6 months were not significantly different between the macular and major groups. In conclusion, patients with major BRVO had higher vitreous levels of inflammatory factors and lower vitreous levels of anti-inflammatory PEDF. Accordingly, regulating inflammatory factors might be more important in major BRVO than macular BRVO.

VITREOUS INFLAMMATORY FACTORS AND SEROUS MACULAR DETACHMENT IN BRANCH RETINAL VEIN OCCLUSION

To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Intravitreal Bevacizumab and Cytokine Levels in Major and Macular Branch Retinal Vein Occlusion

Purpose: My aim was to evaluate the effect of intravitreal bevacizumab and to determine the concentrations of inflammatory cytokines in patients with macular edema due to branch retinal vein occlusion (BRVO), according to the site of the occlusion. Methods: In a prospective interventional case series, 46 eyes of patients with macular edema due to major (n = 30) or macular BRVO (n = 16) were included. The patients were treated primarily with intravitreal bevacizumab (1.25 mg/0.05 ml) and completed 12 months of follow-up. Reinjections were performed if optical coherence tomography showed persistent or recurrent macular edema. Aqueous humor samples were collected at the time of initial intravitreal injection. Multiplex bead assays were used for the measurement of cytokines. Results: The visual acuity and central macular thickness were improved significantly in patients with major and macular BRVO at 12 months. During 12 months, the eyes with major BRVO received a mean of 3.8 intravitreal injections, whereas those with macular BRVO received a mean of 1.9 intravitreal injections (p = 0.009). Significantly increased concentrations of IL-6, IL-8 and MCP-1 were observed in the aqueous humor of BRVO patients compared with control samples. Higher concentrations of IL-6, VEGF, PDGF-AA and MCP-1 were measured in the aqueous humor of patients with major BRVO compared with macular BRVO at baseline (p < 0.05). Conclusion: Intravitreal bevacizumab was similarly effective for improving macular edema in patients with major and macular BRVO. However, macular BRVO required fewer injections and had lower cytokine levels in the aqueous humor than major BRVO.

AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS ARE ASSOCIATED WITH SEROUS MACULAR DETACHMENT SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

The purpose of this study was to determine whether aqueous levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) are associated with developments of serous retinal detachment (SRD) secondary to branch retinal vein occlusion. We recruited 102 patients with branch retinal vein occlusion and 10 controls. We divided patients into two groups according to optical coherence tomography images of the macula. Forty-six of 102 patients showed SRD defined as being subretinal fluid accumulation with low reflectivity, and the remaining 56 patients presented only cystoid macular edema (CME) defined as being hyporeflective intraretinal cavities. We measured the extent of vascular leakage (disk areas) by digital fluorescein angiography and evaluated the retinal ischemia defined as capillary nonperfusion. Aqueous concentrations of VEGF and pigment epithelium-derived factor were measured by enzyme-linked immunosorbent assay and compared between the two groups. The incidence of major branch retinal vein occlusion was higher in the SRD group (38 of 46, 83%) than in the CME group (32 of 56, 66%, P = 0.01). The incidences of ischemic vein occlusion and macular ischemia was similar between the SRD group (18 of 46 and 20 of 46) and the CME group (20 of 56 and 24 of 56), whereas vascular leakage areas were larger in the SRD group than in the CME group (P = 0.02). Aqueous VEGF levels were higher in the SRD group than in the CME group (P < 0.001), whereas aqueous pigment epithelium-derived factor levels were similar. Vascular endothelial growth factor levels were positively correlated with pigment epithelium-derived factor levels (P < 0.001). Our results indicate that excessive increase in vascular permeability because of VEGF upregulation may contribute to the development of SRD secondary to branch retinal vein occlusion.