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David Ellenberg, Phillip H. Scharper; The Effects Of The Initial Intravitreal Bevacizumab Injection On Snellen Visual Acuity, OCT Parameters And Compliance In Resident Clinic Patients With Cystoid Macular Edema Secondary To A Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2012;53(14):926.
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© ARVO (1962-2015); The Authors (2016-present)
To identify the effect of the initial intravitreal bevacizumab injection in resident retina clinic patients with cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO), and how this initial response to treatment as measured by Snellen visual acuity (VA) and optical coherence tomography (OCT) parameters influenced patient compliance.
A retrospective study of 15 eyes in 15 consecutive patients was performed. All patients had a diagnosis of CRVO based on clinical evaluation and fluorescein angiogram (FA), and CME identified on OCT. All patients were treated initially with one injection of intravitreal bevacizumab (1.25 mcg/0.05 cc). Outcome measures were Snellen visual acuity (logMAR), central subfield thickness (CST) and cube average thickness (CAT). Prior to and after the intravitreal bevacizumab treatment, a discussion was held with the patient to review both the VA and OCT results.
At presentation, the mean VA was 20/80 (logMAR 0.6), the mean CST was 532μm, and the mean CAT was 331μm. At the first follow up visit (range 6 to 46 days; mean 11.7 days), the mean VA was 20/70 (logMAR 0.55), the mean CST was 311μm, and the mean CAT was 291μm. Six out of 15 patients (40%) had improvement of VA (mean 0.14 logMAR), 7 out of 15 patients (47%) had no change in VA, and 2 out of 15 patients (13%) had a slight decrease in VA. Eleven out of 15 patients (73%) had improvement of CST (mean 310μm) and 11 out of 13 patients (85%) had improvement of CAT (mean 48.5μm). In total, 13 of the 15 patients (87%) showed at least some improvement of CME on OCT after just one injection of intravitreal bevacizumab. Four out of the 15 patients (27%) had an initial VA of 20/200 or worse. Of these patients 1 of 4 (25%) had improved VA but all 4 patients (100%) had improvement of CST (mean 440μm). Fifteen out of 15 patients (100%) still present for regular follow up and treatment, with the mean follow up time of 14.75 months.
A single intravitreal bevacizumab injection in patients with CME secondary to CRVO has a considerable effect on OCT but a more modest effect on visual acuity. Patients with an initial VA of better than 20/200 (logMAR 1.00) experienced the greatest improvement in VA, while those with worse VA (≤20/200) had the most improvement in the OCT parameters. The results suggest that patients were positively influenced by both the improvement in VA and in the OCT parameters even in cases where the two were mutually exclusive. Reviewing the OCT results with patients may be a valuable tool in improving compliance, particularly in cases when patients do not experience an improvement in VA.
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