Abstract
Purpose: :
Purpose of the study was to evaluate the effect of intravitreal Bevacizumab (IVB) in patients affected by retinal vein occlusion with macular edema and the need for additional photocoagulation laser therapy (PLT) in case of ischemic damage.
Methods: :
Patients presenting with retinal vein occlusion that had fluorescein angiography (FA) at presentation and at 12-30 months follow-up visits were included in the study. CRVO had IVB at presentation and BRVO at 3 months and were included in case of persistent macular edema. PLT was withheld during the initial 12 months follow-up. Evolution of morphological and functional parameters was analyzed and the need for additional PLT for significant ischemic involvement and/or retinal neovessels was evaluated.
Results: :
36 patients having enough data were included in the study. 8 had CRVO and 28 BRVO. At last follow-up the mean number of injections received by the patients was 7.84± 3.1. Mean best corrected visual acuity (BCVA) was 0.24±0.21 at presentation, 0.73±0.33 at 12 months, 0.79±0.27 at 24 months and 0.86±0.22 at 30 months. Mean macular OCT thickness was 743.2±273.2µm at presentation, 396.4±152.9µm at 12 months, 340.5± 137.2µm at 24 months and 283.6±68.1µm at 30 months. Initial mean microperimetry values (dB) were 216 ± 89.4 and improved to 291.14±106.5 at 12 and to 326.4± 99.3 at 18 months. Visual field (VF) average mean defect values (MD) were 8.3±4.5 at presentation and decreased to 7.2± 3.6 at one month, to 7.5±5.2 at 6 months, to 5.5±4 at 12 months and to 4.5±3.7 at 18 months. The number of patients needing additional PLT because of significant ischemic involvement was 11/36 (30.5%?) including 5/8 CRVO (62,5%).
Conclusions: :
Anti-VEGF therapy has improved the visual prognosis of BRVO/CRVO compared with historical data. Moreover VF data, especially microperimetry, show good evolution because PLT is no more performed as a primary treatment. However, close follow-up is needed in order to perform PLT secondarily, when necessary, to avoid complications due to retinal ischemia.
Keywords: retina • vascular occlusion/vascular occlusive disease • vascular endothelial growth factor