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Jesse J. Jung, Angela J. Tsuang, David Alevi, Quan V. Hoang, Kenneth J. Wald; Factors Associated with Optical Coherence Tomography Response to Focal Grid Laser Treatment in Branch Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2191.
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Antivasogenic drugs may replace photocoagulation grid laser as the standard of care for macular edema secondary to branch retinal vein occlusion (BRVO). We evaluate demographic and retinal features of a series of laser-treated BRVO-related macular edema eyes to determine if a subset have an augmented response to laser, therefore suggesting a preferred therapeutic strategy.
28 patients with a diagnosis of macular edema secondary to BRVO, who had spectral domain optical coherence tomographs (OCTs) performed at baseline, 6 and 12 month followup visits were reviewed for response to treatment defined as a central foveal thickness measurement (CFT, in µm) < 250 or a 100 decrease from baseline. OCTs were graded based on CFT as Grade 1 (< 250), 2 (250-299), 3 (300-399), 4 (400-499) or 5 (above 500). The associations between response and baseline characteristics were analyzed by logistic regression.
28 eyes were followed (73% female). Mean age was 63.4 +/- 2.1 years (mean +/- standard error mean, range 41-87). Baseline OCT Grade was 2.8 +/- 0.2. Baseline CFT was 440 +/- 23.5 (range 211-785). Mean Snellen visual acuity (VA) was 20/80 (range 20/25 to count fingers).At 6 months, 18 of 28 patients had a response to treatment. Responders had a mean OCT grade of 1.2 +/- 0.1, CFT of 274.3 +/- 10.1 (range 194-357) and a change from baseline of -217.6 +/- 25.2 (range -460 to -17). Those unresponsive to treatment had a mean OCT grade of 1.7 +/- 0.3, CFT of 333.5 +/- 27.8 (range 257-474) and a change from baseline of -21.1 +/- 21.2 (range -90 to +112). There was a significant association between treatment response and both a baseline OCT grade of ≥ 3 (odds ratio 8.17, p = 0.019) and a baseline CFT of ≥ 500 (odds ratio 6.29, p = 0.047) by univariate analysis. There was no significant association between treatment response and age, gender, > 90 day observation prior to laser, prior laser, baseline VA > 20/100, hemorrhagic BRVO, hard exudates, lens status, hypertension, diabetes, coronary artery disease, aspirin use or glaucoma. At 12 months, 14 of 18 patients had a response to treatment. Univariate regression showed no significant effects from any variables, likely due to limited sample size.
Focal grid laser treatment for macular edema in branch retinal vein occlusion results in a good response on OCT imaging as demonstrated in previous reports. Of the factors studied, only baseline OCT characteristics such as higher grade or absolute center foveal thickness are predictors of response to treatment at 6 months.
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