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A. Khemichian, C. C. Patel, J. E. Puklin; Functional versus Anatomical Improvement in Visual Acuity in Patients Treated With Bevacizumab for Macular Edema From Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4721. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate whether eyes with macular edema from retinal vein occlusion (RVO) who respond to intravitreal bevacizumab therapy with improvement in central foveal thickness (CFT) have a corresponding improvement in best corrected visual acuity (BCVA).
Retrospective chart review of consecutive eyes treated with intravitreal bevacizumab for macular edema (ME) due to RVO was performed. Eyes with an improvement in CFT measured by optical coherence tomography (OCT) were included. Eyes with macular ischemia based on fluorescein angiography, or with any other macular pathology that could cause ME or vision loss were excluded. Eyes were defined as having no improvement in their vision if final BCVA was equal to or worse than initial BCVA. BCVA was converted to LogMAR for statistical calculations.
Twenty eyes of 20 patients met inclusion criteria. Mean age was 69.5 years. Each eye was injected an average of 3.7 times (range 1-9). Twelve eyes had CRVO, three had HRVO and five had BRVO. Mean CFT improved from 482um to 307um (p=0.0011) at 1 month and 255um (p<0.0001) at final follow up. Mean BCVA improved from 20/224 to 20/120 (p=0.029) at 1 month and to 20/109 (p=0.018) at final follow up.BCVA improved in 14 of 20 eyes (70%); ten with CRVO, three with BRVO and one with HRVO. BCVA improved form 20/289 to 20/110 (p=0.0058) at 1 month and 20/72 (p=0.0001) at final follow up. Mean CFT improved from 550um to 316um (p=0.0014) at 1 month and 256um (p=0.0001) at final follow up.BCVA did not improve in 6 eyes (30%); four had worsening of BCVA (1 CRVO, 1 HRVO, and 2 BRVO) and in 2 eyes it remained unchanged (2 BRVO). BCVA worsened from 20/126 to 20/142 (p= 0.71) at 1 month and 20/283 (p=0.126) at final follow up. Mean CFT improved from 322um to 283um at 1 month (p=0.20) and 254um (p=0.009) at final follow up.
Visual improvement did not accompany reduction in CFT in a large number of patients (30%). This suggests that restoration of macular anatomy may not always lead to functional improvement in patients treated with intravitreal bevacizumab for macular edema from RVO.
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