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June-Gone Kim, Byung Gil Moon, JOO YONG LEE, Young Hee Yoon; Baseline and sequential predictors of chronic refractory macular edema secondary to branch retinal vein occlusion after anti-VEGF; a long-term follow-up study. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4171. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Despite the benign nature of branch retinal vein occlusion (BRVO), some patients experience multiple recurrences of macular edema (ME) and require additional treatment. We performed a retrospective clinical study to evaluate the baseline and sequential predictors related to chronic refractory ME despite multiple injections of anti-VEGF in patients with BRVO.
Patients who were received one or more intravitreal anti-VEGF and were followed at least 24 months due to ME secondary to BRVO were divided into two groups; the better response (BME) group in which ME resolved after few injections of anti-VEGF and the chronic refractory ME (RME) group which required more than 10 injections due to multiple recurrences of ME. Baseline characteristics, ophthalmologic examinations and the responsibility for anti-VEGF after 3 months of injection were compared between the two groups. Six months after the initial injection, fluorescein angiographic characteristics were also compared.
With a mean follow-up of 34.4 months, 57 of 108 patients (53%) met criteria of the RME group and other 51 patients (47%) were included in the BME group. The RME group were older (62.3 vs 58.4 years), had longer pretreatment duration of symptoms (9.3 vs 5.9weeks) than the BME group (p=0.036, 0.038). Three months following the initial injection, the RME group had poor best corrected visual acuity (0.32 vs 0.19 logMAR), thicker central retinal thickness (367.6 vs 275.0μm), a larger proportion of external limiting membrane disruption (58% vs 26%) than the BME group (p=0.004, <0.001 and <0.001, respectively). Six months following the initial injection, the proportion of macular ischemia (46% vs 18%) and the area of peripheral nonperfusion (4.1 vs 2.6 disc areas) was higher in the RME group (p<0.002, 0.013).
About 53% of patients experienced chronic refractory ME despite multiple treatment. Long pretreatment duration was related to chronic refractive ME thus early treatment of anti-VEGF obtains better outcomes and lower recurrence rates. They had some differences on the baseline and sequential examinations other than the BME group. Therefore, not only baseline examinations but also sequential examinations performed to evaluate the responsibility for anti-VEGF, are important to predict the occurrence of chronic refractory macular edema due to BRVO.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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