Abstract
Purpose :
To investigate the effect of retinal nonperfusion area (NPA) on 2-year outcomes of anti-VEGF therapy for macular edema (ME) associated with branch retinal vein occlusion (BRVO).
Methods :
Fifty-eight eyes in 58 patients with ME associated with treatment-naïve acute BRVO, were included. All patients received 3 monthly and PRN intravitreal injections of ranibizumab (IVR) and were examined monthly, for 2 years after the initial injection. For evaluation of perfusion status of the entire retina, wide-field fluorescein angiography was performed before and a year after the initial injection. OCT angiography (OCTA) was performed at every visit, to evaluate the macular perfusion status. OCTA also helped classify the relative anatomical vessel position at the affected arteriovenous crossing.
Results :
At baseline, the mean logMAR visual acuity (VA) was 0.28±0.27. The macular NPAs of superficial and deep capillary plexuses (SCP, DCP) were 1.54±0.59mm2 and 1.79±0.69mm2, and total NPA was 14.0±16.8-disc area (DA). Arterial and venous overcrossing were determined in 28 (48.3 %) and 23 (39.7 %) eyes on OCTA. At 1 year, the macular NPA of both the SCP and DCP did not change from baseline; however, the total NPA significantly increased to 33.1±32.9 DA (P<0.001). The total NPA in venous overcrossing (47.2±28.0 DA) was significantly larger than that in arterial overcrossing (16.7±25.6 DA, P=0.001). At 2 years, the logMAR VA was 0.03±0.16, which ameliorated from baseline (P＜0.001). The macular NPAs of both the SCP and DCP did not change from baseline and 1 year. The final logMAR VA correlated with the final macular NPA of the DCP (R=0.364, P=0.019), but not with total NPA significantly at both baseline and 1 year. The number of IVR injections required was 5.4±2.5, which correlated with the final macular NPA of both the SCP and DCP (P=0.018, 0.001), but not with the total NPA at both baseline and 1 year (P=0.018, 0.001). The final VA and number of IVRs were not different at each crossing type. However, 6 eyes (26.1%) with venous overcrossing showed neovascularization elsewhere (NVE), while no eyes with arterial overcrossing showed NVE.
Conclusions :
In IVR treatment for BRVO, the final VA and the number of IVR injections required correlate with final macular NPA, but not with total NPA. The affected crossing type may be associated with the prevalence of neovascular complications.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.