Correlation between initial visit binocular intraocular pressure difference and mean pulse pressure, and the number of ranibizumab administrations in branch retinal vein occlusion

Abstract

Purpose : Intravitreal injection of anti-VEGF drugs is the first choice for macular edema associated with retinal vein occlusion (RVO). Patients often need multiple injections. RVO complicates hypertension and is associated with decreased intraocular pressure (IOP) in RVO onset eyes. We examined factors that are correlated with the number of intravitreal ranibizumab injection (IVR) in patients who received IVR for branch RVO (BRVO), focusing on blood pressure and IOP.

Methods : Sixteen eyes of 16 patients (average age: 71 ± 8.5 years; 6 males, 10 females) with major BRVO who first visited Shinshu University Hospital from January to December 2017 were included. At the initial visit, mean IOP was 12.4 ± 2.2 mmHg on the affected side and 13.3 ± 2.7 mmHg on the unaffected side, which was significantly reduced on the affected side (p < 0.05, paired t-test). The average number of IVR was 3.5 ± 2.2 times per year. One plus pro re nata IVR was performed every month. We investigated the factors that showed a single correlation with the number of IVRs per year. Patients who required IVR in the latter six months were classified as the recurrence group and t-tests were performed on factors that were significant in a multiple regression analysis. In addition, OCT angiography (OCTA) images were analyzed with Angio Tool^®.

Results : A significant positive correlation was found between the annual IVR number with the IOP difference between the affected and non-affected side at the initial visit (R² = 0.3523), the non-affected side IOP at the initial visit (R² = 0.3101), and annual mean pulse pressure (R² = 0.248) (p < 0.05). Multiple regression analysis was carried out with four factors including the mean systolic blood pressure. The intraocular pressure difference at the initial visit (p < 0.01) and annual mean pulse pressure (p < 0.05) were determined as significant predictors. Both were significantly higher in the recurrence group (p < 0.05, unpaired t-test).
In OCTA, the superficial layer and the deep layer in the 3-mm range tended to be positively correlated with the intraocular pressure difference at the initial visit.

Conclusions : Patients with lower IOP in the BRVO eye than in the non-affected eye at initial visit and who had high pulse pressure received more IVR, indicating a need to consider IOP and pulse pressure in RVO treatment.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.