Abstract
Purpose :
Patients with macular edema following branch retinal vein occlusion (BRVO) generally exhibit large improvement in visual acuity (VA) under treatment with anti-vascular endothelial growth factor (VEGF). However, some visual gains were lost during the follow-up. Although this is known as “loss of peak (LoP)” (Iftikhar et al. AJO 2019), the cause of LoP was not clearly elucidated. The purpose of this study is to evaluate long-term visual outcomes and find factors related to LoP.
Methods :
This retrospective, longitudinal observational study reviewed patients diagnosed with BRVO at a tertiary eye center, enrolling those with at least two years of follow-up. Treatment included anti-VEGF with a pro re nata regimen, steroids, and photocoagulation. LoP in VA was defined as the change from peak VA to the most recent follow-up visit. Macular perfusion was assessed using spectral domain OCT angiography (XRAvanti, Optovue) at the peak VA visit and the final visit. Patients with macular edema within six months of the last visit were considered to have persistent macular edema. Regression analysis identified factors associated with LoP in VA.
Results :
From an initial 187 eyes identified through chart review, 82 eyes from 82 subjects (mean age: 68 ± 10 years; 39 females) met the study criteria. The mean follow-up was 47 ± 14 months, averaging 8.0 ± 2.5 visits per year. The average number of anti-VEGF injections was 7.4 ± 5.6. Twenty-four eyes received sub-Tenon steroid injections, and 43 underwent photocoagulation. The initial Best-Corrected Visual Acuity (BCVA) was 0.52 ± 0.38 LogMAR, improving to a final VA of 0.18 ± 0.25 LogMAR. Peak VA (0.040 ± 0.014 LogMAR) was achieved on average within 16 months. During follow-up, 34 (41%) eyes lost over 0.10 LogMAR (one line) from peak VA, and 14 (17%) lost over 0.30 LogMAR (three lines). Multivariable logistic regression models revealed that ellipsoid zone (EZ) disruption (P = 0.0096) and vascular density changes from peak to final visit (P = 0.017) were associated with a LoP of 15 or more letters. Persistent macular edema was also associated with VA loss of 15 or more letters, though not reaching statistical significance (P = 0.056).
Conclusions :
In the short term, eyes with BRVO showed good visual outcomes. However, maintaining peak VA was challenging. Photoreceptor damage, ischemia progression, and persistent macular edema are potential causes of LoP.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.