Early Intravitreal Bevacizumab for Non-Ischaemic Branch Retinal Vein Occlusion

Abstract

Purpose: To evaluate the effect of early intravitreal bevacizumab application in patients with macular oedema due to non-ischaemic branch retinal vein occlusion (BRVO). Procedures: The study included 21 patients (21 eyes) with macular oedema due to non-ischaemic BRVO. Inclusion criteria were significant macular oedema as measured by optical coherence tomography, loss of visual acuity and leakage in fluorescence angiography. All patients received 3 intravitreal injections of 1.5 mg bevacizumab. The mean follow-up was 6.2 ± 1.2 months (mean ± standard deviation). The mean duration of the BRVO prior to treatment was 9.2 ± 5.4 days. Results: The visual acuity improved significantly from baseline 0.81 ± 0.53 logMAR to 0.54 ± 0.47 logMAR (p < 0.001) at 1 month, 0.55 ± 0.46 (p = 0.001) at 3 months and to 0.55 ± 0.49 (p = 0.002) at 6 months after the first injection. The mean central retinal thickness decreased significantly (p < 0.001) from 492 ± 113 μm at baseline to 294 ± 117 μm at 1 month after the first injection to 325 ± 127 μm at 3 months (p < 0.001) and to 316 ± 117 μm at 6 months (p < 0.001) after the first injection. The increase in visual acuity correlated significantly (p < 0.01) with the decrease in macular thickness. Conclusions: Early intravitreal injection of bevacizumab may decrease macular oedema and improve visual acuity in eyes with non-ischaemic BRVO.

Comparison of Bevacizumab and Triamcinolone for Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion in a Pair-Matched Analysis

“…The patient (case 1) (table 2) with the strongest gain of lines at 8 weeks and the final visit was treated swiftly after the onset of BRVO. This observation is supported by other authors and may be explained by the limited tissue damage and a high intravitreal VEGF-A level shortly after the manifestation of BRVO [25]. Other case-related prognostic factors for a visual increase in these eyes seem to be thrombus localization and macular perfusion status in bevacizumab-treated patients.…”

Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion

“…It has been shown that VEGF is a key factor for macular edema in retinal vein occlusion [20,21], Therefore, inhibition of VEGF should theoretically offer a therapeutic benefit for BRVO. This effect has been shown with anti-VEGF drugs such as bevacizumab [8][9][10][11][12][22][23][24], ranibizumab [25,26], and pegaptanib [27] in terms of both VA improvement and CMT reduction. However, there are some concerns about their safety and their adverse effect on macular perfusion.…”

“…Early intervention (less than 12 weeks) before establishing the irreversible macular changes was mandatory for this trial. This has been advocated by some other authors [24,50]. In a multicenter, randomized clinical trial of 411 participants with macular edema secondary to BRVO (the SCORE study), the efficacy of 1 and 4 mg IVT was compared with macular photocoagulation (MPC) as the standard of care [19].…”

Intravitreal bevacizumab vs. sham treatment in acute branch retinal vein occlusion with macular edema: results at 3 months (Report 1)

“…Some believe that treatment should be initiated as soon as possible [5,6] because in the acute stage of BRVO, VEGF production levels are highest and deferring treatment at this stage may result in irreversible damage to photoreceptors and macular microstructures [24,31].…”