Macular edema secondary to retinal vein occlusion in a real-life setting: a multicenter, nationwide, 3-year follow-up study

Abstract

Purpose To evaluate the presence of macular edema secondary to retinal vein occlusion (RVO)-both central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-3 years after diagnosis in patients who underwent intravitreal therapy and to identify potential prognostic factors and biomarkers of persistent macular edema. Methods National multicenter, observational, exploratory, retrospective cohort study of 104 consecutive patients with macular edema secondary to RVO diagnosed from January 2014 to December 2015 with minimum 3-year follow-up time. Data analyzed included best-corrected visual acuity (BCVA), clinical and demographic data, and spectral domain optical coherence tomography parameters.Results At final observation, median baseline central retinal thickness significantly improved from baseline 538 to 290 μm (p < 0.001) and complete macular edema resolution was achieved in 51.0% of patients (56.3% and 42.5% in BRVO and CRVO patients, respectively). BCVA also improved (p < 0.01). Logistic regression analysis revealed a relationship between recurrence of macular edema and disorganization of retinal inner layers (DRIL) at baseline (odds ratio = 2.88; p = 0.013). Conclusion Good long-term anatomical and functional outcomes are achieved with intravitreal treatments in RVO patients. Anatomical success and visual gains seen in the first year were maintained throughout the entire follow-up, though DRIL is a major risk factor for recurrence.

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

“…However, increasing evidence suggests an association between superior functional (increased BCVA) and anatomical (reduced CMT) outcomes and beginning steroid treatment earlier [52,61,[63][64][65]. Although steroids are associated with increased IOP and cataract formation [80], this is not an inevitable outcome for all of the patients treated with steroids, as studies reported these side effects in less than half of patients. In addition, side effects could be caused not only by steroids but also by the preservatives used in their preparation [44].…”

“…The authors hypothesized that this may have been because conbercept only inhibits downstream VEGF inflammatory mediators and does not affect the upstream inflammatory mediators of VEGFs, such as PGE1, PGE2, and PGF2a [75]. Costa et al reported that intravitreal anti-VEGF injections are prioritized over other treatment methods, including macular grid photocoagulation [80]. Compared with steroid injections, anti-VEGFs are superior because they have fewer side effects; as with their use in DME, steroids are associated with a higher incidence of increased IOP and cataract formation [80].…”

“…Costa et al reported that intravitreal anti-VEGF injections are prioritized over other treatment methods, including macular grid photocoagulation [80]. Compared with steroid injections, anti-VEGFs are superior because they have fewer side effects; as with their use in DME, steroids are associated with a higher incidence of increased IOP and cataract formation [80]. A systematic review and meta-analysis were performed by Liu and colleagues to evaluate the efficacy of conbercept and ranibizumab with or without LP in patients with ME secondary to RVO [81].…”

Background factors affecting visual acuity at initial visit in eyes with central retinal vein occlusion: multicenter study in Japan

“…However, the visual prognosis of CRVO is still not any better than that for branch retinal vein occlusion (BRVO). [13][14][15] It is known that the baseline best-corrected visual acuity (BCVA) is the strongest predictor for the nal BCVA in eyes with CRVO. [16][17][18][19][20] However, a PubMed search did not extract any study examining the background factors of the patients that were signi cantly associated with poorer BCVAs at the initial visit to the hospital.…”

Background Factors Affecting Visual Acuity at Initial Visit in Eyes with Central Retinal Vein Occlusion: Multicenter Study in Japan

“…At present, several different types of treatments have been used for eyes with a CRVO, including laser photocoagulation [ 8 ], intravitreal injection of corticosteroids including triamcinolone acetonide [ 9 ], intravitreal implantation of dexamethasone [ 10 ], and intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents [ 11 , 12 ]. However, the visual prognosis of CRVO is still not good [ 13 , 14 , 15 ].…”