Optical Coherence Tomography Biomarkers Predicting Visual Acuity Change after Intravitreal Bevacizumab Injections for Macular Edema Secondary to Branch Retinal Vein Occlusion

Abstract

<b><i>Purpose:</i></b> This study aimed to identify baseline optical coherence tomography (OCT) factors in branch retinal vein occlusion (BRVO) that predict response to bevacizumab injections. <b><i>Methods:</i></b> It is a retrospective case series of consecutive patients that underwent OCT at diagnosis, and the central macular thickness (CMT), extent of disorganized retinal inner layers, and outer retinal layers including external limiting membrane, ellipsoid zone (EZ), and cone outer segment tips (COST) were measured. Patients received 3 consecutive monthly injections of bevacizumab followed by pro re nata treatment. The main outcome measure was improvement in best-corrected visual acuity (BCVA) after 1 year. Results are expressed as mean ± SD, and <i>p</i> value <0.05 was considered statistically significant. <b><i>Results:</i></b> Overall, 66 eyes of 66 patients, with an average age of 68.5 ± 11.4 years, were included. The mean BCVA improved significantly from 0.68 logMAR at baseline to 0.50 logMAR at 1 year (<i>p</i> < 0.001). Baseline logMAR BCVA (<i>r</i> = 0.41, <i>p</i> < 0.001) and CMT (<i>r</i> = 0.23, <i>p</i> = 0.04) were associated with improvement while EZ (<i>r</i> = −0.24, <i>p</i> = 0.05) and COST (<i>r</i> = −0.32, <i>p</i> = 0.01) disruption with deterioration in BCVA. <b><i>Conclusion:</i></b> In patients with naïve BRVO treated with bevacizumab, BCVA improvement at 1 year can be predicted from baseline BCVA, CMT, extent of COST disruption, and EZ disruption.

Factors influencing ranibizumab efficacy and prognosis of patients with retinal vein occlusion and macular edema based on systemic inflammatory indexes and OCT parameters

“…We believe that this might be attributed to prolonged retinal and ME in eyes with longer disease duration, as prolonged edema can result in irreversible retinal damage [16] and more severe visual impairment, thereby increasing the likelihood of poor visual prognosis post-treatment. Another investigation revealed a correlation between poorer pre-treatment BCVA and worse visual recovery post-treatment [17]. Our results demonstrated that patients' eyes in the poor prognosis group had significantly lower pre-treatment BCVA compared to those in the good prognosis group and was an independent risk factor for BRVO-ME eye prognosis following ranibizumab treatment, indicating the importance of early intervention in BRVO-ME eyes during treatment to enhance BCVA for improved prognosis.…”

Update on Retinal Vein Occlusion

“…In RVO, optical coherence tomography (OCT) has been widely used to assess the presence and the extent of ME, subretinal fluid (SRF), cotton wools, and hard exudates 64,65. Studies have shown that while SRF is common at presentation, baseline SRF is not a predictor of functional or anatomic results long-term 66,67…”

“…64,65 Studies have shown that while SRF is common at presentation, baseline SRF is not a predictor of functional or anatomic results long-term. 66,67 Assessing the amount and duration of ME is important, as a shorter duration has been associated with better outcomes in BRVO. 68 The junction between the inner and the outer segments of the photoreceptors is particularly important as its integrity is fundamental for the visual prognosis.…”