Two-year outcomes of intravitreal bevacizumab therapy for macular oedema secondary to branch retinal vein occlusion

Abstract

AimTo determine the 2-year outcomes of intravitreal bevacizumab (IVB) injections in eyes with macular oedema (ME) following branch retinal vein occlusion (BRVO).MethodsOf 105 consecutive eyes (105 treatment-naïve patients) with ME following BRVO, 89 eyes were followed for 2 years after the first injection. During the 2-year follow-up period, patients were examined at least every 3 months and received an IVB injection (1.25 mg/0.05 mL) if they met prespecified retreatment criteria. Rescue grid laser was permitted based on the findings of the Branch Vein Occlusion Study.ResultsThe baseline logarithm of the minimum angle of resolution visual acuity (VA) was 0.64±0.24 (mean±SD), which significantly (p=0.001) improved 1 month after the first injection to 0.39±0.22. One year after the first injection, VA improved significantly (p=0.001) to 0.33±0.21 and remained 0.34±0.21 until 2 years after the first injection (p=0.001). The changes in foveal thickness were correlated with those of VA during the 2-year follow-up period with a mean of 3.8±1.5 injections (including the first injection).ConclusionsThis relatively large case series study showed favourable 2-year outcomes using bevacizumab to treat ME following BRVO. Bevacizumab provides substantial long-term benefits in the treatment of ME following BRVO.

New Developments in the Classification, Pathogenesis, Risk Factors, Natural History, and Treatment of Branch Retinal Vein Occlusion

“…A recent study showed that after IVB treatment, there is an increase of retinal venous outflow that may possibly influence the resolution of macular edema [100]. Compared with intravitreal triamcinolone acetonide, intravitreal bevacizumab can achieve better long-term VA outcomes with much lower rate of adverse events (e.g., cataract and glaucoma), despite the fact that triamcinolone acetonide may achieve equal visual acuity and morphology improvement for the first few months right after treatment [101, 102]. Also, IVB can result in better outcome in the recurrent CME, while subthreshold grid laser was completely ineffective [103].…”

“…Small studies have demonstrated good clinical outcomes with micropulse laser, for initial visual acuity better or worse than 20/40, although larger studies are necessary [165–168]. However, in specific subsets of patients such as recurrent CME after conventional laser treatment, anti-VEGF treatment is still the preferred treatment rather than SMDLP [102]. …”

Combination therapy of intravitreal bevacizumab with single simultaneous posterior subtenon triamcinolone acetonide for macular edema due to branch retinal vein occlusion

“…In several clinical studies bevacizumab, one of anti-VEGF agent, was reported to significantly reduce ME and improve visual function in BRVO. [10][11][12] However, its half-life in vitreous is as short as 4.32 days and its effective concentration is maintained for 30 days, thus multiple injection is usually required for maintaining its effect. 13 Multiple injections of bevacizumab increase the risk of injection-related complications such as vitreous hemorrhage, retinal detachment, and endophthalmitis, and it can be an economic burden to patients.…”

Review of the latest treatments for retinal vein occlusions: emphasis on pharmacologic therapy

“…Sixty-nine percent of eyes gained 3 lines, whereas only 7% lost 3 lines. Mean foveal thickness improved from 572 to 220 mm, the average number of injections was 3.8 and 8% of eyes required only one injection [87].…”