Clinical Implications of Serous Retinal Detachment in Branch Retinal Vein Occlusion and Response After Primary Intravitreal Bevacizumab Injection

Comparison of the Effect of Intravitreal Conbercept and Ranibizumab on Aqueous Humor Cytokines in Central Retinal Vein Occlusion-Related Macular Edema

Purpose: To analyze changes in the levels of angiogenic and inflammatory cytokines following the administration of intravitreal conbercept (IVC) or intravitreal ranibizumab (IVR) in patients with macular edema (ME) due to central retinal vein occlusion (CRVO). Methods: This retrospective study was conducted between June 2015 and January 2016 in The First Hospital of China Medical University. We administered 3 consecutive monthly doses of IVC (23 eyes) or IVR (19 eyes) in 42 eyes with CRVO-ME. At each injection, we collected aqueous humor samples and used multiplex bead assays to measure 7 angiogenic and inflammatory cytokines [vascular endothelial growth factor (VEGF), placental growth factor (PlGF), platelet-derived growth factor (PDGF)-AA, monocyte chemoattractant protein (MCP)-1, and interleukins (ILs)-6, 8, and 12]. Results: Visual acuity and ME improved significantly in both groups during the treatment period. Compared with the baseline, all the cytokine concentrations in the aqueous humor samples decreased significantly at 1 and 2 months after the initial dose of IVC or IVR. The improvement of visual acuity and ME and the changes of aqueous humor cytokine levels were similar in both groups. Concentrations of VEGF, PlGF, MCP-1, PDGF-AA, IL-6, IL-8, and IL-12 levels did not show significant intergroup differences after 1 month (P = 0.369, 0.312, 0.185, 0.353, 0.135, 0.487, and 0.337, respectively) and 2 months (P = 0.305, 0.376, 0.230, 0.519, 0.114, 0.960, and 0.830, respectively) of follow-up. Conclusion: IVC and IVR induced comparable improvements in clinical parameters, along with equivalent reductions in the concentrations of angiogenic and inflammatory cytokines in the aqueous humor.

Choroidal thickening in retinal vein occlusion patients with serous retinal detachment

PURPOSE

To evaluate choroid thickness and macular retinal metrics in treatment naïve retinal vein occlusion (RVO) patients with serous retinal detachment (SRD) before and after intravitreal anti-vascular endothelial cell growth factor (VEGF) injection and to elucidate the possible role of choroid in the development of SRD and the potential role of SRD as a prognostic parameter.

METHODS

This is a retrospective study involving 85 RVO patients, 41 central retinal vein occlusion (CRVO), and 44 branch retinal vein occlusion (BRVO), with macular edema: 21 central retinal vein occlusion and 22 branch retinal vein occlusion with SRD and the rest without SRD. Patients were evaluated with ophthalmic examinations and swept-source optical coherence tomography (SS-OCT) both before and 4-6 weeks after intravitreal anti-VEGF treatment. Choroid thickness and retinal metrics were measured and compared between SRD and non-SRD groups within each RVO subtype.

RESULTS

In both CRVO and BRVO patients, the mean central subfield foveal thickness (CSFT) and central subfoveal choroid thickness (CSCT) of the SRD groups were thicker than those in the non-SRD groups (p < 0.05) at onset. After one anti-VEGF injection, CSFT and FNRT decreased in all groups (p < 0.05). The CSCTs were thicker in the SRD groups compared with the non-SRD groups (p < 0.05). The mean changes of CSFT were more remarkable in the SRD groups (p < 0.05).

CONCLUSION

Thicker choroid was a feature of naïve RVO patients with SRD and SRD may be an indicator of better anatomical recovery of retina in RVO patients after a single dose of anti-VEGF treatment.

Comparison of Ranibizumab versus Aflibercept in Treating Macular Edema among Patients with Serous Retinal Detachment Secondary to Branch Retinal Vein Occlusion

Purpose: To compare the effectiveness of ranibizumab and aflibercept in macular edema (ME) with serous retinal detachment (SRD) following branch retinal vein occlusion (BRVO).Methods: Once every month for 3 months, 33 patients were treated with ranibizumab (Group 1), whereas 30 others were treated with aflibercept (Group 2). In 9 months after that, patients were evaluated every 4 weeks and received additional injections if they met prespecified criteria for retreatment. Corrected visual acuity (BCVA), central foveal thickness (CFT), and height of SRD was measured.Results: During the first 3 months, the improvement of CFT, BCVA, and height of SRD were greater in Group 2 than Group 1. Those differences disappeared in the subsequent 9 months, and changes in CFT, BCVA, and height of SRD were similar between groups at all other visits.Conclusion: Aflibercept was more effective than ranibizumab from baseline to Month 3 in ME with SRD following BRVO.

Choroidal Maps in Different Types of Macular Edema in Branch Retinal Vein Occlusion Using Swept-Source Optical Coherence Tomography

PURPOSE

To compare choroidal thickness maps of different types of macular edema secondary to branch retinal vein occlusion (BRVO) using swept-source optical coherence tomography (SS OCT).

DESIGN

Retrospective cross-sectional study.

METHODS

We generated choroidal thickness maps of 55 eyes of 55 patients with BRVO using the macular volumetric raster scan protocol of the SS OCT. The enrolled eyes were classified into 4 types of macular edema according to the captured OCT images: no macular edema (nME, 13 eyes), cystoid macular edema (CME, 15 eyes), serous retinal detachment (SRD, 12 eyes), and mixed type (CME + SRD, 15 eyes). The data from normal fellow eyes served as the control. Statistical analysis was performed to compare choroidal thickness maps according to the type of macular edema.

RESULTS

The mean choroidal thicknesses in the control, nME, CME, SRD, and mixed-type groups were 205.77 ± 41.65 μm, 211.56 ± 46.34 μm, 214.30 ± 49.21 μm, 249.18 ± 43.51 μm, and 248.05 ± 49.51 μm, respectively. No statistical difference in choroidal thickness was observed among the nME, CME, and control groups, while the SRD and mixed groups showed larger choroidal thickness values than the control group (P < .001). No topographic feature in the choroidal thickness was observed to vary according to the location of BRVO.

CONCLUSIONS

The results suggest the choroidal thickness in BRVO varies according to the type of macular edema. Among the macular edema groups, choroidal thickness was significantly increased in eyes with SRD relative to those without SRD, which suggests that increased choroidal thickness may influence the development of SRD in BRVO.

Bevacizumab treatment for acute branch retinal vein occlusion accompanied by subretinal hemorrhage

PURPOSE

The purpose of this study was to compare the efficacy of intravitreal bevacizumab (IVB) in the treatment of acute (<3 months [mo]. duration) macular edema (ME), with or without subretinal hemorrhage (SRH), resulting from branch retinal vein occlusion (BRVO).

MATERIALS AND METHODS

We conducted a retrospective review of 33 consecutive patients (n = 33 eyes) with ME caused by acute BRVO. All patients received an injection of IVB at baseline examination. All patients were followed monthly, with administration of additional IVB injections if there was persistent or recurrent ME. Specific patterns of ME were investigated using spectral-domain optical coherence tomography (SD-OCT).

RESULTS

SD-OCT revealed serous retinal detachments in the fovea of 15 eyes, 10 of which had accompanying foveal SRH. Based on initial detection of foveal SRH, patients were divided into SRH-negative (n = 23 eyes) or SRH-positive (n = 10 eyes) groups. Initial best-corrected visual acuity (BCVA) did not differ between the two groups. In the SRH-negative group, both BCVA and central macular thickness (CMT) improved significantly after IVB injections (mean, 2.3 injections) at the 6-mo. follow-up examination. In the SRH-positive group, there was no significant improvement in BCVA after IVB injections (mean, 2.0 injections), although there was a significant decrease in CMT. The final BCVA of the SRH-positive group was significantly poorer than that of the SRH-negative group (p = 0.001).

CONCLUSION

The presence of foveal SRH may be a negative predictor of IVB treatment outcomes for BRVO patients with ME.