Quantitative Reduction in Central Foveal Thickness After First Anti-VEGF Injection as a Predictor of Final Outcome in BRVO Patients

Treatment strategy for BVO-ME based on long-term outcomes correlating retinal structure by OCT image and visual acuity

BACKGROUND

Intravitreal anti-vascular endothelial growth factor (VEGF) is a mainstream treatment for reducing ME secondary to BRVO (BVO-ME). Regrettably, most reports of intravitreal anti-VEGF for BVO-ME have disclosed only short-term outcomes. Here, we characterized long-term indicators for the visual prognosis of patients with BVO-ME, including the correlation between retinal structure by OCT and visual acuity.

METHODS

Patients with BVO-ME were retrospectively recruited based on clinical records in Kansai Medical University Hospital from June 2012 to March 2022. This study enrolled patients with vision loss who received intravitreal injection of anti-VEGF for BVO-ME. Inclusion criteria were that patients received intravitreal injection of anti-VEGF as their first treatment and were followed for at least 36 months. Exclusion criteria were those patients with ocular disease other than BRVO or who had been previously treated for BVO-ME. Patients were divided into two groups according to BCVA at the final visit: Group A (≥ 0.7) and Group B (< 0.7).

RESULTS

Forty-seven eyes from 45 patients were assessed. The mean follow-up period from initial to final visit was 64.38 ± 15.07 (range, 38-100) months. BCVA in Group A (n = 32) was significantly greater than in Group B (n = 15) at all timepoints. The ratio that the number of eyes which the EZ band and the foveal bulge were intact in Group A was higher than in Group B (p = 0.0004 and p = 0.0002, respectively). The ratio that the number of eyes which recurrence SRD was observed by the final visit in Group A was lower than in Group B (p = 0.0485).

CONCLUSIONS

The integrity of the EZ band and an intact foveal bulge were significant predictors for visual acuity. In contrast, recurrent SRD led to poor visual acuity in the long term, even if BCVA was good in the short term.

Association of Retinal Inner Layer Disorganization With Ultra-Widefield Fluorescein Angiographic Features and Visual Acuity in Branch Retinal Vein Occlusion

BACKGROUND AND OBJECTIVE

To assess the impact of the disorganization of retinal inner layers (DRIL) on visual acuity (VA) and its correlation with ischemic index (IsI) on ultra-widefield fluorescein angiography (UWFFA) in eyes with acute, treatment-naïve branch retinal vein occlusion (BRVO).

PATIENTS AND METHODS

Retrospective, longitudinal study of BRVO eyes with 1 year of follow-up or more. Area of intraretinal cysts, DRIL length, extent of disruption of external limiting membrane (ELM), and ellipsoid zone (EZ) were graded on the central 1,000 μm of foveal optical coherence tomography (OCT) scan. Baseline IsI was calculated on UWFFA.

RESULTS

Thirty eyes of 30 patients with a mean follow-up of 25.4 months ± 11.0 months were evaluated. At baseline, 50% had DRIL (mean 443.1 μm ± 460.4 μm). DRIL length at baseline was predictive of worse VA at 12 months (P = .029), and DRIL length at 12 months was predictive of worse final VA(P = .011). In multivariate analyses, DRIL length was associated with final VA (P = .008) after controlling for other OCT parameters. There was no association between baseline IsI on UWFFA and DRIL.

CONCLUSIONS

DRIL served as an independent OCT biomarker predictive of worse VA during a period of 2 years in acute, treatment-naïve BRVO. Development of DRIL was influenced by presence of CME, intraretinal cyst area, and extent of ELM and EZ disruption, but not by severity of baseline IsI. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:354-364.].