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Macular edema due to BRVO treated with ranibizumab: long-term results and predictive factors for functional improvement

Session Details

Session Title: Quick Fire Free Paper Session 04

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 12:40

Venue: Hall C (Level 1)

First Author: J.Marques PORTUGAL

Co Author(s):    C. Farinha   E. Almeida   P. Melo   M. Costa     

Abstract Details

"Purpose:

To assess long term results of intravitreal ranibizumab (IVR) in the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) and to identify predictive factors for functional improvement using multimodal retinal imaging.

Setting:

Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal. Associação para a Investigação Biomédica e Inovação em Luz e Imagem (AIBILI), Coimbra, Portugal.

Methods:

Clinical records of BRVO patients treated with IVR for macular edema and a minimum follow-up of 3 years were retrospectively analyzed. Sixteen eyes of sixteen consecutive patients meeting the inclusion criteria were included. All patients underwent a complete ophthalmologic examination with best–corrected visual acuity (BCVA), biomicroscopy, tonometry, fundus observation, color fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) for retinal and choroidal imaging. Perifoveal capillary network disruption status was accessed in FA images. Central retinal thickness (CRT) in SD-OCT was determined both manually and using the automated fast macular thickness map. Enhanced depth imaging (EDI) SD-OCT was used to manually calculate choroidal thicknesses (CT) in the fovea and 1 and 3 mm apart in the horizontal and vertical meridians. Statistical correlations (Pearson and Spearman’s rank correlation coefficients) were conducted to evaluate the relative contribution of baseline best-corrected visual acuity (BCVA) and SD-OCT characteristics such as CRT, CT, external limiting membrane (ELM) status, photoreceptor inner segment/outer segment (IS/OS) integrity and retinal pigment epithelium (RPE) integrity on final visual outcomes.

Results:

Sixteen eyes of 16 patients were included, with a mean age at diagnosis of 67.4±10.9 years. Mean follow-up was 45.3±8.9 months and mean time between diagnosis and first IVR was 6.5±9.2 months (median 2.5 months). Fourteen patients (87.5%) had a major BRVO while two (12.5%) presented with tributary (macular) BRVO. Thirteen eyes (81.3%) had virgin macular edema. The average number of IVR during follow-up was 6.1, with a decreasing need of injections over time: 3.7 during the first year, 1.4 during the second year, 0.6 during the third year and 0.8 during the fourth year (follow-up included 9 patients). Mean BCVA increased from 51.7±26.8 ETDRS letters (L) at baseline to 54.8±25.5 L with a final mean gain of 5.5±19.5 L, although this increase was not statistically significant (p>0.05). Mean automated CRT decreased from 556.6±221.3 μm to 301.3±142.5 μm (p<0.05). Final mean subfoveal and macular CT were 250.2±95 μm and 226.3±76.7 μm, respectively. Final perifoveal capillary network was preserved in 20% of the eyes and disrupted in 80%. Final BCVA correlated with baseline BCVA (p<0.05), final subfoveal CT (p<0.05), final submacular CT (p<0.05), final ELM status (p<0.05) and final IS/OS integrity (p<0.05). No systemic or vision-threatening complications were reported after IVR.

Conclusions:

In our long-term follow-up, IVR injections proved safe and resulted in a significant reduction of ME in BRVO. Baseline BCVA and SD-OCT characteristics such as final subfoveal CT, final submacular CT, final ELM status and final IS/OS integrity were found to correlate with final BCVA, proving to be of prognostic relevance for visual outcome."

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