Abstract
Purpose
To compare visual and anatomical recovery of immediate versus deferred intravitreal Bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion (BRVO).
Methods
In a pilot study, 40 treatment naïve patients of branch retinal vein occlusion with macular oedema and vision 6/12 or less presenting within one month of onset were randomised into 2 groups (20 each) to receive either immediate intravitreal Bevacizumab or deferred (after 3 months of observation). Outcome in terms of visual recovery and decrease in central macular thickness on the Optical Coherence Tomography (OCT) from pre-treatment level was analysed at 6 and 12 months from starting of treatment and compared between the two groups.
Results
The mean visual gain in the two groups early and delayed intervention was 0.38 log MARs and 0.15 log MAR units, respectively, and the superior vision gain in the early intervention group was statistically significant (p < 0.001). The difference in visual improvement between the two groups persisted till 1 year of follow-up. The early intervention group required fewer injections (2.6 ± 71 vs. 3.5 ± 0.51), and rescue laser treatment (15 vs. 25%) as compared to deferred group. Both groups showed significant decrease in central macular thickness (328 and 289 µ, respectively) from baseline thickness, but the difference between the two groups was not statistically significant (p = 0.45).
Conclusions
Both early as well as deferred injection of Bevacizumab in macular oedema due to BRVO resulted in reduction of macular oedema and visual gain but immediate injection were associated with significantly greater visual gain with lesser number of injections fewer rescue laser treatment.
Similar content being viewed by others
References
Rogers S, McIntosh RL, Cheung N, Lim L, Wang JJ, Mitchell P, Kowalski JW, Nguyen H, Wong TY (2010) International Eye Disease Consortium. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology 117(2):313–319
Rogers SL, McIntosh RL, Lim L, Mitchell P, Cheung N, Kowalski JW, Nguyen HP, Wang JJ, Wong TY (2010) Natural history of branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 117(6):1094–1101
Laouri M, Chen E, Looman M, Gallagher M (2011) The burden of disease of retinal vein occlusion: review of the literature. Eye 25(8):981–988
Jaulim A, Ahmed B, Khanam T, Chatziralli IP (2013) Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature. Retina 33(5):901–910
Branch Vein Occlusion Study Group (1984) Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol 98(3):271–282
Glanville J, Patterson J, McCool R, Ferreira A, Gairy K, Pearce I (2014) Efficacy and safety of widely used treatments for macular oedema secondary to retinal vein occlusion: a systematic review. BMC Ophthalmol 14(1):1
Pielen A, Feltgen N, Isserstedt C, Callizo J, Junker B, Schmucker C (2013) Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review. PLoS ONE 8(10):e78538
Pichi F, Specchia C, Vitale L, Lembo A, Morara M, Veronese C, Ciardella AP, Nucci P (2014) Combination therapy with dexamethasone intravitreal implant and macular grid laser in patients with branch retinal vein occlusion. Am J Ophthalmol 157(3):607–615.e1
Mitry D, Bunce C, Charteris D (2013) Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion. Cochrane Database Syst Rev 1:CD009510. doi:10.1002/14651858.CD009510.pub2
Brown DM, Campochiaro PA, Bhisitkul RB, Ho AC, Gray S, Saroj N, Adamis AP, Rubio RG, Murahashi WY (2011) Sustained benefits from Ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology 118(8):1594–1602
SCORE Study Research Group (2009) A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study report 6. Arch Ophthalmol 127(9):1115
Ho M, Liu DT, Lam DS, Jonas JB (2016) Retinal vein occlusions, from basics to the latest treatment. Retina 36(3):432–448
Leitritz MA, Gelisken F, Ziemssen F, Szurman P, Bartz-Schmidt KU, Jaissle GB (2013) Grid laser photocoagulation for macular oedema due to branch retinal vein occlusion in the age of bevacizumab? Results of a prospective study with crossover design. Br J Ophthalmol 97(2):215–219
Wang MD, Jeng-Miller KW, Feng HL, Prenner JL, Fine HF, Shah SP (2015) Retina specialists treating cystoid macular oedema secondary to retinal vein occlusion recommend different treatments for patients than they would choose for themselves. Br J Ophthalmol Dec 30:bjophthalmol-2015
Jun Lee S, Jun Koh H (2009) Enlargement of the foveal avascular zone in diabetic retinopathy after adjunctive intravitreal bevacizumab (avastin) with pars plana vitrectomy. J Ocul Pharmacol Ther 25(2):173–174
Jeon S, Lee WK (2012) Aggravated capillary non-perfusion after intravitreal bevacizumab for macular edema secondary to systemic lupus erythematosus and anti-phospholipid syndrome. Lupus 21(3):335–337
Setta M, Ozaki S, Tabuchi A (2016) Long-term outcomes in eyes receiving of Bevacizumab early in the course of branch retinal vein occlusion. Nippon Ganka Gakkai Zasshi 120(5):396
Ho AC (2010) Subgroup analyses of month 12 visual acuity outcomes in the BRAVO study. In: Retina Society Annual Meeting 2010 Sep 23
Jaissle GB, Szurman P, Feltgen N, Spitzer B, Pielen A, Rehak M, Spital G, Heimann H, Meyer CH (2011) Retinal vein occlusion study group. Predictive factors for functional improvement after intravitreal bevacizumab therapy for macular edema due to branch retinal vein occlusion. Graef’s Arch Clin Exp Ophthalmol 249(2):183–192
Ach T, Hoeh AE, Schaal KB, Scheuerle AF, Dithmar S (2010) Predictive factors for changes in macular edema in intravitreal bevacizumab therapy of retinal vein occlusion. Graefe’s Arch Clin Exp Ophthalmol 248(2):155–159
Kim YG, Kim ES, Kim MS, Yu SY, Kwak HW (2009) Early and late intravitreal bevacizumab injection in macular edema due to branch retinal vein occlusion. J Korean Ophthalmol Soc 50(10):1527–1530
Rehak M, Spies E, Scholz M, Wiedemann P (2013) Intravitreal treatment of patients with branch retinal vein occlusion depending on the duration of macular edema. Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 110(10):966–974
Funding
This study did not receive any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
M. A. Khan, Varakutti Mallika and Dattakiran Joshi declares that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethical committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Dr. M. A. Khan and Dr. Varakutti Mallika were formerly at Ophthalmology, Command Hospital Air Force Bangalore, India.
Rights and permissions
About this article
Cite this article
Khan, M.A., Mallika, V. & Joshi, D. Comparison of immediate versus deferred intravitreal Bevacizumab in macular oedema due to branch retinal vein occlusion: a pilot study. Int Ophthalmol 38, 943–949 (2018). https://doi.org/10.1007/s10792-017-0538-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-017-0538-y