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Bevacizumab improves VA, anatomic factors in eyes with cystoid macular edema secondary to RVO
Ophthalmol. 2009;116(12):2415-2421.
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Eyes that underwent anti-VEGF therapy for cystoid macular edema secondary to retinal vein occlusion had significantly improved visual acuity and retinal anatomy at 6 months to 1 year, a study showed.
"Although best corrected visual acuity testing is an established modality, it only represents foveal function," the study authors wrote. "Evaluation of the topographic sensitivity of the entire central retinal field is much more informative."
The prospective, uncontrolled study included 29 eyes of 28 patients with a mean age of 66 years.
Investigators used conventional optical coherence tomography and spectral domain OCT to measure central retinal thickness, central subfield thickness, mean retinal thickness and retinal volume. Microperimetry and ETDRS charts were used to assess central retinal function and BCVA.
Patients received three consecutive 1.25-mg intravitreal injections of Avastin (bevacizumab, Genentech) at 4-week intervals. Re-treatment was indicated for persistent edema larger than 250 µm or for five-letter vision loss.
Study data showed that mean area of absolute scotoma diminished from 21.4% of the tested central visual field to 6.4% at 6 months of treatment. Mean central retinal thickness decreased from 562 µm at baseline to 384 µm at 6 months and 315 µm at 12 months. Mean central subfield thickness diminished from 516 µm at baseline to 385 µm at 6 months and 353 µm at 12 months.
Mean BCVA improved from 51 letters (20/100) at baseline to 65 letters (20/50) at 6 months and 66 letters at 12 months. The improvement from baseline to 12 months was statistically significant (P < .001).
Visual acuity showed a significant association with mean retinal sensitivity, scotoma size and number of scotomas (all P < .0001), the authors said.
Dr. Kriechbaum et al’s study correlated structural anatomic data (OCT findings) with functional outcomes (best corrected ETDRS visual acuity and macular microperimetry) in patients with macular edema secondary to retinal vein obstruction (RVO) treated with anti-VEGF (bevacizumab) intravitreal injections over a 1-year period. Twenty-eight patients were enrolled but the breakdown between central retinal vein obstruction and branch retinal vein obstruction was not specified. Overall, the patients gained five letters (one line) of visual acuity. A correlation between structure and function was found, suggesting that OCT central retinal thickness may be a useful short-term surrogate for determining overall success of macular edema therapy in RVO. The correlation between the two functional studies, scotoma size and VA, was strong as well, but scotoma size correlated only with central retinal thickness but not mean retinal thickness or retinal volume on OCT. This study reconfirms clinicians’ widespread use of OCT to determine success of macular edema therapy.
– Jay S. Duker, MD
OSN Retina/Vitreous
Board Member