Abstract

SO.21.08

OCT patterns of macular edema and response to bevacizumab therapy in retinal vein occlusion

Alexandra Hoeh, Mira Ruppenstein, Thomas Ach, Stefan Dithmar
Universitäts-Augenklinik Heidelberg

Objective
To evaluate the influence of morphological patterns of macular edema (ME) due to branch (BRVO) or central retinal vein occlusion (CRVO) on response to treatment with bevacizumab.
Methods
100 patients (55 BRVO, 45 CRVO) were treated with 2.5mg bevacizumab. Reinjections were only performed if ME persisted or recurred. Only patients with sufficient OCT scan quality and a minimum follow-up of 15 weeks (mean follow-up: 59±31weeks) were included in the analysis (34 CRVO, 30 BRVO). OCT morphology at baseline was analysed retrospectively to evaluate its effect on treatment outcome. OCT scans were studied regarding the presence of serous retinal detachment (SRD), intraretinal cystoid spaces and maximum horizontal diameter of the largest delimitable cystoid space.
Results
BRVO patients with a cystoid space >600m (6%) had a significantly worse visual acuity (VA) than patients with smaller or no delimitable cystoid spaces (0.30; 0.52±0.22 logMAR versus 0.55; 0.26±0.18 logMAR; p=0.007). As far as patients could provide details, the duration of retinal vein occlusion was significantly longer in patients with cystoid spaces >600m (p=0.007). In patients with cystoid spaces <600m, there was no correlation between the cystoid space diameter and final VA or duration of BRVO. Final central retinal thickness (CRT) and VA, CRT and patient´s age at last visit did not differ between patient with or without cystoid spaces >600m. 35.3% of BRVO had SRD at baseline. Although thickness of SRD strongly correlated with baseline VA (Pearson´s r=0.72, p=0.009), baseline SRD did not show any effect on final VA or final CRT.
In CRVO patients there was no relation of OCT patterns with treatment response regarding SRD, the presence and diameter of cystoid spaces. In contrast to BRVO, CRVO patients with thinner baseline CRT (<600m) showed a significantly better final VA and final CRT.
Conclusions
In BRVO patients cystoid spaces with a diameter of >600m are associated with a long duration of vein occlusion and a bad functional response to treatment with bevacizumab. In CRVO patients no OCT patterns with effect on treatment outcome could be identified.

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