Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion

AIM：To investigate the predictive factors for shortterm effects of intravitreal bevacizumab injections on central subfield foveal thickness（CSFT）in patients with macular edema（ME）secondary to central retinal vein occlusion（CRVO）.·METHODS：This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO.Follow-up was three months.The Early Treatment Diabetic Retinopathy Study（ETDRS）score and CSFT measured by spectral-domain optical coherence tomography（SD-OCT）were used to observe the changes in best-corrected visual acuity（BCVA）.Baseline BCVA,CSFT,age,CRVO duration and the presence of cystoid macular edema（CME）or subretinal fluid（SRF）were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections.·R ESULTS：BCVA improved from 0.9 log MAR at baseline to 0.6 log MAR at 3mo,which was associated with a significant reduction in CSFT from 721μm to 392μm 3mo after injection.About 50%of CME cases and more than90%of SRF cases responded to treatment with a complete resolution at 3mo.Age（=0.036）and low baseline CSFT（=0.037）were associated with a good 3-month prognosis.Patients〉60 years old achieved better CME resolution（=0.031）and lower CSFT at 3mo（305μm 474μm,=0.003）.·CONCLUSION：Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo.Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes.The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF.

Foveal thickness reduction after anti-vascular endothelial growth factor treatment in chronic diabetic macular edema

AIM：To report foveal thickness reduction in eyes with resolution of macular edema and recovery of a foveal depression after one-year of anti-vascular endothelial growth factor（anti-VEGF） therapy for center-involving diabetic macular edema（DME）.METHODS：Foveal thickness was assessed with optical coherence tomography to determine the central subfield foveal thickness（CSFT） and macular volume in 42 eyes with DME（CSFT〉275 μm）. Evaluations also included measurement of best-corrected visual acuity（BCVA）, and were performed at baseline, and upon foveal depression recovery achieved after 12 monthly intravitreal injections of either 1.5 mg/0.06 mL bevacizumab（n=21） or 0.5 mg/0.05 mL ranibizumab（n=21）. Data was compared to 42 eyes of normally sighted, non-diabetic, healthy individuals with similar age, gender and race distributions.RESULTS：Mean baseline BCVA was 0.59±0.04 and 0.32± 0.03 log MAR（P〈0.001） after treatment and resolution of DME, with all, but 3 eyes, showing BCVA improvement. Mean CSFT before treatment was 422.0±20.0 μm, and after treatment, decreased to 241.6±4.6 μm（P〈0.001）, which is significantly thinner than CSFT found in control subjects（272.0±3.4 μm; P〈0.001）. Moreover, in 33/42 DM eyes（79%）, CSTF was thinner than the matched control eye. Macular volume showed comparable results, but with lower differences between groups（control：8.5±0.4 mm^3; DME：8.2±1.0 mm^3; P=0.0267）.CONCLUSION：DME eyes show significantly lower foveal thickness than matched controls after DME resolution achieved with one-year anti-VEGF therapy. Further investigation into the reasonsfor this presumable retinal atrophy using fluorescein angiography and functional parameters as well as establishing possible predictors is warranted. This finding should be considered during the treatment of DME.

Superficial foveal avascular zone area changes before and after idiopathic epiretinal membrane surgery

To investigate the foveal morphological changes and foveal avascular zone（FAZ）area before and after epiretinal membrane（ERM）surgery.Twenty-two eyes with treatmentnaive ERM were included in this retrospective study.The central foveal thickness（CFT）and FAZ area were measured via swept-source optical coherence tomography（SS-OCT）and OCT angiography pre-and postoperatively.The unaffected fellow eyes were used as controls.The preoperative superficial FAZ area was significantly smaller in patients（0.08±0.04 mm^2）than in controls（0.33±0.09 mm^2;P〈0.001）.The postoperative superficial FAZ（0.12±0.06 mm^2）area was significantly greater than the preoperative area（P〈0.001）.The preoperative superficial FAZ area was strongly negatively correlated with CFT（P〈0.001,rho=-0.763）.ERM induced significant foveal morphological changes and reduction of the superficial FAZ area.Foveal thickness was restored and FAZ area increased postoperatively.However,the process is rather slow and the recovery is incomplete.

Efficacy and safety of ranibizumab for wet age-related macular degeneration in Chinese patients

AIM： To evaluate the clinical efficacy and safety of ranibizumab for wet age-related macular degeneration （wAMD） in Chinese patients and to determine the mean number of injections administered over one year of follow-up. METHODS： This single centre, retrospective observational case series study included data from 121 patients with wAMD （121 eyes） who were diagnosed by indirect ophthalmoscopy, fluorescence fundus angiography （FFA）, indocyanine green angiography, and optical coherence tomography. Ranibizumab was injected into the vitreous cavities once per month for 3mo and as needed afterwards. Changes in visual acuity and central foveal thickness （CFT） during the follow-up period were compared, and the mean number of injections over the year was calculated. Patients with one or more adverse events related to the drugs and injections were recorded for further adverse events analysis.RESULTS： The study population included 70 males and 51 females aged between 50 and 87y （mean： 71.32±9.41y）. The mean number of injections over the first year was 5±1 （range： 3-9）. The mean best-corrected visual acuity by Early Treatment Diabetic Retinopathy Study increased from 43.2±19.3 （95%CI： 39.8-46.7） at baseline to 51.7±20.1 （95%CI： 48.1-55.3）, and central foveal thickness （CFT） decreased from 526.5±277.0 μm （95%CI： 476.6-576.4） to 258.2±161.6 μm （95%CI： 229.2-287.3） at 12mo. The differences were statistically significant （P〈0.001）. Visual acuity significantly improved in 34.1% of the patients （38 eyes）, stabilized in 66.1% of the patients （80 eyes）, and significantly decreased in 2.5% of the patients （3 eyes）. CFT at baseline was an independent risk factor of decreased CFT and increased visual acuity. None of the patients had severe adverse events during the follow-up period.CONCLUSION： Ranibizumab can effectively control disease progression and improve visual acuity in patients with wAMD. The disease conditions of most patients stabilized after a one-year treatment with an average of 5 injections.

One-year follow-up evaluation of combined phacovitrectomy for idiopathic epiretinal membrane

AIM:To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens(IOL)implantation in patients with severe idiopathic epiretinal membrane(iERM)and concurrent cataract.METHODS:A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane(ERM)peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017.The best-corrected visual acuity(BCVA)and central foveal thickness(CFT)were measured preoperatively and at 1,3,6 mo and 1 y postoperatively.Temporal changes and bivariate correlations of these parameters were analyzed.RESULTS:Mean logMAR BCVA improved and CFT decreased significantly(P<0.001)until 6 mo after surgery.Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA(r=0.716,P<0.001 at 1 mo,r=0.417,P=0.014 at 3 mo,r=0.359,P=0.037 at 6 mo,and r=0.369,P=0.032 at 12 mo post-op respectively),but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA.There was a positive correlation between CFT and logMAR BCVA at 1 mo(r=0.346,P=0.045),6 mo(r=0.347,P=0.045),and 12 mo(r=0.342,P=0.048)post-operatively.The intraand postoperative complications were relatively mild,and the incidences were generally low.CONCLUSION:For severe iERM patients with significant visual symptoms,combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT.Early surgery in selected patients may help preserving better visual function.