The influence of the choroidal thickness of the affected eye about anti-vascular endothelial growth factor drug treatment for retinal vein occlusion with macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

Fu Yan , Yang Na , Li Liying , Wen Xiaoying , Gu Zhaohui ,  Zhang Yueling

The Second Department of Ophthalmology, The First Central Hospital of Baoding of Hebei Province, Baoding 071000, China;

Corresponding author：

Zhang Yueling, Email: 490409241@qq.com

Keywords：

Retinal vein occlusion; Macular edema; Choroidal thickness

DOI：

10.3760/cma.j.cn511434-20200901-00423

Video：

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Objective To observe the effect of intravitreal injection of anti-vascular endothelial growth factor drugs on the subfoveal choroid thickness (SFCT) of patients with retinal vein occlusion (RVO) and macular edema (ME). Methods A prospective clinical study. From January 2017 to January 2019, 59 monocular RVO-ME patients with 59 eyes diagnosed in the eye examination of The First Central Hospital of Baoding were included in the study. Among them, there were 31 males with 31 eyes and 28 females with 28 eyes; the average age was 57.4±10.3 years old. The course of the disease was 5 days to 1 month, all of whom had the first-onset disease. Branch retinal vein occlusion (BRVO) was found in 35 eyes (BRVO-ME group); non-ischemic central retinal vein occlusion (CRVO) was found in 24 eyes (CRVO-ME group). Best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (OCT) were performed. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. The Cirrus HD-OCT 5000 instrument from Carl Zeiss company of Germany was used to measure the central macular thickness (CMT) and SFCT. All eyes were treated with intravitreal injection of anti-vascular endothelial growth factor drugs. The follow-up time after treatment was 6 months, and the changes of BCVA, CMT and SFCT of eyes before treatment and 2 weeks after treatment were compared and observed, as well as the occurrence of treatment-related complications. The comparison of BCVA, CMT, and SFCT at different times before and after treatment were adopted repeated measures analysis of variance; pairwise comparison of differences at different time points adopts the least significant difference t test. Results Before treatment, the average logMAR BCVA and CMT of RVO-ME eyes were 0.92±0.46 and 604.71±169.35 μm, respectively. At 2 weeks, 1, 3, and 6 months after treatment, the average logMAR BCVA of the affected eye was significantly improved compared with that before treatment, and the CMT was significantly decreased. The difference was statistically significant (F=55.664, 59.518; P＜0.05). Before treatment, the average SFCT of the affected eye and the contralateral eye of RVO-ME patients were 306.3±65.8 and 241.3±59.8 μm, respectively. The SFCT of the affected eye was significantly thicker than that of the contralateral healthy eye, and the difference was statistically significant (t=25.772, P＜0.05). At 2 weeks, 1, 3, and 6 months after treatment, the average SFCT of the eyes were 267.7±81.4, 252.3±57.3, 239.2±46.5, 240.6±48.3 μm, respectively. Compared with before treatment, treatment SFCT decreased significantly at different times afterwards, and the difference was statistically significant (F=924.341, P＜0.001). There was no significant difference in SFCT between CRVO-ME group and BRVO-ME group at 2 weeks, 1, 3, and 6 months after treatment (P＞0.05). No complications such as endophthalmitis, cataract progression and neovascular glaucoma occurred during the follow-up period of all eyes. Conclusion The SFCT of eyes with short course of disease and first-onset RVO-ME is thickened; anti-VEGF drug treatment can effectively reduce SFCT, improve ME, and increase BCVA.

Citation： Fu Yan, Yang Na, Li Liying, Wen Xiaoying, Gu Zhaohui, Zhang Yueling. The influence of the choroidal thickness of the affected eye about anti-vascular endothelial growth factor drug treatment for retinal vein occlusion with macular edema. Chinese Journal of Ocular Fundus Diseases, 2021, 37(9): 681-686. doi: 10.3760/cma.j.cn511434-20200901-00423 Copy

1.	Yeh S, Kim SJ, Ho AC, et al. Therapies for macular edema associated with central retinal vein occlusion: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2015, 122(4): 769-778. DOI: 10.1016/j.ophtha.2014.10.013.
2.	Tsuiki E, Suzuma K, Ueki R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central retinal vein occlusion[J]. Am J Ophthalmol, 2013, 156(3): 543-547. DOI: 10.1016/j.ajo.2013.04.008.
3.	Du KF, Xu L, Shao L, et al. Subfoveal choroidal thickness in retinal vein occlusion[J]. Ophthalmology, 2013, 120(12): 2749-2750. DOI: 10.1016/j.ophtha.2013.08.031.
4.	Yumusak E, Ornek K, Dikel NH. Comparison of choroidal thickness changes following intravitreal dexamethasone, ranibizumab, and triamcinolone in eyes with retinal vein occlusion[J]. Eur J Ophthalmol, 2016, 26(6): 627-632. DOI: 10.5301/ejo.5000734.
5.	Park J, Lee S, Son Y. Effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness and retinal vessel diameter in branch retinal vein occlusion[J]. Int J Ophthalmol, 2016, 9(7): 999-1005. DOI: 10.18240/ijo.2016.07.11.
6.	Vinković M, Bosnar D, Tedeschi Reiner E, et al. Combined treatment with bevacizumab and triamcinolone acetonide for macular edema due to retinal vein occlusion[J]. Acta Clin Croat, 2020, 59(4): 569-575. DOI: 10.20471/acc.2020.59.04.01.
7.	Noma H, Minamoto A, Funatsu H, et al. Intravitreal levels of vascular endothelial growth factor and interleukin-6 are correlated with macular edema in branch retinal vein occlusion[J]. Graefe's Arch Clin Exp Ophthalmol, 2006, 244(3): 309-315. DOI: 10.1007/s00417-004-1087-4.
8.	Pranata R, Vania A, Vania R, et al. Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: systematic review and meta-analysis[J]. Eur J Ophthalmol, 2021, 31(4): 1907-1914. DOI: 10.1177/1120672120947595.
9.	Hykin P, Prevost AT, Vasconcelos JC, et al. Clinical effectiveness of intravitreal therapy with ranibizumab vs aflibercept vs bevacizumab for macular edema secondary to central retinal vein occlusion: a randomized clinical trial[J]. JAMA Ophthalmol, 2019, 137(11): 1256-1264. DOI: 10.1001/jamaophthalmol.2019.3305.
10.	Eliwa TF, Hegazy OS, Mahmoud SS, et al. Choroidal thickness change in patients with diabetic macular edema[J]. Ophthalmic Surg Lasers Imaging Retina, 2017, 48(12): 970-977. DOI: 10.3928/23258160-20171130-03.
11.	Rewbury R, Want A, Varughese R, et al. Subfoveal choroidal thickness in patients with diabetic retinopathy and diabetic macular oedema[J]. Eye (Lond), 2016, 30(12): 1568-1572. DOI: 10.1038/eye.2016.187.
12.	Coban-karatas M, Altan-yaycioglu R, Ulas B, et al. Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion[J]. Int J Ophthalmol, 2016, 9(5): 725-729. DOI: 10.18240/ijo.2016.05.16.
13.	Chung YK, Shin JA, Park YH. Choroidal volume in branch retinal vein occlusion before and after intravitreal anti-VEGF injection[J]. Retina, 2015, 35(6): 1234-1239. DOI: 10.1097/IAE.0000000000000455.
14.	Maruko I, Iida T, Sugano Y, et al. Subfoveal choroidal thickness in fellow eyes of patients with central serous chorioretinopathy[J]. Retina, 2011, 31(8): 1603-1608. DOI: 10.1097/IAE.0b013e31820f4b39.
15.	Mrejen S, Spaide RF. Optical coherence tomography: imaging of the choroid and beyond[J]. Surv Ophthalmol, 2013, 58(5): 387-429. DOI: 10.1016/j.survophthal.2012.12.001.
16.	Kim KH, Lee DH, Lee JJ, et al. Regional choroidal thickness changes in branch retinal vein occlusion with macular edema[J]. Ophthalmologica, 2015, 234(2): 109-118. DOI: 10.1159/000437276.
17.	Kang HM, Kwon HJ, Yi JH, et al. Subfoveal choroidal thickness as a potential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age-related macular degeneration[J]. Am J Ophthalmol, 2014, 157(5): 1013-1021. DOI: 10.1016/j.ajo.2014.01.019.
18.	Rayess N, Rahimy E, Ying GS, et al. Baseline choroidal thickness as a predictor for response to anti-vascular endothelial growth factor therapy in diabetic macular edema[J]. Am J Ophthalmol, 2015, 159(1): 85-91. DOI: 10.1016/j.ajo.2014.09.033.
19.	Rayess N, Rahimy E, Ying GS, et al. Baseline choroidal thickness as a short-term predictor of visual acuity improvement following antivascular endothelial growth factor therapy in branch retinal vein occlusion[J]. Br J Ophthalmol, 2019, 103(1): 55-59. DOI: 10.1136/bjophthalmol-2018-311898.
20.	Okamoto M, Yamashita M, Sakamoto T, et al. Choroidal blood flow and thickness as predictors for response to anti-vascular endothelial growth factor therapy in macular edema secondary to branch retinal vein occlusion[J]. Retina, 2018, 38(3): 550-558. DOI: 10.1097/IAE.0000000000001566.
21.	Akay F, Gundogan FC, Yolcu U, et al. Choroidal thickness in systemic arterial hypertension[J]. Eur J Ophthalmol, 2016, 26(2): 152-157. DOI: 10.5301/ejo.5000675.
22.	Kong M, Kwun Y, Sung J, et al. Association between systemic hypertension and macular thickness measured by optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2015, 56(4): 2144-2150. DOI: 10.1167/iovs.14-16080.
23.	Teruyo T, Shou O, Masanori F, et al. Long-term follow-up changes of central choroidal thickness thinning after repeated anti-VEGF therapy injections in patients with central retinal vein occlusion-related macular edema with systemic hypertension[J]. Ophthalmologica, 2020, 243(2): 102-109. DOI: 10.1159/000504754.
24.	Fukami M, Iwase T, Yamamoto K, et al. Changes in retinal microcirculation after intravitreal ranibizumab injection in eyes with macular edema secondary to branch retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2017, 58(2): 1246-1255. DOI: 10.1167/iovs.16-21115.
25.	Flores-moreno I, Lugo F, Duker JS, et al. The relationship between axial length and choroidal thickness in eyes with high myopia[J]. Am J Ophthalmol, 2013, 155(2): 314-319. DOI: 10.1016/j.ajo.2012.07.015.
26.	Ooto S, Hangai M, Yoshimuta N. Effects of sex and age on the normal retinal and choroidal structures on optical coherence tomography[J]. Curr Eye Res, 2015, 40(2): 213-225. DOI: 10.3109/02713683.2014.952828.
27.	Rayess N, Rahimy E, Ying GS, et al, et al. Baseline choroidal thickness as a predictor for teatment outcomes in central retinal vein occlusion[J]. Am J Ophthalmol, 2016, 171: 47-52. DOI: 10.1016/j.ajo.2016.08.026.

1. Yeh S, Kim SJ, Ho AC, et al. Therapies for macular edema associated with central retinal vein occlusion: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2015, 122(4): 769-778. DOI: 10.1016/j.ophtha.2014.10.013.
2. Tsuiki E, Suzuma K, Ueki R, et al. Enhanced depth imaging optical coherence tomography of the choroid in central retinal vein occlusion[J]. Am J Ophthalmol, 2013, 156(3): 543-547. DOI: 10.1016/j.ajo.2013.04.008.
3. Du KF, Xu L, Shao L, et al. Subfoveal choroidal thickness in retinal vein occlusion[J]. Ophthalmology, 2013, 120(12): 2749-2750. DOI: 10.1016/j.ophtha.2013.08.031.
4. Yumusak E, Ornek K, Dikel NH. Comparison of choroidal thickness changes following intravitreal dexamethasone, ranibizumab, and triamcinolone in eyes with retinal vein occlusion[J]. Eur J Ophthalmol, 2016, 26(6): 627-632. DOI: 10.5301/ejo.5000734.
5. Park J, Lee S, Son Y. Effects of two different doses of intravitreal bevacizumab on subfoveal choroidal thickness and retinal vessel diameter in branch retinal vein occlusion[J]. Int J Ophthalmol, 2016, 9(7): 999-1005. DOI: 10.18240/ijo.2016.07.11.
6. Vinković M, Bosnar D, Tedeschi Reiner E, et al. Combined treatment with bevacizumab and triamcinolone acetonide for macular edema due to retinal vein occlusion[J]. Acta Clin Croat, 2020, 59(4): 569-575. DOI: 10.20471/acc.2020.59.04.01.
7. Noma H, Minamoto A, Funatsu H, et al. Intravitreal levels of vascular endothelial growth factor and interleukin-6 are correlated with macular edema in branch retinal vein occlusion[J]. Graefe's Arch Clin Exp Ophthalmol, 2006, 244(3): 309-315. DOI: 10.1007/s00417-004-1087-4.
8. Pranata R, Vania A, Vania R, et al. Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: systematic review and meta-analysis[J]. Eur J Ophthalmol, 2021, 31(4): 1907-1914. DOI: 10.1177/1120672120947595.
9. Hykin P, Prevost AT, Vasconcelos JC, et al. Clinical effectiveness of intravitreal therapy with ranibizumab vs aflibercept vs bevacizumab for macular edema secondary to central retinal vein occlusion: a randomized clinical trial[J]. JAMA Ophthalmol, 2019, 137(11): 1256-1264. DOI: 10.1001/jamaophthalmol.2019.3305.
10. Eliwa TF, Hegazy OS, Mahmoud SS, et al. Choroidal thickness change in patients with diabetic macular edema[J]. Ophthalmic Surg Lasers Imaging Retina, 2017, 48(12): 970-977. DOI: 10.3928/23258160-20171130-03.
11. Rewbury R, Want A, Varughese R, et al. Subfoveal choroidal thickness in patients with diabetic retinopathy and diabetic macular oedema[J]. Eye (Lond), 2016, 30(12): 1568-1572. DOI: 10.1038/eye.2016.187.
12. Coban-karatas M, Altan-yaycioglu R, Ulas B, et al. Choroidal thickness measurements with optical coherence tomography in branch retinal vein occlusion[J]. Int J Ophthalmol, 2016, 9(5): 725-729. DOI: 10.18240/ijo.2016.05.16.
13. Chung YK, Shin JA, Park YH. Choroidal volume in branch retinal vein occlusion before and after intravitreal anti-VEGF injection[J]. Retina, 2015, 35(6): 1234-1239. DOI: 10.1097/IAE.0000000000000455.
14. Maruko I, Iida T, Sugano Y, et al. Subfoveal choroidal thickness in fellow eyes of patients with central serous chorioretinopathy[J]. Retina, 2011, 31(8): 1603-1608. DOI: 10.1097/IAE.0b013e31820f4b39.
15. Mrejen S, Spaide RF. Optical coherence tomography: imaging of the choroid and beyond[J]. Surv Ophthalmol, 2013, 58(5): 387-429. DOI: 10.1016/j.survophthal.2012.12.001.
16. Kim KH, Lee DH, Lee JJ, et al. Regional choroidal thickness changes in branch retinal vein occlusion with macular edema[J]. Ophthalmologica, 2015, 234(2): 109-118. DOI: 10.1159/000437276.
17. Kang HM, Kwon HJ, Yi JH, et al. Subfoveal choroidal thickness as a potential predictor of visual outcome and treatment response after intravitreal ranibizumab injections for typical exudative age-related macular degeneration[J]. Am J Ophthalmol, 2014, 157(5): 1013-1021. DOI: 10.1016/j.ajo.2014.01.019.
18. Rayess N, Rahimy E, Ying GS, et al. Baseline choroidal thickness as a predictor for response to anti-vascular endothelial growth factor therapy in diabetic macular edema[J]. Am J Ophthalmol, 2015, 159(1): 85-91. DOI: 10.1016/j.ajo.2014.09.033.
19. Rayess N, Rahimy E, Ying GS, et al. Baseline choroidal thickness as a short-term predictor of visual acuity improvement following antivascular endothelial growth factor therapy in branch retinal vein occlusion[J]. Br J Ophthalmol, 2019, 103(1): 55-59. DOI: 10.1136/bjophthalmol-2018-311898.
20. Okamoto M, Yamashita M, Sakamoto T, et al. Choroidal blood flow and thickness as predictors for response to anti-vascular endothelial growth factor therapy in macular edema secondary to branch retinal vein occlusion[J]. Retina, 2018, 38(3): 550-558. DOI: 10.1097/IAE.0000000000001566.
21. Akay F, Gundogan FC, Yolcu U, et al. Choroidal thickness in systemic arterial hypertension[J]. Eur J Ophthalmol, 2016, 26(2): 152-157. DOI: 10.5301/ejo.5000675.
22. Kong M, Kwun Y, Sung J, et al. Association between systemic hypertension and macular thickness measured by optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2015, 56(4): 2144-2150. DOI: 10.1167/iovs.14-16080.
23. Teruyo T, Shou O, Masanori F, et al. Long-term follow-up changes of central choroidal thickness thinning after repeated anti-VEGF therapy injections in patients with central retinal vein occlusion-related macular edema with systemic hypertension[J]. Ophthalmologica, 2020, 243(2): 102-109. DOI: 10.1159/000504754.
24. Fukami M, Iwase T, Yamamoto K, et al. Changes in retinal microcirculation after intravitreal ranibizumab injection in eyes with macular edema secondary to branch retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2017, 58(2): 1246-1255. DOI: 10.1167/iovs.16-21115.
25. Flores-moreno I, Lugo F, Duker JS, et al. The relationship between axial length and choroidal thickness in eyes with high myopia[J]. Am J Ophthalmol, 2013, 155(2): 314-319. DOI: 10.1016/j.ajo.2012.07.015.
26. Ooto S, Hangai M, Yoshimuta N. Effects of sex and age on the normal retinal and choroidal structures on optical coherence tomography[J]. Curr Eye Res, 2015, 40(2): 213-225. DOI: 10.3109/02713683.2014.952828.
27. Rayess N, Rahimy E, Ying GS, et al, et al. Baseline choroidal thickness as a predictor for teatment outcomes in central retinal vein occlusion[J]. Am J Ophthalmol, 2016, 171: 47-52. DOI: 10.1016/j.ajo.2016.08.026.

Chinese Journal of Ocular Fundus Diseases

The influence of the choroidal thickness of the affected eye about anti-vascular endothelial growth factor drug treatment for retinal vein occlusion with macular edema

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