Prognostic Tests at 1 Month Foretell Macular Edema Outcome

Damian McNamara

September 12, 2016

UPDATED September 14, 2016 // COPENHAGEN — For patients with macular edema secondary to branch retinal vein occlusion, some features seen on spectral-domain optical coherence tomography can predict long-term response to anti-VEGF therapy, a case series of 60 patients suggests.

"Looking for spectral-domain OCT prognostic factors — like ellipsoid zone, external limiting membrane, and foveal bulge — is more informative 1 month after the first anti-VEGF injection in branch retinal vein occlusion than at the first visit prior to the first injection," said Kumar Saurabh, MD, from the Aditya Birla Sankara Nethralaya Eye Care Hospital in West Bengal, India.

In addition, "the higher the reduction in central foveal thickness 1 month after the first anti-VEGF injection, the better the outcome," Dr Saurabh told Medscape Medical News.

He presented data from his series here at the European Society of Retina Specialists 16th EURETINA Congress.

The 60 treatment-naïve patients with macular edema secondary to branch retinal vein occlusion were treated with intravitreal bevacizumab 1.25 mg/0.05 mL injections as needed. All presented with a central foveal thickness of at least 300 µm.

One month after the first injection, the patients underwent spectral-domain optical coherence tomography. Dr Saurabh then assessed the integrity of the external limiting membrane and ellipsoid zone and the thickness of the foveal bulge. Mean follow-up was 16 months.

When he stratified patients by foveal bulge thickness, he found better 16-month outcomes in those who had a reduction from baseline central foveal thickness of more than 25% at 1 month.

The extent of the reduction is a useful prognostic marker, Dr Saurabh reported.

Table 1. Outcomes at 16-Month Follow-up by Central Foveal Thickness at 1 Month

Outcome ≤25% Reduction (n = 23) >25% Reduction (n = 37) P Value
LogMAR best corrected visual acuity 0.46 0.25 .03
Dry macula 39% 76% .005

 

Certain features seen at 1 month on spectral-domain optical coherence tomography also predict 16-month outcomes.

Table 2. Predictors at 16-Month Follow-up by Best Corrected Visual Acuity at 1 Month

Predictor <20/40 Vision (n = 23) ≥20/40 Vision (n = 37) P Value
Intact external limiting membrane 22% 78% .001
Intact ellipsoid zone 48% 76% .02
Foveal bulge 9% 32% .03

 

"The idea of looking early is good. The study shows that people with a 25% or more reduction will do better," said session moderator Marc de Smet, MD, from the University of Amsterdam.

 
This could help us plan better.
 

"You can get a good sense pretty early if someone is going to be a responder or not. This could help us plan better," he told Medscape Medical News.

Current practice is to administer three initial doses and then assess response, which can take 6 to 8 months. "If you identify a response sooner, you can switch to a different agent earlier," Dr de Smet explained.

Dr Saurabh has disclosed no relevant financial relationships. Dr de Smet is a consultant for Allergan.

European Society of Retina Specialists 16th EURETINA Congress. Presented September 9, 2016.

Follow @MedscapeEye and Damian McNamara @MedReporter on Twitter.

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