title: Macular cystic changes as predictive factor for the recurrence of macular oedema in branch retinal vein occlusion.
abstract: OBJECTIVE
  To evaluate the role of small cystic macular changes as a prognostic factor for the recurrence of macular oedema (ME) in patients with branch retinal vein occlusion (BRVO) treated with anti-VEGF drugs.
  
  
  METHODS
  We performed retrospective chart analysis of 116 patients treated with intravitreal injection of ranibizumab (IVR) or bevacizumab (IVB) for ME secondary to BRVO. At the baseline and monthly follow-up visits over a period of 12 months, a comprehensive ophthalmologic examination including best-corrected visual acuity (BCVA) and volume scan of macula using Spectral domain optical coherence tomography (SD-OCT) were performed. Patients without ME (CRT <250 μm) were screened for the presence of intraretinal cysts. In these patients, the changes in BCVA and CRT were evaluated over a period of 12 months and compared with the baseline.
  
  
  RESULTS
  In the IVR group (41 patients), 91 events of macular cysts, without a worsening of BCVA, were detected by OCT. In 89 of 91 events (97%), BCVA and CRT deteriorated significantly (p < 0.0001) within the next 4-11 (in mean 7.1 ± 2.0) weeks. BCVA decreased from 0.38 ± 0.25 to 0.49 ± 0.27 logMAR and CRT increased significantly from 223 ± 43 to 605 ± 244 μm. In the IVB group (19 patients), 54 events of cystic changes were detected. All of these patients showed significant worsening of BCVA from 0.40 ± 0.19 to 0.57 ± 0.22 logMAR and CRT from 251 ± 17 to 490 ± 147 μm within 4-10 (in mean 7.8 ± 2.8) weeks after the first presence of small macular cysts.
  
  
  CONCLUSIONS
  In BRVO patients treated with anti-VEGF drugs, the macular cystic changes may be used as an early indicator for impending recurrence of ME, with the decrease in BCVA in the following weeks. These patients should be scheduled for a next visit within 6-8 weeks.
authors.affiliation: Department of Ophthalmology, University of Leipzig, Leipzig, Germany.
authors.forename: Eric
authors.initials: E
authors.lastname: Tilgner
authors.affiliation: Department of Ophthalmology, São José Hospital - Dr Homero de Miranda Gomes Hospital, Santa Catarina, Brazil.
authors.forename: Maiara
authors.initials: M
authors.lastname: Dalcegio Favretto
authors.affiliation: Department of Ophthalmology, University of Leipzig, Leipzig, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Tuisl
authors.affiliation: Department of Ophthalmology, University of Leipzig, Leipzig, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Wiedemann
authors.affiliation: Department of Ophthalmology, University of Leipzig, Leipzig, Germany.
authors.forename: Matus
authors.initials: M
authors.lastname: Rehak
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage; D003560:Cysts / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology*; D008269:Macular Edema / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage; D012008:Recurrence; D012170:Retinal Vein Occlusion / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: bevacizumab; macular microcystic changes; macular oedema; ranibizumab; retinal vein occlusion