Short-term Efficacy And Influencing Factors Of Ranibizumab In The Treatment Of Macular Edema Secondary To Retinal Vein Occlusion

Purpose:To observe the short-term efficacy of ranibizumab for treating macular edema secondary to retinal vein occlusion and to investigate the relationship between the baseline of different degrees of macular edema and prognostic indicators.Methods:This is a retrospective study,with 70 treatment naive patients(70 eyes)involved.All patients were diagnosed with RVO-ME and received anti-VEGF treatment from September 2020 to November 2022 at Shandong Provincial Hospital.Based on the central macular thickness(CMT)on optical coherence tomography(OCT)images,patients were divided into 2 groups:group A for CMT<500 μm and group B for CMT>500 μm.Patients enrolled were given ranibizumab 0.05 ml(0.5 mg)intravitreal injection and followed up for 2 weeks after surgery.Using OCT examination,the changes and characteristics of central macular thickness,best corrected visual acuity(BCVA),subfoveal choroidal thickness(SFCT),small to medium vessel layer(SMVL)thickness,large vessel layer(LVL)thickness,external limiting membrane(ELM)integrity and ellipsoid zone(EZ)integrity in the two groups were analyzed before and after treatment,to get the baseline characteristics of different degrees of RVO-ME and the response to treatment.Results:(1)Analysis of general clinical dataThere was no significant difference between the two groups in gender,eye and the proportion of CRVO(p=0.617,p=0.779,p=0.716),but a statistically significant difference in age(p=0.021),with group A being younger than that of group B.(2)Analysis of CMT and BCVACompared with the baseline CMT,the CMT after treatment in the two groups decreased significantly(p<0.001);the baseline CMT in group A was smaller than that in group B(p<0.001).After treatment,CMT was not significantly different between the two groups(p=0.394).The extent of CMT reduction and the CMT improvement rate in group A were both less than those in group B(both p<0.001).There was a statistically significant difference on BCVA(logMAR)in baseline and after treatment in either group A or group B(p<0.001).The baseline BCVA(logMAR)in group A was better than that in group B(p<0.001),and still better after treatment(p=0.003).(3)Analysis of choroid thicknessThere was a statistically significant decrease in subfoveal SFCT and LVL in group A after treatment(p=0.012,p=0.024),but the change of SMVL was not significant(p=0.151).After treatment,SFCT,SMVL,and LVL in group B decreased significantly(p<0.001,p<0.001,p=0.004).There was no significant difference between the two groups in SFCT,SMVL,and LVL either before or after treatment(p=0.580,p=0.129,p=0.993,p=0.877,p=0.966,p=0.869).(4)Analysis of ELM and EZ integrityThere were more eyes with damage of ELM and EZ in macular region in group B than that of group A before(p<0.001,p=0.001)and after(p=0.001,p<0.001).(5)Analysis with different types of ME in two groupsGroup A had more diffuse retinal thickening(DRT)type,while group B was dominated by serous retinal detachment(SRD)type and cystoid macular edema(CME)type.There was a statistical difference in the types of ME between the two groups(p=0.001).(6)Analysis of prognostic factorsUnivariety binary logistic regression analysis of all RVO-ME patients showed that the extent of improvement in BCVA after 2 weeks treatment was associated with the baseline of ELM integrity,the baseline of EZ integrity,CMT group(group A and group B),the baseline of BCVA(logMAR)and age(p=0.001,p=0.024,p=0.023,p<0.001,p=0.004),but not with baseline CMT or baseline SFCT(p=0.160,p=0.494).Baseline BCVA(logMAR)can be an independent predictor of significant improvement in postoperative visual acuity.Conclusions:1.The short-term efficacy of ranibizumab on the treatment of RVO-ME was significant,in improving visual acuity,reducing macular edema,decreasing choroid thickness and restoring photoreceptor integrity.2.RVO with milder macular edema had better baseline visual acuity,more integrated ELM and EZ and tend to get better therapeutic effect.3.RVO with poorer baseline vision had more visual acuity improvement after treated with ranibizumab in short term.Baseline BCVA(logMAR)is an independent predictor of short-term visual prognosis.