Real World Clinical Features And Predictive Factors For Macular Edema Due To Retinal Vein Occlusion Treated By Ranibizumab

Real world clinical features and predictive factors for macular edema due toretinal vein occlusion treated by ranibizumab ObjectiveTo investigate the clinical features and predictive factors of patients suffered with RVO-ME by analyze the baseline characteristics,medical history,clinical course,OCT features and funds characteristics of the patients who diagnosed RVO-ME and treated with Ranibizumab in our center from January 2016 to January 2019 MethodIn the first part of the study,a retrospective analysis was conducted on all RVO patients who received first therapy in our center from January 2016 to January 2019.General condition,past medical history,BCVA,number of injections,length of followup,number of follow-up final BCVA and the type of macular edema were taken into analyze.The general condition,age distribution,different ages,macular edema classification and macular edema classification in different duration were analyzed statistically.In the second part of the study,240 patients with ME resolved at the last visit were selected from the 456 patients enrolled in the first part.Research the relationship between final BCVA,vision gain and another 10 factors include age,baseline BCVA,duration,average baseline central retinal thickness and length SRF,height of SRF,the number of cotton-wool spots,the largest trans diameter of the largest cystoid,central retinal thickness decreased percentage one week after the first treatment,SRF/CRT at macular central foveal.The relationship between baseline ME type and final BCVA,vision gain.To investigate whether the baseline SRF and duration length were related to final EZ disruption length.ResultIn the first part,235 patients(235 eyes)with BRVO and 221 patients(221 eyes)with CRVO were enrolled.Baseline BCVA of BRVO patients was 0.89±0.52,1.34±0.68 of CRVO patients,and baseline vision of BRVO patients was significantly better than that of CRVO patients.However,the patients with CRVO have longer followed up length and more time of visit.The prevalence of the hypertension and diabetes in BRVO group was 55% and 7.6% respectively.The prevalence of the hypertension and diabetes in CRVO group was 41.2% and 18.1% respectively.The most common age range of RVO is from 50 to 70,and is uncommon under the age of 40.The older BRVO patients have longer follow-up length and better compliance,which was not found in CRVO.According to the feature of OCT,ME was divided into 3 types: intraretinal fluid type,subretinal fluid type,and mixed type.The majority of baseline ME type was mixed type(BRVO 51.5%,CRVO 50.7%).One week after the first treatment,the intraretinal fluid type and mixed type decreased while the subretinal fluid type increased significantly(BRVO 51.1%,CRVO 42.1%).The transformation trend was mixed type to subretinal fluid type(BRVO 69.4%,CRVO 60.6%),the type was mainly converted to normal(BRVO 65.4%;CRVO 50%),the subretinal fluid type was still dominant(BRVO 83.3%,CRVO 66.7%).This indicated that IRF seems response faster to ranibizumab therapy than SRF.In the BRVO group and the CRVO group,the proportion of patients with duration less than 3 months present SRF(84.2% and 71.9%)was higher than the rest part of the cases(57% and 56.4%).In the second part of the study,132 patients(132 eyes)of BRVO and 108 patients(108 eyes)of CRVO were enrolled.In the BRVO and CRVO groups,age,baseline BCVA,duration,mean retinal thickness and SRF length in the central region of baseline were positively correlated with final BCVA.Both baseline BCVA and final BCVA in the different ME type of BRVO were presented as mixed type > subretinal fluid type> retinal fluid type,while the CRVO group had no significant different.Predictors of vision improvement were baseline BCVA(positive correlation)in the BRVO group while age(negative correlation)and baseline BCVA(positive correlation)in the CRVO group.The length of EZ disruption after ME resolved was greater in patients with baseline SRF both in the BRVO and CRVO group,and the length of EZ disruption was greater in patients with duration ≥3 months in BRVO than the rest part of cases.There was no difference in any duration group of CRVO.ConclusionPart 1:1)Patients in their 50 s and 70 s age seem more susceptible to RVO.2)Baseline BCVA of BRVO patients was better than that of CRVO patients,and the total number of injections was smaller than that of CRVO patients.3)The baseline ME type mainly corresponds to mixed type.4)IRF response faster to ranibizumab therapy than SRF.5)SRF often presents in the early stage of RVO-ME,while the patients with a long course of RVO showed smaller percentage of SRF.Part 2:1)In both groups,age,baseline BCVA,duration,baseline mean thickness of retina in the central region and SRF length were positively correlated with terminal BCVA,which could be used as predictors of final vision outcome.2)The degree of visual improvement in the BRVO group was correlated with baseline BCVA.The degree of vision improvement in the CRVO group was positively correlated with baseline BCVA and negatively correlated with age.3)The patient with worse baseline BCVA often indicates worse terminal vision but more vision acuity gain achieved.4)In both the BRVO and CRVO group,the patients with SRF showed longer EZ disruption after the ME resolved.In BRVO group,longer duration of the disease indicated larger EZ disruption.