Effect Of Anti-VEGF Therapy On Macular Edema Secondary To Branch Retinal Vein Occlusion

Objective By observation of HRA OCT system measuring branch retinal vein occlusion(branch retinal vein occlusion,BRVO)in patients with macular center concave 3 mm of retinal thickness of each layer in the area of numerical,as well as the specific circumstances of the layers of the retina edema subsided further explore anti VEGF before and after treatment in patients with BRVO the change of the retinal thickness of each layer,so as to provide the basis for clinical diagnosis and treatment of BRVO and new ideas.Methods A total of 43 patients(43 eyes)diagnosed with branch retinal vein obstructive macular edema were collected from Ningxia Eye Hospital from January 2020 to October2020.There were 25 males and 18 females,aged between 43 and 72 years old,all of whom had monocular onset.According to the expert consensus of morphological response classification,the expert consensus of "3+PRN" regimen was used for treatment.The percentage reduction of macular fovea thickness(CRT)in 43 BRVO patients at 1 month after treatment compared with baseline was divided into two groups: non-response group(≤25%)and response group(> 25%).The changes of macular fovea,Best corrected visual acuity(BCVA)and retinal layer thickness were compared before and after treatment in the response group(n=31)and the non-response group(n=12).The changes of macular fovea,the best corrected visual acuity and the thickness of each retinal layer were compared between the two groups before and after treatment.Results(1)Comparison of the effiecacy group before and after treatment: the thickness of macular fovea was significantly reduced,and the overall difference was statistically significant(F=1405.56,P =0.00).The values of the best corrected visual acuity increased significantly compared with the others,and the overall difference was statistically significant(F=40.88,P =0.00).Thickness of each retinal layer: nerve fiber layer,inner plexus layer,inner plexus layer,outer plexus layer and outer nuclear layer decreased significantly,and the overall difference was statistically significant(P < 0.05)(nerve fiber layer F=292.78,P=0.00,inner plexus layer F=11.88,P =0.00,inner plexus layer F=60.20,P =0.00,outer plexus layer F=41.23,P=0.00,outer nuclear layer F=57.14,P=0.00).There was no significant change in the thickness of ganglion cell layer and pigment epithelium,and the overall difference was not statistically significant P > 0.05(F=1.47,P=0.24,F=1.69,P=0.19).(2)Comparison of the ineffiecacy group before and after treatment: the macular fovea thickness decreased significantly before and after treatment(F = 307.89,P = 0.00).The best corrected visual acuity increased significantly(F = 20.71,P = 0.00).The thickness of each layer of retina: nerve fiber layer,ganglion cell layer,inner plexiform layer and inner nuclear layer decreased significantly,and the overall difference was statistically significant(P < 0.05)(nerve fiber layer f = 112.98,P = 0.00,ganglion cell layer f = 4.80,P = 0.03,inner plexiform layer F = 12.03,P = 0.01,inner nuclear layer f = 12.03,P = 0.01).There was no significant difference in the thickness of outer plexiform layer,outer nuclear layer and pigment epithelium layer(P > 0.05)(outer plexiform layer f = 2.82,P = 0.80,outer nuclear layer f =1.39,P = 0.10,pigment epithelium layer f = 1.39,P = 0.31).(3)Comparison between the two groups: macular fovea thickness: in the first month,second month and third month after treatment,the value of the response group was significantly less than that of the ineffiecacy group,the difference was statistically significant(P = 0.00,0.00,0.00).Best corrected visual acuity: there was no significant difference between the two groups(P = 0.78,0.79,0.74).Retinal layer thickness: outer nuclear layer:after one month,two months,three months of treatment,the response group was significantly less than the ineffiecacy group,the difference was statistically significant(P =0.00,0.00,0.00).Nuclear layer: three months after treatment,the response group was significantly less than the ineffiecacy group,the difference was statistically significant(P =0.01).Outer plexiform layer: three months after treatment,the value of response group was significantly lower than that of ineffiecacy group,the difference was statistically significant(P = 0.00).There was no significant difference in the thickness of other retinal layers between the two groups(P > 0.05).Conclusion 1.Anti-VEGF treatment of ME secondary to BRVO has definite short-term efficacy,which can improve visual acuity to a certain extent and restore retinal structure and function.2.Anti-VEGF treatment of BRVO effectively improved the best corrected visual acuity,and tended to stabilize after 2 months of treatment.3.Anti-VEGF treatment Secondary ME of BRVO can significantly reduce the thickness of retinal nerve fiber layer,inner plexus layer and inner core layer,suggesting that when macular edema concentrates on these three layers,anti-VEGF treatment can significantly improve the thickness of retina.4.In the non-response group,the thickness of the external retinal nucleus layer at each time point of treatment was significantly higher than that of the response group,indicating that non-response group patients may need more anti-VEGF therapy,and even some patients need other combination therapy.