Anti-Vascular Endothelial Growth Factor Therapy with or Without Initial Steroid Therapy for Macular Edema in Branch Retinal Vein Occlusion

Figures & data

Table 1 Baseline Clinical Characteristics and Cytokine Levels in Patients Treated by Intravitreal Ranibizumab Injection (IRI) Alone (IRI Group) and by IRI Combined with Subtenon Triamcinolone Acetonide Injection (Combination Group)

Findings	IRI Group (N=21)	Combination Group (N=20)	P value
Age (years)	63.9±10.1^‡	64.7±11.5^‡	0.793
Sex (female/male)	12/9	8/12	0.272
High blood pressure measurement	16	15	0.929
Systolic pressure (mmHg)	147±14^‡	152±32^‡	0.501
Diastolic pressure (mmHg)	91±13^‡	93±16^‡	0.697
Hyperlipidemia	11	10	0.878
Duration of macular edema (days)	33.6 ± 24.9^‡	42.2 ± 38.0^‡	0.403
BCVA at baseline (logMAR)	0.48±0.35^‡	0.45±0.28^‡	0.684
BCVA at 12 months (logMAR)	0.09±0.27^‡	0.08±0.19^‡	0.946
CMT at baseline (μm)	654±213^‡	679±167^‡	0.679
CMT at 12 months (μm)	310±165^‡	299±116^‡	0.820
Aqueous flare value at baseline (photon counts/ms)	8.69±4.55^‡	9.21±3.72^‡	0.687
Aqueous flare value at 12 months (photon counts/ms)	6.44±3.63^‡	6.18±2.36^‡	0.782
VEGF (pg/mL)	94.2 ± 70.4^‡	91.8 ± 64.7^‡	0.908
PlGF (pg/mL)	8.19 ± 9.21^‡	6.44 ± 6.09^‡	0.488
PDGF-AA (pg/mL)	18.2 ± 4.85^‡	15.9 ± 3.32^‡	0.080
sICAM-1 (ng/mL)	36.7 ± 72.8^‡	25.7 ± 27.1^‡	0.559
MCP-1 (pg/mL)	2611 ± 1141^‡	2238 ± 828^‡	0.239
IL-6 (pg/mL)	13.2 ± 15.5^‡	10.3 ± 7.46^‡	0.450
IL-8 (pg/mL)	28.9 ± 21.5^‡	29.7 ± 28.7^‡	0.912
IP-10 (pg/mL)	193 ± 67.5^‡	148 ± 116^‡	0.135

Note: ^‡Mean ± standard deviation (SD).

Abbreviations: BCVA, best-corrected visual acuity; CMT, central macular thickness; IRI, intravitreal ranibizumab injection; STTA, subtenon triamcinolone acetonide; VEGF, vascular endothelial growth factor; PlGF, placenta growth factor; PDGF, platelet-derived growth factor; sICAM, soluble intercellular adhesion molecule; MCP, monocyte chemotactic protein; IL, interleukin; IP-10, interferon-inducible 10-kDa protein.

Figure 1 Time course of best-corrected visual acuity, central macular thickness, and aqueous flare value (A) Best-corrected visual acuity improved significantly over time in both the intravitreal ranibizumab injection (IRI) group (dotted line; P < 0.001) and combination group (IRI plus subtenon triamcinolone acetonide; solid line; P < 0.001). The trend profile was not significantly different between the two groups (P = 0.729). (B) Central macular thickness improved significantly over time in both the IRI (dotted line; P < 0.001) and combination groups (solid line; P<0.001). The trend profile was not significantly different between the two groups (P = 0.698). (C) Aqueous flare values improved significantly over time in both the IRI (dotted line; P = 0.017) and combination groups (solid line; P < 0.001). The trend profile was not significantly different between the two groups (P = 0.476). *P value for group comparison (P<0.05).

Abbreviations: BCVA (logMAR), best-corrected visual acuity (logarithm of the minimum angle of resolution); CMT, central macular thickness.

Table 2 Features of Intravitreal Ranibizumab Injection (IRI) in Patients Treated by IRI Alone (IRI Group) and by IRI Combined with Subtenon Triamcinolone Acetonide Injection (Combination Group)

Findings	IRI Group (N=21)	Combination Group (N=20)	P value
Number of IRIs	3.9 ± 1.5^‡	3.1 ± 1.8^‡	0.085
1 injection (no recurrence)	1/21 (4.8%)	6/20 (30.0%)	0.032
2 injections	2/21 (9.5%)	1/20 (5.0%)	0.578
3 injections	4/21 (19.0%)	6/20 (30.0%)	0.414
4 injections	9/21 (42.9%)	3/20 (15.0%)	0.050
5 injections	2/21 (9.5%)	1/20 (5.0%)	0.578
6 injections	1/21 (4.8%)	3/20 (15.0%)	0.269
7 injections	2/21 (9.5%)	0/20 (0.0%)	0.157
Time to recurrence (months)	2.5 ± 0.5^‡	3.7 ± 1.5^‡	0.003

Note: ^‡Mean ± standard deviation (SD).

Abbreviation: IRI, intravitreal ranibizumab injection.

Figure 2 Time course of intraocular pressure. Intraocular pressure (IOP) increased significantly over time in the combination group (intravitreal ranibizumab injection [IRI] plus subtenon triamcinolone acetonide injection; solid line; P = 0.006), but no significant increase was found in the IRI-only group (dotted line; P = 0.282). The trend profile of IOP was significantly different between the two groups (P = 0.007). *P value for group comparison (P < 0.05).

Abbreviation: IOP, intraocular pressure.