¡¡¡¡MATERIALS

¡¡¡¡A consecutive series of 32 eyes of 32 patients who were treated with intravitreal bevacizumah for ME secondery to BRVO who had poor outcomes after other treatment such as laser coagulation, intravitreal TA injection, or vitrectomy. Patients with uncontrolled hypertension or any recent history of cerebral vascular accident were excluded.

¡¡¡¡METHODS

¡¡¡¡Informed consent was obtained from all patients before treatment. They were especially informed about the offª²label character of the treatment and the potential risk of endophthalmitis and retinal detachment and the likelihood that additional treatments might be required.

¡¡¡¡At each visit, complete ophthalmic examination was performed, including determination of bestª²corrected distance Snellen visual acuity, slitª²lamp examination, intraocular pressure measurement, biomicroscopy of retina using a 90ª²diopter lens, central retinal thickness by optical coherence tomography (stratus OCT; Carl Zeiss Meditec, Jena, Germany), fundus photography of the macular area or/and fluorescein angiography as well.

¡¡¡¡The BRVO eye was prepared using topical antibiotics (moxifloxacin hydrochloride) and 50mL/L iodine, and topical anesthesia was induced by applying 10g/L tetracaine at least three times before injection. A 0.1L dose containing 2.5g of Avastin was injected using a 27ª²gauge needle via the pars plana. After injection, intraocular pressure and retinal artery perfusion were assessed, and patients were instructed to administer antibiotic eye drops (moxifloxacin hydrochloride) for 3 days four times per day.

¡¡¡¡All patients were seen by two examiners on the next day, 1 week, and 1 month after the injection. One month after the first injection£¬reinjection was performed at the discretion of the investigators mainly by the change on OCT, which was repeatedly performed at 1ª²month interval.

¡¡¡¡The main outcome measurements were Snellen visual acuity and central retinal thickness measured by OCT.

¡¡¡¡Statistical Analysis  Statistical analysis was performed using SPSS statistical software (version 12.0£¬SPSS Inc, Chicago, IL).For all statistical tests, P£¼0.05 was considered significant. Extended graphical analysis and methods such as regression models and analysis of variance models were performed where appropriate.

¡¡¡¡RESULTS

¡¡¡¡Of the 32 patients (32 eyes) with ME associated with BRVO, ninteen were male and 13 were female, and the mean age was 50.7 (range from 24 to 71)years. The mean length of followª²up was 4.7£¨range from 3 to 8£©months. Twentyª²one patients (66%) had a history of hypertension, six patients(19%) had a history of glaucoma, 4 (13%) had diabetes, and 1 (3%) patient had no history of systemic diseases. Twentyª²seven patients (84%) had limited or no response to prior treatment with either focal laser coagulation or intravitreal TA injections. Five patients received bevacizumab as primary therapy for BRVO. The mean duration between BRVO diagnosis and treatment with intravitreal bevacizumab was 20(range from 0 to 49) months£®The mean number of injections for each patient was two (range from 1 to 3). The injections appeared to be well tolerated in all patients. No cases of uveitis, endophthalmitis, ocular toxicity, or any systemic adverse events were observed.

¡¡¡¡Snellen visual acuity testing was applied for all patients. At baseline the mean visual acuity was 20/200ª² (range from 20/70 to 20/count fingers£¬median, 20/200). After the first injection with bevacizumab the mean visual acuity improved to 20/100ª² at 1 month, 20/100£« at 3 months and last followª²up (range at last followª²up, 20/30ª² to 20/200, median, 20/80ª²)(P£¼0.01 at each time). At the last followª²up, fifteen of the 32 (47%) patients experienced a halving of the visual angle, and no patients experienced a loss of vision greater than one line.

¡¡¡¡Twentyª²nine of the 32 patients (91%) demonstrated a decrease in retinal thickness within 1 month of intravitreal bevacizumab injection. Complete resolution of the ME was observed in 4 of the 32 patients£¨13%£© after 1 month. Statistical analysis of the central 1mm area of retinal thickness by OCT was done on all 32 patients. The mean retinal thickness was 483¦Ìm at baseline and decreased to a mean thickness of 275¦Ìm at 1 month, 342¦Ìm at 3 months, and 301¦Ìm at last followª²up (P£¼0.01 at each time). Recurrence rate of ME was observed in 7 (22%) patients after the initial injection. These patients were reinjected and all showed moderate to complete reduction in macular edema by OCT.

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