Prognostischer Wert des frühen OCT-kontrollierten Ansprechens des konsekutiven Makulaödems der retinalen venösen Verschlüsse nach intravitrealer Gabe von Bevacizumab

Zusammenfassung

Hintergrund Ziel dieser Arbeit war, mithilfe der OCT-Untersuchung das Verhalten des Makulaödems retinaler Venenverschlüsse nach Gabe von Bevacizumab zu untersuchen, um daraus eine Prognose über den Krankheitsverlauf und über die Re-Injektionsintervalle abzuleiten.

Material und Methoden Retrospektiv wurden 24 Patienten nach einem retinalen Venenverschluss mittels Fluoreszenzangiografie und OCT der Makula untersucht. Mittels wiederholter OCT-Aufnahmen wurde die frühe Antwort des Makulaödems nach Bevacizumabgabe dokumentiert. Weitere OCT-Aufnahmen erfolgten im Rahmen der Therapie mit insgesamt 3 Bevacizumabinjektionen im Abstand von 30 Tagen sowie bei der letzten Kontrolle am 105. Tag nach der 1. Injektion.

Ergebnisse Nach einer Bevacizumabinjektion kommt es bereits nach 3 Stunden zu einer signifikanten Abnahme des Makulaödems. Diese signifikante Abnahme bleibt bis zum 3. Tag erhalten. Die größte Abnahme findet in den ersten 24 Stunden statt. Patienten, die am 1. Tag (24 Stunden) eine Foveadicke unter 300 µm erreichen, sind 30 Tage später noch rezidivfrei. Die Patienten, die am 1. Tag mehr als 300 µm Foveadicke zeigen, erleiden zu 50% ein Rezidiv nach 30 Tagen. Der günstige Verlauf der 1. Gruppe ist auch bei der letzten Kontrolle am 105. Tag nach der 1. IVOM nachweisbar.

Diskussion und Schlussfolgerung Eine OCT-Untersuchung 24 Stunden nach der 1. IVOM mit Bevacizumab hat einen prognostischen Wert und kann Patienten identifizieren, die längere Therapieintervalle tolerieren und weniger Injektionen benötigen. Mithilfe dieser OCT-Untersuchung 24 Stunden nach der 1. Injektion kann eine Individualisierung der Therapie erfolgen. Auch Patienten, die schlecht auf die Therapie ansprechen, können früh identifiziert werden, um ggf. andere Therapiemöglichkeiten zu erwägen.

Abstract

Introduction The goal of this study was to examine the response of macular edema (ME) secondary to retinal vein occlusion (RVO) to predict macular edema course and re-injection intervals.

Material and Methods Twenty-four eyes from 24 patients with ME secondary to RVO, both central (CRVO) and branch (BRVO), were retrospectively included. All eyes received intravitreal bevacizumab therapy (1.25 mg/0.1 ml). Repetitive optical coherence tomography (OCT) examinations were performed to document the early macular edema response to treatment and the course of the disease during the first three monthly injections until the last follow-up 105 days after the first injection.

Results A significant ME reduction is present as early as three hours after the first injection of bevacizumab. This significant reduction of central retinal thickness (CRT) is present until the third post-injection day. The greatest reduction occurs during the first 24 hours. Patients who reach a CRT less than 300 µm after 24 hours (day 1) have no recurrence after 30 days. Patients with a CRT over 300 µm on day 1 have a 50% rate of recurrence after 30 days. The favorable results of the first group are still present during the last follow-up examination, 105 days after the first injection.

Discussion and Conclusion An OCT examination, 24 hours after the first bevacizumab injection, has a prognostic value and can identify the patients that can tolerate longer intervals between injections, this results in fewer bevacizumab injections during the course of the disease. This way an individualization of the treatment, opposed to a fixed therapy pattern, can be implemented. Also, patients with poor prognosis can be identified early and treatment can be altered or intensified accordingly.

Schlüsselwörter

Retina - Bevacizumab - Prognosefaktoren - retinale venöse Verschlüsse

Key words

retinal vein occlusion - macular edema - prognostic factors - bevacizumab

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