The Role of Serum Inflammation-Based Factors in Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion and Its Subtypes

Objective: The aim of this work was to evaluate the association between pretreatment inflammation-based factors and outcomes in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) and its subtypes after intravitreal ranibizumab or conbercept implant. Methods: This retrospective observational study included patients who were diagnosed with ME secondary to RVO at the First Affiliated Hospital of Nanchang University between January 2017 and January 2019, and who subsequently received intravitreal anti-vascular endothelial growth factor (VEGF) treatment. Blood-based parameters were measured before treatment, and correlations between best-corrected visual acuity (BCVA) and each of 3 parameters - neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) - were analyzed to identify predictors of effective intravitreal injection treatment outcomes. Results: A total of 315 treatment-naive eyes treated with anti-VEGF drugs for RVO-ME were retrospectively analyzed in this study. The mean PLR value was significantly different in the effective and ineffective group for RVO-ME (138.03 +/- 48.61 vs. 106.79 +/- 27.28), branch RVO (BRVO)-ME (216.47 +/- 53.04 vs. 185.94 +/- 51.47), and central RVO (CRVO)-ME (231.07 +/- 66.05 vs. 196.20 +/- 60.44). The cutoff value of the PLR was 97.92, the area under the curve was 0.70, and the sensitivity and specificity were 81.5 and 44.3%, respectively. The mean NLR value was significantly different in the effective and ineffective groups for RVO-ME (2.20 +/- 1.40 vs. 1.92 +/- 0.89), and BRVO-ME (2.01 +/- 0.80 vs. 1.82 +/- 0.84), but not in patients with CRVO-ME (2.51 +/- 2.02 vs. 2.12 +/- 0.95). There are no significant differences between BRVO-ME and its subtype groups in MLR values. But the mean MLR value was significantly higher in the conbercept group than in the ranibizu-mab group among patients in the effective group (0.27 +/- 0.11 vs. 0.25 +/- 0.14). Conclusion: Higher pretreatment PLR was associated with BCVA in patients with RVO-ME and its subtypes who were treated with anti-VEGF drugs. The PLR may be used as a predictive and prognostic tool for effective intravitreal injection treatment outcomes.