Abstract
Background/aimsTo evaluate retinal hard exudates (HEs) progression in patients with cystoid macular edema (CME) secondary to diabetic retinopathy (DR) or branch retinal vascular occlusion (BRVO) after intravitreal injections of ranibizumab (IVR) treatment and identify the risk factors for the deterioration of HEs.MethodsThis retrospective study enrolled 288 eyes with center-involving CME secondary to DR or BRVO from 288 patients (one eye per patient). All patients were treated with three loading doses of ranibizumab intravitreally at a monthly interval. The morphologic features of HEs were observed, and the HEs areas were quantified using a semi-automatic method at baseline, 1 month after the first dose of IVR and 1 month after the third dose of IVR therapy. HEs progression was defined as having a > =2-grade increase in the HEs severity scale. The best-corrected vision acuity (BCVA) and alterations in HEs areas were compared between DR and BRVO groups. And logistic regression analyses were used to identify the risk factors for HEs exacerbation.ResultsMorphological changes of retinal HEs occurred in all eyes after IVR therapy, although HEs area was not significantly changed in some eyes. DR group has a higher percentage of eyes with progressed HEs area than the BRVO groups (34.9% vs. 21.8%, P = 0.019) 1 month after the first dose of IVR. Both DR and BRVO groups had a decreased percentage of enlarged HEs 1 month after the third injection, but the DR group is still higher than the BRVO group (17.1% vs. 8.4%, P = 0.027). At baseline, there was no correlation between VA and HEs areas. After the first and third doses of IVR, there still was no consistent correlation between HEs severity and change in VA over time. Furthermore, CME with subretinal fluid (SRF) is associated with a higher risk of HEs progression (P = 0.001). Long CME duration and high serum low-density lipoprotein cholesterol (LDL-C) level were identified as risk factors for HEs progression following IVR treatment in both univariable and multivariable regression analyses (Odds ratio (OR) = 1.88, P = 0.012 and OR = 1.14, P = 0.021, respectively).ConclusionsAlterations in the area of retinal HEs are widely observed after IVR treatment for CME. The eyes with CME secondary to DR have a higher percentage of progressed HEs than the BRVO eyes. DME with SRF, extended duration of CME, and high LDL-C level are potential risk factors of deteriorated HEs after IVR treatment.
Highlights
Macular edema (ME) is a major vision-threatening complication in patients with diabetic retinopathy (DR) [1] or other retinal vascular disorders, such as retinal venous occlusion (RVO) [2]
Alterations in the area of retinal hard exudates (HEs) are widely observed after IVR treatment for cystoid macular edema (CME)
The eyes with CME secondary to DR have a higher percentage of progressed HEs than the branch retinal venous occlusion (BRVO) eyes
Summary
Macular edema (ME) is a major vision-threatening complication in patients with diabetic retinopathy (DR) [1] or other retinal vascular disorders, such as retinal venous occlusion (RVO) [2]. In these ischemic retinal diseases, breakdown of the blood-retina barrier leads to increased vascular permeability of the macular capillaries and results in the various appearance of ME [3]. One of the most common reasons is the occurrence of retinal hard exudates (HEs), which can be frequently observed along with ME [5]; profound central vision loss will occur when HEs congregate at the foveal center. Since it is difficult to improve visual acuity when outer retina structures of macular are destroyed by HEs, there is an urgent need to improve our understanding of the pathophysiologic mechanisms of HEs development and prevent it from reaching the foveal center
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