Abstract
Purpose To observe the changes in macular microvascular structure and the correlation between anatomy and visual function in patients with macular edema secondary to branch retinal vein occlusion (BRVO) treated with antivascular endothelial growth factor for one year. Methods This prospective study enrolled 39 patients (one eye per patient) who received intravitreal injections of ranibizumab for macular edema secondary to BRVO. All patients received a minimum of 3 initial monthly ranibizumab injections and criteria-driven pro re nata (PRN) dosing thereafter for visual acuity (VA) and central retinal thickness (CRT) stabilization. The follow-up period of this study was one year. The vascular density (VD) of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP), the foveal avascular zone (FAZ) area, the FAZ perimeter, the VD within a 300 μm wide ring surrounding the FAZ (FD-300), and the acircularity index (AI) were measured automatically by optical coherence tomography angiography (OCTA) at baseline, month 6, and month 12. Results Compared with those before treatment, the VD of the SCP significantly decreased 6 months after treatment (P < 0.05), while the area and perimeter of the FAZ increased significantly (P < 0.01). After 12 months of treatment, the area and perimeter of the FAZ increased significantly (P < 0.01). There was no significant difference in any parameters between 12 months and 6 months after treatment (P > 0.05). The change in BCVA was negatively correlated with the VD of the SCP at 12 months (P=0.0447, r = −0.3233). There was a relationship between the DBP and AI, and CRT was related to VD of DCP at baseline (P=0.028, 0.0209; r = 0.383, −0.384). The PERIM and AI at 12 months were significantly associated with the recurrence of macular edema, and the changes in vascular density in the SCP and PERIM were significantly associated with the number of injections within 12 months (P < 0.05). Conclusions One year after ranibizumab treatment, the area and perimeter of the FAZ were enlarged, while the VD of the SCP and DCP remained stable, which indicated that ranibizumab treatment did not improve macular blood supply and macular ischemia in BRVO patients.
Highlights
Branch retinal vein occlusion (BRVO) is a common sightthreatening retinal vascular disease. e prevalence of BRVO is 4.42 cases per 1,000 people [1, 2]
We found that the visual acuity of BRVO patients significantly improved and central retinal thickness (CRT) significantly decreased, but the area and perimeter of the foveal avascular zone (FAZ) were enlarged, and the vascular density (VD) of macular capillaries was not significantly improved one year after treatment with ranibizumab, as detected by optical coherence tomography angiography (OCTA) software. ese results indicated that intravitreal injection with ranibizumab can effectively treat macular edema, it cannot improve macular blood supply and macular ischemia in patients with BRVO
We found that macular ischemia was aggravated within 6 months after treatment with ranibizumab, and macular ischemia persisted from 6 months to one year and was relatively stable and did not improve or aggravate
Summary
Branch retinal vein occlusion (BRVO) is a common sightthreatening retinal vascular disease. e prevalence of BRVO is 4.42 cases per 1,000 people [1, 2]. Branch retinal vein occlusion (BRVO) is a common sightthreatening retinal vascular disease. The treatment options for BRVO include antivascular endothelial growth factor (VEGF), corticosteroids, and macular lasers [4, 5]. OCTA, as a novel dyeless technology, is instantaneous, fast, noninvasive, and high resolution, and it clearly shows retinal vessels of different levels and enables a direct view of the retinal capillary plexus (DCP), which is involved in BRVO and is not visible on fluorescein fundus angiography (FFA); the observation of abnormal vessels is clearer than in traditional fluorescein fundus angiography (FFA) [6]. A few studies have reported the correlation of anatomy and visional function in BRVO eyes evaluated with OCTA
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