Disorganization of Retinal Inner Layers in Retinal Vein Occlusions: New Insights From Anti-VEGF Treatment

Abstract

Purpose: The purpose of this study is to determine the significance of disorganization of the retinal inner layers (DRIL) in patients with retinal vein occlusions (RVOs) and whether this is influenced by the choice of antivascular endothelial growth factor (anti-VEGF) agent used. Methods: A retrospective chart study was conducted on patients with RVO and center-involved macular edema (ME) presenting to the University of Wisconsin with a minimum follow-up time of 12 months. Medical records were reviewed for demographics, vision, and imaging at baseline and 2 study visits over the course of 1 year. Two masked graders evaluated spectral-domain optical coherence tomography scans for DRIL and other features within the 1-mm-wide area centered on the foveal depression. Results: Twenty-two eyes had DRIL at baseline. DRIL resolved in 10 eyes at the first study visit, and in 2 more eyes at the second study visit. Although we could not establish an association between visual acuity (VA) and DRIL at baseline, we found a more robust correlation between DRIL extent and VA at baseline in eyes with central retinal vein occlusion/hemicentral vein occlusion compared to eyes with branch retinal vein occlusion. There was an association between DRIL improvement at the first study visit and VA improvement at the second study visit ( P = .049). However, this effect was smaller than the effect of initial VA improvement on final VA improvement. No significant difference in DRIL change was observed between the 3 anti-VEGF treatment algorithms: bevacizumab only, aflibercept only, and bevacizumab followed by aflibercept. Additionally, there was no significant correlation between RVO risk factors and change in DRIL over time. Conclusions: In our study, DRIL was not associated with VA in RVO-ME, but its resolution was predictive of VA improvement in response to anti-VEGF therapy. The choice of anti-VEGF agent (bevacizumab, aflibercept or a combination of the 2) did not affect the magnitude of DRIL resolution in RVO.