Abstract
Purpose: To investigate the changes in the macular microvascular structure after anti-vascular endothelial growth factor (anti-VEGF) treatment in retinal vein occlusion (RVO) patients with and without macular ischemia.Methods: A total of 39 patients were divided into the macular ischemia group (n = 22) and the nonischemia group (n = 17) at baseline. All the patients received an intravitreal injection of ranibizumab with a 3+ pro re nata (PRN) regimen. The foveal avascular zone (FAZ) areas, macular vessel density (VD), and macular ischemic index (ISI) were evaluated at baseline and 3 and 6 months after treatment.Results: After treatment, some patients in the macular ischemia group achieved obvious reperfusion in macular nonperfusion areas. The VD and macular ISI improved in RVO patients, but the changes in VD and macular ISI were different in the two groups. The improvement of best corrected visual acuity (BCVA) was positively correlated with the improvement of macular perfusion status. Macular perfusion remained stable in most patients in RVO and only one patient had macular ischemia aggravation.Conclusion: The macular microvascular structures were stable in most RVO patients after anti-VEGF treatment. At the same time, some patients with macular ischemia presented reperfusion in macular nonperfusion areas, and still a few patients presented aggravated macular ischemia. Macular ISI is a good way to evaluate macular perfusion status in RVO compared to VD.
Highlights
Retinal ischemia caused by retinal vein occlusion (RVO) has been of great concern in clinical studies and is present in ∼66% of main branch RVO (BRVO) and ischemic central RVO (CRVO) cases [1, 2]
In the macular ischemia group, the logarithm of the minimum angle of resolution best corrected visual acuity (BCVA) changed from 0.85 ± 0.42 to 0.61 ± 0.35 (p < 0.001) and to 0.60 ± 0.41 (p = 0.908) and the foveal avascular zone (FAZ) area and central foveal thickness (CFT) showed no significant changes
The superficial layer vessel density (VD) changed from 40.2 ± 4.6% to 41.7 ± 4.8% (p = 0.009) and to 41.7 ± 5.2% (p = 0.966), whereas the superficial macular ischemic index (ISI) changed from 57.8 ± 4.5% to 56.1 ± 4.7% (p = 0.010) and to 56.0 ± 4.9% (p = 0.902) at the endpoint
Summary
Retinal ischemia caused by retinal vein occlusion (RVO) has been of great concern in clinical studies and is present in ∼66% of main branch RVO (BRVO) and ischemic central RVO (CRVO) cases [1, 2]. Anti-vascular endothelial growth factor (VEGF) treatment, as a first-line treatment for RVO, has been proven to significantly improve macular edema. It has been controversial whether anti-VEGF treatment aggravates ischemia. Terui et al [3] reported increased nonperfusion areas after anti-VEGF treatment in several cases. Other studies have suggested that retinal ischemia develops gradually and irreversibly, Macular Ischemia Improving in RVO irrespective of anti-VEGF treatment [4, 5]. Campochiaro et al [6] have shown that anti-VEGF treatment effectively improves macular edema and prevents the progression of nonperfusion areas. No study has compared the different anti-VEGF treatments in RVO patients with and without macular ischemia
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