Acute Branch Retinal Vein Occlusion Research Articles

RELATIONSHIP BETWEEN RETINAL HEMORRHAGE ON GREEN AND RED CHANNELS OF ULTRA-WIDEFIELD FUNDUS IMAGES AND RETINAL PERFUSION IN ACUTE BRANCH RETINAL VEIN OCCLUSION.

To explore the relationship between retinal hemorrhage in the green and red channels on ultra-widefield fundus images and the nonperfusion area (NPA) on ultra-widefield fundus fluorescein angiography in patients with acute branch retinal vein occlusion (BRVO). This was a retrospective cross-sectional study with 96 patients, including 46 with ischemic BRVO and 50 with nonischemic BRVO. Correlation analysis between green channel hemorrhage (GCH), red channel hemorrhage (RCH), and NPA was performed. Panretina was divided into posterior and peripheral areas. Ischemic BRVO showed significantly higher GCH% and RCH% than nonischemic BRVO in the peripheral regions (both P < 0.001), whereas no significant differences were observed in the panretinal and posterior areas (all P > 0.05). Significant correlations were found between NPA% in the panretinal and peripheral areas and the corresponding GCH% and RCH% (all P < 0.01). However, no significant correlation was observed between posterior NPA% and posterior GCH% or RCH% (both P > 0.05). In addition, peripheral GCH% and RCH% were related to panretinal NPA% (r = 0.506, P < 0.001; r = 0.558, P < 0.001). Retinal hemorrhage on ultra-widefield fundus image was significantly associated with NPA, providing insights for assessing retinal perfusion status in acute BRVO patients.

Inner Retinal Changes in Acute Experimental BRVO Treated With Bevacizumab or Triamcinolone Acetonide.

Apoptosis is a key process in neural degeneration associated with retinal vascular diseases. Vascular endothelial growth factor (VEGF) antagonists, including bevacizumab, are used to treat macular edema in these diseases. As VEGF has a critical role in the preservation of retinal neuronal cells, this study investigates the effects of bevacizumab on neural damage in a pig model of branch retinal vein occlusion (BRVO) and compares it with triamcinolone acetonide (TA) which is reported to possess neuroprotective properties. Thirty-six pigs had a photothrombotic BRVO in both eyes. Six pigs were injected with bevacizumab in one eye and TA in the fellow eye, then they were sacrificed, the eyes enucleated, and retinas processed at 2, 6, 10, and 20 days, respectively, together with three pigs (six eyes) BRVO only and three normal pigs (six eyes). Neuronal degeneration (apoptosis) and associated inner retinal changes were determined by terminal deoxyynuclotidyl transferase dUTP nick-end labeling (TUNEL), histology, and immunohistochemistry for macrophages. TUNEL labeling showed significantly higher apoptosis rates in the ganglion cell layer (GCL) and the inner nuclear layer (INL) in the bevacizumab-treated compared with the TA-treated retinas at 2, 10, and 20 day time points after occlusion (P < 0.05). Pyknotic cells were significantly higher in the GCL in bevacizumab-treated eyes at 6, 10, and 20 days and in the INL at 2 days compared to TA-treated retinas (P < 0.05). Macrophage infiltration was seen at all time points in both untreated and treated retinas with an absence of significance between bevacizumab- and TA-treated retinas (P > 0.05). Neurodegeneration in the BRVO acute phase is exacerbated by current standard treatments for BRVO. These results may have implications for the timing and treatment type. In the acute phase of BRVO, VEGF suppression with bevacizumab and to a lesser extent with triamcinolone exacerbates apoptosis in the inner retinal layers, which has implications for both the timing and choice of treatment.

Subfoveal Choroidal Thickness and Treatment Outcomes of Intravitreal Aflibercept for Branch Retinal Vein Occlusion.

We aimed to investigate the relationship between subfoveal choroidal thickness (SCT) and treatment outcomes of intravitreal aflibercept (IVA) for macular edema (ME) due to branch retinal vein occlusion (BRVO). We retrospectively evaluated 46 patients with treatment-naive BRVO-ME who underwent IVA treatment between March 2016 and February 2017. There was no significant difference in visual acuity within 6 months (0.29 ± 0.20 vs. 0.27 ± 0.19, p = 0.338), the mean central foveal thickness improvement (332.0 ± 162.2 μm vs. 303.9 ± 166.6 μm, p = 0.492), and the mean number of IVA injections (1.7 ± 0.7 vs. 1.6 ± 0.7 times, p = 0.658) between the SCT thickened (n = 26 patients, 26 eyes) and SCT non-thickened groups (n = 20 patients, 20 eyes). The rate of ME recurrence was significantly lower in the SCT decreased group (6/17 eyes (35.2%) vs. 19/30 eyes (63.3%); p = 0.038). In conclusion, pretreatment choroidal thickening does not affect the therapeutic effect of IVA for BRVO, but ME recurrence was lower in cases of treatment-related choroidal thinning. Thus, changes in SCT may be a therapeutic indicator of IVA for acute BRVO.

Prognostic Value of Hyperreflective Material on Visual Acuity in Treatment-Naïve BRVO.

To correlate between hyperreflective material (HRM) seen on optical coherence tomography (OCT) and visual outcomes in treatment-naïve acute branch retinal vein occlusion (BRVO). Demographic and OCT features of patients with acute BRVO were analyzed retrospectively. OCT parameters noted were macular edema type, HRM presence and location, and outer retinal layer integrity. Eyes were separated into two groups: Group 1 (BRVO without HRM) and Group 2 (BRVO with HRM). Forty-seven eyes (67%) were included in Group 1 and 23 eyes (33%) were included in Group 2. Mean presenting logMAR visual acuity in Groups 1 and 2 was 0.521 ± 0.428 (mean Snellen equivalent = 20/66) and 0.627 ± 0.427 (mean Snellen equivalent = 20/85), respectively. Poor vision at final visit was noted in the BRVO with HRM group (P = .027). More intravitreal injections were required for macular edema resolution in the HRM group (4.83 vs. 2.67). Presence of HRM in BRVO is associated with poorer vision. It can be a useful prognostic biomarker. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:320-327.].

Increased cardio-ankle vascular index values in patients with acute branch retinal vein occlusion.

Purpose:Patients with retinal vein occlusions (RVOs) are at increased risk of cardiovascular disease. Arterial stiffness is an independent risk factor for cardiovascular events. Our aim is to evaluate the arterial stiffness in patients with acute branch retinal vein occlusion (BRVO) by using cardio-ankle vascular index (CAVI).Methods:This prospective study included 42 patients (18 male, mean age 57.5 ± 11.3) with acute BRVO and a matched control group (by age, sex, and presence of hypertension) with 70 (26 male, mean age 54.4 ± 9.4) patients. All patients and control subjects underwent complete ocular examination and CAVI measurement. BRVO was diagnosed based on clinical examination.Results:There were no significant differences between baseline clinical and demographic characteristics, echocardiographic measurements of left ventricular ejection fraction, systolic and diastolic blood pressure, and body mass index of the BRVO and control group. Both right and left CAVI values were found significantly higher in BRVO group (7.94 ± 1.53 vs 7.28 ± 1.25, P < 0.05 and 8.06 ± 1.41 vs 7.30 ± 1.26, P < 0.05, respectively). There were no significant difference in right and left ankle-brachial index values between the groups (1.05 ± 0.10 vs 1.06 ± 0.08, P = 0.46 and 1.04 ± 0.12 vs 1.05 ± 0.08, P = 0.46, respectively).Conclusion:Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI which is a novel marker of the arterial stiffness is increased in patients with acute BRVO compared to controls.

Impact and Implication of Fovea-Involving Intraretinal Hemorrhage after Acute Branch Retinal Vein Occlusion

To compare clinical outcomes in patients with branch retinal vein occlusion (BRVO) with (group A) or without (group B) fovea-involving intraretinal hemorrhage (IRH). Retrospective cohort study. All patients diagnosed with acute, treatment-naive BRVO seen by the Duke Eye Center Retina Service from January 1, 2009, through June 30, 2017 who had treatment-naive BRVO with disease onset <3 months before presentation, macular involvement, spectral-domain OCT and color fundus photographs at presentation, and >12 months offollow-up. Retrospective study using a database of patients diagnosed with BRVO over an 8-year period. The presence of fovea-involving IRH was determined from baseline fundus photographs by human graders and confirmed with multimodal imaging. Presenting features, treatment patterns, and clinical outcomes were compared. Visual acuity (VA), cystoid macular edema (CME), central subfield thickness (CST), and number of anti-vascular endothelial growth factor (VEGF) injections. Of 172 patients with BRVO, 33 (19.2%) presented with fovea-involving IRH. At presentation, group A had worse VA (0.54±0.06 logMAR [Snellen equivalent, 20/69] vs. 0.34±0.03 logMAR [Snellen equivalent, 20/44]; P = 0.001), greater CST (523.8±32 μm vs. 345.9±11.8 μm; P < 0.001), were more likely to have CME (93.9% vs. 48.2%; P < 0.001), and received more anti-VEGF injections in the first year (4.50±3.43 vs. 1.89±3.26; P < 0.001) than group B. Final VA was worse in group A (0.57±0.12 logMAR [Snellen equivalent, 20/74] vs. 0.35±0.05 logMAR [Snellen equivalent, 20/45]; P = 0.05). More patients in group A had loss of >2 lines of VA (36.4% vs. 18.7%; P = 0.04) or >3 lines (27.3% vs. 10.8%; P = 0.05) at final follow-up. Group A was more likely to have CME (63.6% vs. 27.3%; P < 0.001) at final follow-up with greater treatment burden, yet experienced a greater decrease in CST (-197.8±45.3 μm vs. -51.7±14.7 μm; P = 0.005). Acute BRVO presenting with fovea-involving IRH is associated with worse presenting features, greater treatment burden, and worse clinical outcomes despite current therapeutic interventions.

Evaluation of Vascular Morphological Changes in The Superficial and Deep Retinal Plexuses by Optical Coherence Tomography Angiographyin Cases of Acute Phase Branch Retinal Vein Occlusion

Background: Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and an important cause of visual morbidity and blindness Aim of the work: was to detect if there are diagnostic signs in the two intra retinal layers superficial network layer and deep network layer by Optical coherence tomography angiography (OCT-A) to diagnose branch retinal vein occlusion. Patients and Methods: an observational cross-sectional study included a total of ten patients with branch retinal branch retinal vein occlusion of recent onset within three months attending at the Ophthalmology Department AlAzhar University Hospitals, Cairo. Demographic data such as age, gender, sex and hypertensive history were obtained. A detailed evaluation of cases including complete anterior segment evaluation and posterior segment evaluation was done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological changes in the branch retinal vein occlusion (BRVO)area. Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no ischemia in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that detected the ischemia in the superficial retinal plexus (SCP) in 4 cases (40%) and detected no ischemia in 6 cases (60%), but it detected the ischemia in the deep retinal plexus (DCP) in 6 cases(60%) and detected no ischemia in 4 cases (40%). Conclusion: It could be concluded that that OCT-A was superior to FA in detection of macular ischemia, macular ischemia detected by OCT-A had stronger negative relation with V.A. than macular ischemia detected by FA and retinal ischemia in the DCP was more evident than that of SCP by OCT-A.

Evaluation of Vascular Morphological Changes in The Superficial and Deep Retinal Plexuses by Optical Coherence Tomography Angiographyin Cases of Acute Phase Branch Retinal Vein Occlusion

Evaluation of Vascular Morphological Changes in The Superficial and Deep Retinal Plexuses by Optical Coherence Tomography Angiographyin Cases of Acute Phase Branch Retinal Vein Occlusion

Acute retinal vein occlusion and cystic fibrosis

BackgroundThe ocular manifestations of cystic fibrosis typically present with surface irritation or nyctalopia due to Vitamin A deficiency, however, there have been two previous reports of patients with cystic fibrosis that developed retinal vein occlusions. These reports hypothesized that either elevated fibrinogen levels due to chronic infections or elevated homocysteine levels have predisposed patients with cystic fibrosis to develop retinal vein occlusions.Case presentationWe present a case of a 35-year-old male with cystic fibrosis complicated by chronic sinusitis with no history of organ transplantation or chronic pulmonary infections who presented with an acute branch retinal vein occlusion in his left eye with associated macular edema. Evaluation revealed an elevated fibrinogen level, while the rest of his workup was relatively unremarkable including a normal homocysteine level. His vision remained 20/20 throughout his care and he did not require treatment of his macular edema.ConclusionsPatients with cystic fibrosis are at an increased risk of developing retinal vein occlusions likely due to a variety of systemic thrombogenic factors rather than a single risk factor which had been reported previously. Elevated fibrinogen levels in these patients may not be due to chronic infections, but inherent to the cystic fibrosis.

Evaluation of Capillary Network Abnormalities in Branch Retinal Vein Occlusion by Optical Coherence Tomography Angiography

Objectives: Is to detect the vascular morphological changes in the two intra retinal; layers superficial network layer and deep network layer by optical coherence tomography angiography (OCT-A) in cases with acute onset branch retinal vein occlusion (BRVO). Study Design: An observational cross-sectional study in new Kafer El-Sheikh Ophthalmology Hospital. Population: This study included ten patients with (BRVO) of recent onset within the last three months. Methods: Demographic data such as age, gender, sex and hypertensive history were obtained. A detailed evaluation of cases including complete anterior segment evaluation and posterior segment evaluation was done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological changes in the (BRVO) area. Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no ischemia in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that detected the ischemia in the superficial capillary plexus (SCP)in 4 cases (40%), and detected no ischemia in 6 cases (60%), but it detected the ischemia in the deep capillary plexus (DCP) in 6 cases (60%) and detected no ischemia in 4 cases (40%). Conclusion: Our study demonstrated that OCT-A was superior to FA in detection of macular ischemia in cases with acute onset branch retinal vein occlusion (BRVO), macular ischemia detected in the DCP by OCT- A had stronger negative relation with V.A. than that of SCP. By OCT-A macular edema (ME) was present mainly in the DCP compared to SCP.

Neuronal degeneration and associated alterations in cytokine and protein in an experimental branch retinal venous occlusion model

The mechanisms of neuronal degeneration and associated acute alterations in intraretinal cytokine and protein levels remain poorly understood in variable ischaemic retinopathies such as in branch retinal vein occlusion (BRVO). Herein we investigate neuronal damage and alterations in retinal cytokines and proteins in a pig model of acute BRVO. Twelve pigs had a BRVO induced photothrombotically in both eyes. Three pigs (6 eyes) each at 2, 6, 10 and 20 days were sacrificed together with an additional 3 control (6 eyes), enucleated, retinas dissected and processed. Apoptosis in the inner retina was determined by terminal deoxyynuclotidyl transferase mediated dUTP nick end labelling (TUNEL) and histology. Expression of glial acidic fibrillary protein (GFAP), aquaporin-4 (AQP4), inward rectifier potassium channel 10 protein (Kir 4.1) encoded by KCNJ10 gene, vascular endothelial growth factor (VEGF), stromal derived growth factor-1α (SDF-1) encoded by CXCL12 gene and interleukin (IL) −6 and 8 were analysed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) and immunohistochemistry. TUNEL labelling showed positive nuclei in the ganglion cell layer (GCL) and the inner nuclear layer (INL) which was significantly higher at 2 days after BRVO compared to other time points (p < 0.05). Analysis by RT-qPCR revealed that compared with controls, BRVO significantly increased mRNA expression of GFAP at 6, 10 and 20, AQP4 at 20, VEGF at 6, SDF-1 at 20 and IL-8 at 2 and 10 days respectively (p < 0.05): Kir 4.1 at 6, VEGF at 2 and 10, and IL-6 at 2 days were significantly decreased (p < 0.05). This study indicates that neural cell death occurs early in this acute model and the responses include inflammation and breakdown of osmohomeostasis as evidenced by the upregulation of GFAP and IL-8 and down regulation of Kir 4.1 associated with glyotic changes. Early short term VEGF upregulation seen may be related to involvement of Muller glial cells. These findings support the development of acute therapeutic strategies aimed at preservation of retinal neural cells as part of an overall management plan for BRVO.

Association between retinal hemorrhagic pattern and macular perfusion status in eyes with acute branch retinal vein occlusion.

This prospective study included 63 eyes with acute branch retinal vein occlusion (BRVO) to evaluate the retinal hemorrhagic patterns at the posterior poles and explore their clinical relevance in macular perfusion differentiation. Retinal hemorrhagic patterns and macular perfusion status were evaluated via fundus photography and fluorescein angiography, respectively. Macular perfusion was judged as nonischemic in 30, ischemic in 28, and undeterminable in 5 among the 63 eyes. Predominant hemorrhagic patterns were flame-shaped in 39 (67.2%) and non-flame-shaped in 19 (32.8%) eyes. All 39 eyes with a flame-shaped hemorrhage showed a nonischemic macula. Of the 19 eyes classified as having a non-flame-shaped hemorrhage, 13 (68.4%) had an ischemic macula and 6 (31.6%) had a nonischemic macula (P < 0.001). Parallelism in eyes with a flame-shaped hemorrhage was higher than in those with a non-flame-shaped hemorrhage (P < 0.001), and in those with a nonischemic macula versus those with an ischemic macula (P < 0.001). The area under the curve for parallelism was 0.975 (P < 0.001), suggesting an accurate diagnostic parameter for macular perfusion differentiation. In conclusion, we objectively evaluated retinal hemorrhagic patterns at the posterior pole in BRVO using the parallelism method, which was useful in differentiating macular perfusion status.

Metamorphopsia Associated with Branch Retinal Vein Occlusion

PurposeTo apply M-CHARTS for quantitative measurements of metamorphopsia in eyes with acute branch retinal vein occlusion (BRVO) and to elucidate the pathomorphology that causes metamorphopsia.MethodsThis prospective study consisted of 42 consecutive patients (42 eyes) with acute BRVO. Both at baseline and one month after treatment with ranibizumab, metamorphopsia was measured with M-CHARTS, and the retinal morphological changes were examined with optical coherence tomography.ResultsAt baseline, metamorphopsia was detected in the vertical and/or horizontal directions in 29 (69.0%) eyes; the mean vertical and horizontal scores were 0.59 ± 0.57 and 0.52 ± 0.67, respectively. The maximum inner retinal thickness showed no association with the M-CHARTS score, but the M-CHARTS score was correlated with the total foveal thickness (r = 0.43, p = 0.004), the height of serous retinal detachment (r = 0.31, p = 0.047), and the maximum outer retinal thickness (r = 0.36, p = 0.020). One month after treatment, both the inner and outer retinal thickness substantially decreased. However, metamorphopsia persisted in 26 (89.7%) of 29 eyes. The posttreatment M-CHARTS score was not correlated with any posttreatment morphological parameters. However, the posttreatment M-CHARTS score was weakly correlated with the baseline total foveal thickness (r = 0.35. p = 0.024) and closely correlated with the baseline M-CHARTS score (r = 0.78, p < 0.001).ConclusionsMetamorphopsia associated with acute BRVO was quantified using M-CHARTS. Initial microstructural changes in the outer retina from acute BRVO may primarily account for the metamorphopsia.

Changes in Choroidal Thickness in Branch Retinal Vein Occlusion

Purpose: To compare the choroidal thickness of a branch retinal vein occlusion (BRVO) lesion and that of other areas in the eyes. Methods: Patients who visited the Ophthalmologic Clinic of Inje University Sanggye Paik Hospital for BRVO between March 2015 and October 2015 were reviewed retrospectively. We performed basic ophthalmologic exam and enhanced depth imaging optical coherence tomography in 48 eyes of 24 patients with BRVO. The choroidal thickness was compared in a total of 4 places, the branch retinal vein occlusion lesion, the symmetric site in the same eye, and the equivalent sites in the fellow eye by paired t-test. All measurements were performed by 2 independent observers. Results: Choroidal thickness had strong inter-observer correlation. Choroidal thickness of the BRVO lesion was significantly thicker than that in the symmetric site of same eye, the equivalent site of lesion, and the equivalent site of the symmetric site to lesion in the fellow eye. Conclusions: Choroidal thickness in acute BRVO lesions was thicker than choroidal thickness in other areas of the eyes. It is thought that both hydrostatic pressure and the effects of vascular endothelial growth factor influence choroidal thickness in the acute phase of BRVO. J Korean Ophthalmol Soc 2016;57(8):1222-1227

Foveal Damage Due to Subfoveal Hemorrhage Associated with Branch Retinal Vein Occlusion.

To investigate the functional and morphologic prognoses of eyes with subfoveal hemorrhage from acute branch retinal vein occlusion (BRVO), and to examine the effect of intravitreal ranibizumab injection (IVR) on these prognoses, we assessed 81 eyes with acute BRVO, of which 38 did not receive IVR [IVR(-) group], and 43 were treated with IVR [IVR(+) group] for macular edema. The foveal morphologic changes were examined via optical coherence tomography (OCT). At initial examination, 63 eyes exhibited subfoveal hemorrhage. At final examination, the defect lengths in the foveal external limiting membrane (ELM) and ellipsoid lines in these eyes were longer, and final VA was significantly poorer, compared with eyes without subfoveal hemorrhage. In comparisons between the final measurements in eyes with subfoveal hemorrhage in the IVR(-) and IVR(+) groups, while there were no differences in initial ocular conditions, final VA was significantly better in the IVR(+) group. The defects in the ELM and ellipsoid lines in the IVR(+) group were shorter than those of the IVR(-) group (p = 0.002 in both). Final VA was correlated with the defect lengths of foveal ELM and ellipsoid lines in both the IVR(-) and IVR(+) groups (both p < 0.001). In addition, the defect lengths of foveal ELM and ellipsoid lines were closely correlated with the duration of subfoveal hemorrhage (both p < 0.001). BRVO-associated subfoveal hemorrhage caused damage to the foveal photoreceptors, and visual dysfunction. However, IVR improved these prognoses, by accelerating the absorption of the subfoveal hemorrhage.

Comparative analysis of the development of collateral vessels in macular edema due to branch retinal vein occlusion following grid laser or ranibizumab treatment.

PurposeTo evaluate the differences in the development of collateral vessels in patients with macular edema due to branch retinal vein occlusion (BRVO) after treatment with either grid laser or ranibizumab (RNB).MethodsComparative study including patients with macular edema due to acute BRVO and best-corrected visual acuity (BCVA) between 20/40 and 20/200. The sample was divided into two groups according to the treatment applied: laser group, including eyes treated with Argon laser when retinal hemorrhages were sufficiently absorbed to perform the treatment, and RNB group, including patients treated initially with one monthly intravitreal injection for a period of 3 months of RNB and more injections according to need thereafter. Before treatment patients in both groups, received a complete ophthalmic examination, including BCVA, fundus examination, optical coherence tomography, fundus color photography, and fundus fluorescein angiography (FA). This same protocol of examination was repeated in every visit after treatment, except FA that was only repeated every 3 months. The detection of the collateral vessels was done by two experienced examiners based on the analysis of the early phase of the FA. If there was a discrepancy in their judgment, the criterion of a third examiner evaluating the FA was considered.ResultsMean baseline BCVA was 0.86±0.26 and 0.82±0.25 (logMAR [logarithm of the minimum angle of resolution]) in the RNB and laser groups, respectively (P=0.83). At the end of the follow-up, mean BCVA was 0.38±0.18 and 0.64±0.33 (logMAR) in the RNB and laser groups, respectively. The difference in the final BCVA between both groups was statistically significant (P=0.002). Collaterals developed in both groups; 66.67% of patients (14 out of 21 patients) developed collaterals at a mean time of 6.14±2.60 months after diagnosis in the RNB group, and 68.18% (16 out of 22 patients) developed collaterals in the laser group at a mean time of 6.2±1.97 months after diagnosis. No statistically significant differences between groups were found in the number of cases developing collateral vessels (P=1.00) as well as in the time required for such development (P=0.947).ConclusionThe use of RNB for the treatment of macular edema due to BRVO does not seem to alter the development of collateral vessels. Future studies with larger samples are required to confirm these outcomes.

Regional Choroidal Thickness Changes in Branch Retinal Vein Occlusion with Macular Edema

Purpose: To investigate regional changes in choroidal thickness in branch retinal vein occlusion (BRVO) patients with macular edema. Methods: Choroidal thickness in the subfoveal, occlusive, and nonocclusive areas in BRVO eyes was measured using enhanced depth imaging by spectral domain optical coherence tomography. The choroidal thickness was compared with the corresponding values both in the fellow eye and in normal controls at baseline. Regional changes in choroidal thickness were then evaluated in the BRVO eyes after intravitreal bevacizumab (IVB) injections. Results: Regional choroidal thickness was measured in 57 eyes at baseline. The mean choroidal thickness of the occlusive area was significantly higher than that of the nonocclusive, subfoveal, and corresponding areas in the fellow eyes and normal controls (p < 0.001). The choroidal thickness in the occlusive area correlated with the retinal thickness in both the central and occlusive areas (rho = 0.590, p < 0.001, and rho = 0.351, p = 0.011, respectively), but not with visual acuity. After IVB, the choroidal thickness in the occlusive area had decreased significantly (p = 0.004), but remained higher than that of other areas (p < 0.001 and p = 0.026). Conclusion: In acute BRVO eyes, the choroid is thicker in the occlusive area. This difference is correlated with the severity of macular edema, but not with visual acuity. Bevacizumab reduces choroidal thickness, but does not restore normal values.

Sarkoidozun İlk Belirtisi Olarak Vitreus Kanamalı Bilateral Akut Retinopati

Acute retinopathy and vitreous hemorrhage (VH) are very rare ocular manifestations of sarcoidosis. A 42-year-old male patient complained of blurred vision and floaters in his left eye for three weeks. On the ophthalmologic examination, bilateral acute retinopathy and VH were observed. Superotemporal branch retinal vein occlusion (BRVO), retinal fibrovascular membrane and VH in the left eye were noted via fundus fluorescein angiography. Mediastinal lymphadenopathies were detected during systemic evaluation of the patient. Transthoracic lymphoid biopsy from the mediastinal region, confirmed the diagnosis of sarcoidosis histologically. Although the patient was treated with oral steroids for sarcoidosis, he underwent pars plana vitrectomy and membranectomy due to progressive VH and tractional fibrovascular membrane. Sarcoidosis should be considered within the differential diagnosis list in patients with bilateral acute retinopathy, BRVO, and VH. Improved outcomes can be achieved through early recognition of the underlying disease and appropriate therapy.

Bevacizumab Treatment for Acute Branch Retinal Vein Occlusion Accompanied by Subretinal Hemorrhage

Purpose: The purpose of this study was to compare the efficacy of intravitreal bevacizumab (IVB) in the treatment of acute (<3 months [mo]. duration) macular edema (ME), with or without subretinal hemorrhage (SRH), resulting from branch retinal vein occlusion (BRVO).Materials and methods: We conducted a retrospective review of 33 consecutive patients (n = 33 eyes) with ME caused by acute BRVO. All patients received an injection of IVB at baseline examination. All patients were followed monthly, with administration of additional IVB injections if there was persistent or recurrent ME. Specific patterns of ME were investigated using spectral-domain optical coherence tomography (SD-OCT).Results: SD-OCT revealed serous retinal detachments in the fovea of 15 eyes, 10 of which had accompanying foveal SRH. Based on initial detection of foveal SRH, patients were divided into SRH-negative (n = 23 eyes) or SRH-positive (n = 10 eyes) groups. Initial best-corrected visual acuity (BCVA) did not differ between the two groups. In the SRH-negative group, both BCVA and central macular thickness (CMT) improved significantly after IVB injections (mean, 2.3 injections) at the 6-mo. follow-up examination. In the SRH-positive group, there was no significant improvement in BCVA after IVB injections (mean, 2.0 injections), although there was a significant decrease in CMT. The final BCVA of the SRH-positive group was significantly poorer than that of the SRH-negative group (p = 0.001).Conclusion: The presence of foveal SRH may be a negative predictor of IVB treatment outcomes for BRVO patients with ME.

Changes in retinal blood flow in patients with macular edema secondary to branch retinal vein occlusion before and after intravitreal injection of bevacizumab.

To investigate the effect of intravitreal bevacizumab (IVB) injections for macular edema secondary to acute branch retinal vein occlusion on the retinal microcirculation. The study was a prospective, interventional case series. Central macular thickness using spectral-domain optical coherence tomography and retinal blood flow (RBF) in untreated eyes with macular edema secondary to acute branch retinal vein occlusion in occluded (V1) and opposite venules in affected eyes (V2) and the equivalent venules in contralateral eyes (V3), using laser Doppler velocimetry during follow-up and after IVB injection, were measured. In 33 eyes with acute branch retinal vein occlusion of <2 months of duration at the first visit, changes in the retinal microcirculation for 1 month was observed; the macular edema improved spontaneously, and the RBF was unchanged in 15 of 33 eyes, and the RBF increased by 23.3% in 18 eyes with persistent macular edema. Twenty-four eyes received an IVB injection (1.25 mg per 0.05 mL). The RBF did not change significantly during follow-up. In 8 of 24 eyes (33%) with improved macular edema 3 months after the treatment, the average RBF values before injection were significantly higher compared with that of eyes with recurrent edema. One IVB injection might have little effect on the retinal microcirculation in patients with macular edema secondary to acute branch retinal vein occlusion at least 3 months after the injection. However, the increased RBF in the occluded venules before injection might be associated with improved macular edema after the IVB injection.