Capillary Nonperfusion Research Articles

Peripheral Capillary Nonperfusion and Vitreolesional Adhesion in Retinal Cavernous Hemangioma

Velazquez-Martin, Juan P. MD*; Domville, Daniela MD†; Fulda, Emiliano MD†; Graue-Wiechers, Federico MD†; Simpson, E. Rand MD*Editor(s): Toth, Cynthia A.; Martel, Joseph; Yiu, Glenn Author Information

Changes of macular sensitivity and morphology after pars plana vitrectomy for macular edema with central retinal vein occlusion: a case series

BackgroundIt is unclear how retinal ischemia influences the changes of visual acuity, macular sensitivity, macular thickness, and macular volume after the performance of pars plana vitrectomy (PPV) for macular edema in patients with central retinal vein occlusion (CRVO).MethodsTen patients (10 eyes) with CRVO and macular edema underwent PPV. Retinal ischemia was evaluated from the area of capillary nonperfusion on fluorescein angiography, and the patients were classified into ischemic or nonischemic groups. Microperimetry was performed with a Micro Perimeter 1. Macular thickness and volume were measured by optical coherence tomography.ResultsIn both groups, the mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly from baseline to 3 and 6 months after PPV (all P < 0.05). In the ischemic group, the mean macular sensitivity within the central 4°, 10°, and 20° fields increased from baseline to 3 and 6 months after PPV, but no significant difference was observed.ConclusionsThese results suggest that PPV may be effective for improving macular thickness, volume, and sensitivity in patients with macular edema secondary to ischemic CRVO, although there was no significant difference.

Paraquat-Induced Retinal Degeneration Is Exaggerated in CX3CR1-Deficient Mice and Is Associated with Increased Retinal Inflammation

To investigate the role of the Fractalkine receptor CX3CR1 pathway in oxidative insults-mediated retinal degeneration and immune activation. A prooxidant, paraquat (0.75 μM) was injected into the vitreous of C57BL/6J, CX3CR1(gpf/+), and CX3CR1(gfp/gfp) mice. Retinal lesions were investigated clinically by topic endoscopic fundus imaging and fluorescence angiography, and pathologically by light- and electron microscopy. Retinal immune gene expression was determined by real-time RT-PCR. Microglial activation and immune cell infiltration were examined by confocal microscopy of retinal flatmounts. Intravitreal injection of paraquat (0.75 μM) resulted in acute retinal capillary nonperfusion within 2 days, which improved from 4 days to 4 weeks postinjection (p.i.). Panretinal degeneration was observed at 4 days p.i. and progressed further at 4 weeks p.i. In the absence of CX3CR1, retinal degeneration was exaggerated and was accompanied by increased TNF-α, iNOS, IL-1β, Ccl2, and Casp-1 gene expression. Confocal microscopy of retinal flatmounts revealed microglial activation and CD44(+)MHC-II(+) monocyte and GR1(+) neutrophil infiltration in paraquat-injected eyes. The number of activated microglia and infiltrating leukocytes was significantly higher in CX3CR1(gfp/gfp) mice than in CX3CR1(gfp/+) mice. Our results suggest that the CX3CR1 signaling pathway may play an important role in controlling retinal inflammation under oxidative and ischemia/reperfusion conditions. In the absence of CX3CR1, uncontrolled retinal inflammation results in exaggerated retinal degeneration.

Characteristics and Ophthalmic Manifestations of the Classic Dengue Fever Epidemic in Singapore (2005-2006).

The aim of this study was to report the characteristics and ophthalmic manifestations associated with dengue fever (DF) in the 2005-2006 DF epidemic in Singapore. A retrospective case series. Eleven patients (7 males, 4 females) who were 14 to 40 years old (mean age, 27.3 years) with visual complaints occurring 1 to 2 weeks after the onset of DF underwent a complete ophthalmologic examination. The presenting visual acuity (VA) ranged from 6/6 to counting fingers. Five patients had bilateral eye involvement. Ophthalmic findings included retinal hemorrhages (15 eyes), cotton wool spots (15 eyes), retinal pigment epithelium alterations (5 eyes), optic disc swelling (3 eyes), foveolitis (3 eyes), and hyperemia (2 eyes). Impaired color vision was noted in 12 eyes. Visual field defects were noted in 13 eyes; 4 of these eyes were asymptomatic. Fundus fluorescein angiography was done in 9 patients; the findings include choroidal hyperfluorescence (9 eyes), blocked fluorescence (8 eyes), and capillary nonperfusion (1 eye). In 2 eyes, it was normal. Electrophysiology confirmed optic neuropathy in 3 eyes and maculopathy in 1 eye. The follow-up ranged from 12 days to 12 months. The VA at the last follow-up ranged from no light perception to 6/6. Visual field abnormalities were noted in 5 eyes despite a normal VA. Dengue fever is associated with a wide spectrum of ophthalmic manifestations. Rarely, ophthalmic complications in DF can result in permanent visual impairment. Further work can be done to elucidate the relationship between systemic and ocular manifestations of DF.

Peripheral capillary nonperfusion and full-field electroretinographic changes in eyes with frosted branch-like appearance retinal vasculitis

We report a patient with frosted branch-like appearance retinal vasculitis associated with peripheral capillary nonperfusion and full-field electroretinographic changes. A 62-year-old man presented with sudden bilateral decreased vision accompanied by headaches. His best-corrected visual acuity was 0.01 in both eyes. Fundus examination and fluorescein angiography showed bilateral frosted branch-like appearance retinal vasculitis, and spectral-domain optical coherence tomography showed severe macular edema in both eyes. The cerebrospinal fluid analyses showed an increased lymphocyte count and protein levels. He was treated with systemic corticosteroid therapy, and his best-corrected visual acuity improved to 0.8 OD and 1.0 OS at 6 months after onset. However, fluorescein angiography showed a lack of capillary perfusion in the periphery, and the oscillatory potentials on full-field electroretinography were severely reduced in both eyes. These findings indicated extensive retinal ischemia and inner retinal dysfunction, and that fluorescein angiography and full-field electroretinograms can be useful during follow-up of eyes with frosted branch-like appearance retinal vasculitis.

Visual field deficit in diabetes mellitus in presence of no or minimal diabetic retinopathy

Introduction: Central visual field examination is a great clinical interest in diabetes mellitus, since changes in the visual field would be accepted as an indication of pathological condition. Hence, it is reflecting structural abnormalities in the ocular and the neural mechanisms of vision. The central visual field was examined in this study to investigate possible early changes in the macular area with a view to providing an assessment of early neural functional integrity in the presence of no or minimal diabetic retinopathy. Materials and Methods The investigation was carried out on a healthy visual system control group and a number of age-and sex-matched non-insulin dependent diabetic groups with different levels of diabetic retinopathy. The psychophysical test used was Oculus Tubingen perimeter. Results: The results were considered in terms of the presence of functional changes relative to the severity of retinopathy and the duration of diabetes. The visual fields test differentiated between normals and those with diabetes but with retinopathy. The test failed to differentiate between normals and diabetics without retinopathy. Conclusion: Visual filed defects are not strongly related to the duration of diabetes, but more to the severity of the retinopathy. They can be correlated to areas of capillary non-perfusion.

MACULAR SENSITIVITY AND MORPHOLOGY AFTER INTRAVITREAL INJECTION OF TRIAMCINOLONE ACETONIDE FOR MACULAR EDEMA WITH BRANCH RETINAL VEIN OCCLUSION

To evaluate the changes of macular sensitivity, thickness, and total macular volume after intravitreal injection of triamcinolone acetonide to treat macular edema with branch retinal vein occlusion. Seventeen eyes of 17 patients with branch retinal vein occlusion with macular edema received intravitreal triamcinolone acetonide. Using capillary nonperfusion on fluorescein angiography, patients were classified into nonischemic or ischemic groups. Microperimetry was used to measure macular sensitivity within the central 4°, 10°, and 20° fields. Macular thickness and macular volume within these fields were measured by optical coherence tomography. The mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly after intravitreal therapy (all Ps < 0.001) as did total macular volume (all Ps < 0.001). Visual acuity was significantly better at 3 and 6 months (P = 0.002) as was the mean macular sensitivity within the three fields (all Ps < 0.05). There were no significant differences in the trend profile of macular thickness and volume within the three fields between the ischemic and nonischemic groups. There were also no significant differences in the trend profile of visual acuity and macular sensitivity. Intravitreal triamcinolone acetonide may improve macular sensitivity and morphology in patients with ischemic and nonischemic branch retinal vein occlusion.

Factors Promoting Success and Influencing Complications in Laser-Induced Central Vein Bypass

To evaluate the factors influencing the successful creation of a laser-induced chorioretinal venous anastomosis (L-CRA) and those involved in the development of complications. Interventional cohort study. Fifty-five patients with a nonischemic central retinal vein occlusion (CRVO) who were randomized to receive an L-CRA from the total of 108 who completed the follow-up period of the Central Vein Bypass Study. Patients who were randomized to L-CRA were followed up for an 18-month period. They were stratified in 2 sets of 2 cohorts: those who did or did not demonstrate an L-CRA and those who did or did not demonstrate neovascular complications at the site of the L-CRA. Subgroup analysis was performed to determine what factors influenced the creation of an L-CRA and the development of complications at each individual laser site. Identification of systemic and local ocular factors associated with increased success rates of L-CRA creation and those involved with an increased risk of neovascular complications. Younger age (P = 0.03), better baseline visual acuity (P = 0.04), and the absence of hypertension (P = 0.001) were systemic features associated with an increased chance of demonstrating a successful L-CRA at each site, whereas sex and duration of the CRVO were not. The position of the L-CRA site did not influence the outcome; however, evidence of rupture of the vein wall at the time of the attempt was associated with a higher chance of success (P = 0.008). Increased risk of neovascularization, which occurred at 12 sites in 10 eyes, was associated with higher central venous pressure before treatment (P = 0.03), prolonged fluorescein transit time (P = 0.0001), and the presence of some capillary nonperfusion (P = 0.01). Younger age, better baseline visual acuity, and the absence of hypertension were associated with an improved success rate, as was evidence of rupture of the vein wall. High baseline central venous pressure, prolonged fluorescein transit time, and the presence of any retinal ischemia were associated with a higher incidence of neovascular complications. Proprietary or commercial disclosure may be found after the references.

Advances in the diagnosis, management and pathophysiology of capillary nonperfusion

‘Capillary dropout’ or ‘nonperfusion’ describes both an anatomic condition and an angiographic appearance in many retinal diseases. In this review, we will discuss several illustrative pediatric and adult retinal vascular diseases including retinopathy of prematurity, familial exudative vitreoretinopathy, diabetic retinopathy and retinal vein occlusions with capillary nonperfusion. Enhanced retinal imaging techniques have demonstrated that capillary nonperfusion is more common in vascular diseases than previously assumed. A large body of experimental evidence in animal models has started to elucidate the underlying pathophysiology of this process. In addition, it has become clear in hereditary and congenital diseases that genetic mutations involving Wnt signaling are integral to retinal vascular development and disease. Defects in the Wnt signaling pathway seem to be related to abnormalities in retinal vascular formation and/or angiomaintenance. Abnormalities in either of these processes may lead to capillary nonperfusion. We review clinical features of capillary nonperfusion and discuss the evolving management of this entity based on novel imaging modalities and molecular mediators.

Fluorescein angiography, optical coherence tomography, and histopathologic findings in a VEGF165 animal model of retinal angiogenesis

To establish an animal model of retinal neovascularization using vascular endothelial growth factor (VEGF165) and analyze the model using optical coherence tomography (OCT), fluorescein angiography (FA), and histopathologic evaluation. Twelve rabbits were divided into groups as follows: group 1 (n = 3), sham intravitreous injections of 0.1ml of balanced saline; group 2 (n = 6), one 10-μg intravitreal injection of VEGF165 on day 0; and group 3 (n = 3), two 10-μg intravitreal injections of VEGF165, one on day 0 and one on day 7. Follow-up evaluations (days 0, 3, 7, 14, 21, 28) included obtaining fundus color photographs and FA, OCT, and histopathologic examinations. Eyes were enucleated and stained with hematoxylin and eosin (H&E). One injection of VEGF (group 2) was associated with dilatation and tortuosity of the retinal blood vessels that developed within 72h. Retinal neovascularization was present by day 7 and regressed by day 14. However, even on day 28, the capillaries were still tortuous. Two VEGF injections (group 3) caused increased leakage and neovascularization up to day 14; severe capillary nonperfusion was seen during week 4. At the end of the follow-up period, OCT and histopathologic examination of group 3 showed peripapillary tractional retinal detachments. By day 7, the differences between the retinal thickness seen on OCT in groups 2 and 3 and the group 1 control group were significant (p < 0.001). The histologic findings showed increased vessel size in groups 2 and 3 by days 14 and 28 compared with the controls. FA, OCT, and histopathologic findings showed that this retinal neovascularization model is efficient, sustainable, and reliable. One injection of VEGF165 created neovascularization that peaked after 1week; two injections created more intense neovascularization that evolved to retinal detachments after 4weeks.

Visual Acuity Recovery in a Case of Idiopathic Retinal Vasculitis Aneurysms and Neuroretinitis

To describe the visual recovery after intravitreal injections of the antivascular endothelial growth factor, bevacizumab, in a case of vaso obliteration from idiopathic retinal vasculitis, aneurysm, and neuroretinitis (IRVAN). The name IRVAN was given to the condition to highlight the key findings present in the disease. IRVAN is a severe, sight threatening condition that can lead to peripheral capillary non-perfusion and vision loss from the ischemic sequelae of vascular occlusion. Panretinal photocoagulation (PRP) is the current standard of care for IRVAN but visual outcome is poor if PRP is initiated after neovascularization develops. Intravitreal bevacizumab has success at treating neovascularization from other ischemic retinopathies and inflammatory retinal conditions that have similar characteristics to IRVAN. This case report describes a patient with decreased vision in the OS. The patient presented with best-corrected visual acuity of 20/20 in the OD and count fingers at 4 ft in the OS. Evaluation revealed findings consistent with an advanced stage of IRVAN. Anterior and posterior neovascularization had developed from extensive capillary non-perfusion in both retinas. A dense vitreous hemorrhage blocked vision OS. Bilateral intravitreal injections of bevacizumab and extensive PRP were given in the area of retinal ischemia for treatment. After 4 months, the patient's vision had improved from count fingers in the OS to 20/40. IRVAN has favorable outcomes when treated with a combination of PRP and intravitreal injections of antivascular endothelial growth factor. This case demonstrates the effectiveness of this combination treatment in a case of IRVAN with both posterior and anterior neovascularization.

Idiopathic Macular Telangiectasia

To review the frequency and nature of idiopathic macular telangiectasia and to classify the disorders based on new clinical and imaging observations. A combined retrospective and prospective analysis of newly diagnosed patients seen over a period of 3 years. Patients were identified based on the Gass-Blodi classification and were studied with biomicroscopy, fluorescein angiography, and optical coherence tomography. Ten patients associated with aneurysmal telangiectasia (Gass-Blodi group 1) and 26 patients with perifoveal telangiectasia (Gass-Blodi group 2) were recruited. None with occlusive telangiectasia (Gass-Blodi group 3) were identified. New observations based on clinical, fluorescein angiographic, and optical coherence tomographic findings were made. Our series was similar to that in the Gass-Blodi study in terms of frequency. New observations in groups 1 and 2 have expanded our knowledge of the clinical spectrum of these disorders. A simplified classification termed idiopathic macular telangiectasia with 2 distinct types (type I, or aneurysmal telangiectasia, and type II, or perifoveal telangiectasia) was proposed to produce a better understanding of the entities and to enhance teaching and research. The third type, occlusive telangiectasia, has been omitted from our classification based on its rarity and presence of capillary nonperfusion rather than macular telangiectasia as the primary abnormality.

Retinopathy associated with interferon therapy in patients with hepatitis C virus.

PurposeTo evaluate retinopathy associated with interferon therapy in patients with chronic hepatitis C.MethodsOne hundred patients with chronic hepatitis C undergoing interferon therapy were examined for the presence of cotton wool spots, retinal hemorrhages, cystoid macular edema, capillary non-perfusion, and arteriolar occlusion. Complete ophthalmological examination including indirect ophthalmoscopic fundus examination was carried out for all patients and colored fundus photography and fluorescein angiography were carried out for the patients with positive fundus findings. The follow-up period was 9 months.ResultsSixteen percent of patients developed retinopathy in the form of cotton wool spots, retinal hemorrhages, cystoid macular edema, and capillary non-perfusion.ConclusionInterferon therapy can lead to retinopathy which is mostly reversible and dose related. Periodic fundoscopic examinations help in early detection and prevent progression to permanent visual loss.

VITREOUS INFLAMMATORY FACTORS AND SEROUS MACULAR DETACHMENT IN BRANCH RETINAL VEIN OCCLUSION

To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Macular infarction secondary to Staphylococcus epidermidis infection.

To describe a patient with macular infarction caused by Staphylococcus epidermidis-induced endophthalmitis. Case report. An 88-year-old woman was referred to our clinic for endophthalmitis after cataract extraction. She was diagnosed to have an S. epidermidis infection. Her vision dropped from 20/50 to hand motions. During the course of her infection, she developed multiple multifocal branch retinal artery occlusions associated with absolute capillary nonperfusion centrally and was diagnosed with macular infarction. Although most commonly associated with aminoglycoside toxicity, macular infarction can occur after endophthalmitis treatment without the use of aminoglycosides.

Vascular Endothelial Growth Factor and Interleukin-6 are Correlated With Serous Retinal Detachment in Central Retinal Vein Occlusion

Purpose/Aim: To investigate aqueous humour and vitreous fluid levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in patients with central retinal vein occlusion (CRVO) and serous retinal detachment.Materials and methods: In twenty patients (20 eyes) with CRVO and 8 patients (8 eyes) with non-ischaemic ocular disease as controls, optical coherence tomography showed that 10 CRVO patients had serous retinal detachment (subretinal fluid with low reflectivity) and 10 patients had cystoid macular oedema (hyporeflective intraretinal cavities). Retinal ischaemia was evaluated from the area of capillary nonperfusion on fluorescein angiograms. To measure VEGF and IL-6 levels, aqueous humour and vitreous fluid samples were obtained during combined pars plana vitrectomy and cataract surgery.Results: Ischaemia was significantly more frequent among the CRVO patients with serous retinal detachment than those with cystoid macular oedema (10/10 vs. 3/10, P = 0.001). Aqueous humour levels of VEGF and IL-6 were significantly higher in the serous patients than the cystoid patients (P = 0.004 and P < 0.001, respectively). Vitreous fluid levels of VEGF and IL-6 were also significantly higher in the serous patients than the cystoid patients (P = 0.007 and P < 0.001, respectively).Conclusions: These results suggest that a marked increase of vascular permeability due to upregulation of VEGF and IL-6 may contribute to serous retinal detachment in patients with CRVO.

Aggravated capillary non-perfusion after intravitreal bevacizumab for macular edema secondary to systemic lupus erythematosus and anti-phospholipid syndrome

A 22-year-old female with history of systemic lupus erythematosus (SLE) was referred for evaluation of decreased visual acuity in her right eye. Her best-corrected visual acuity (BCVA) at the time of presentation was 20/160. Widespread cotton wool spots and macular edema were seen on biomicroscopy. Fluorescein angiography (FA) revealed retinal arterial and venous obstruction with capillary nonperfusion at the superotemporal retina. Antiphospholipid syndrome (APS) was diagnosed based on positive lupus anti-coagulant and ocular manifestations. Scattered laser photocoagulation was applied at the nonperfusion area but the visual acuity continued to deteriorate due to macular edema. Intravitreal bevacizumab (IVB) was administered for macular edema. One day after IVB, the BCVA decreased to count fingers. FA revealed extended non-perfusion from the superotemporal area to the posterior pole. Use of intravitreal bevacizumab for macular edema secondary to SLE or APS should be considered carefully and patients monitored closely for vascular complications.

Intravitreal bevacizumab for severe vaso-occlusive retinopathy in systemic lupus erythematosus

Severe vaso-occlusive retinopathy is a relatively rare form of retinopathy in systemic lupus erythematosus (SLE). We report two patients with severe vaso-occlusive retinopathy in SLE who were treated with intravitreal bevacizumab (IVB). (Patient 1) A 35-year-old woman presented with left visual loss and was diagnosed with SLE after systemic evaluation. Despite systemic immunosuppressive therapy, retinal vascular obstruction progressed and neovascularization of the disk (NVD) developed. The patient was treated with IVB and pan retinal photocoagulation. The progression of vascular obstruction ceased and regressed. (Patient 2) A 24-year-old man with SLE presented with left visual loss. There was retinal vascular obstruction with macular edema in both eyes, and then the patient was treated with IVB. One month after injection, minimal capillary nonperfusion increased to 10 disk area, and 5 months later, neovascularization elsewhere (NVE) developed in the right eye. Six months after injection, vitreous hemorrhage with florid NVE and NVD developed in the left eye. In selected severe vaso-occlusive retinopathy in SLE patients, IVB may be an adjuvant option for treatment.

Soluble Vascular Endothelial Growth Factor Receptor-2 and Inflammatory Factors in Macular Edema with Branch Retinal Vein Occlusion

To investigate relationships among vitreous fluid levels of soluble vascular endothelial growth factor receptor-2 (sVEGFR-2), vascular endothelial growth factor (VEGF), and soluble intercellular adhesion molecule 1 (sICAM-1) in patients with branch retinal vein occlusion (BRVO) and macular edema or patients with idiopathic macular hole. Retrospective case-control study. Tokyo Women's Medical University and Eguchi Eye Hospital. Forty-nine Japanese patients who underwent unilateral vitrectomy (27 with BRVO and 22 with macular hole). Vitreous fluid samples were obtained during vitreoretinal surgery to measure the levels of sVEGFR-2, VEGF, and sICAM-1. Retinal ischemia was evaluated from capillary nonperfusion on fluorescein angiography. Macular edema was examined by optical coherence tomography. Vitreous fluid levels of the 3 molecules and severity of macular edema. BRVO patients had a significantly higher vitreous fluid level of sVEGFR-2 (median, 1670 pg/mL; interquartile range [IQL], 1205 to 2225 pg/mL) than macular hole patients (median, 1265 pg/mL; IQR, 731 to 1800 pg/mL; P = .017), as was the case for VEGF (median, 237 pg/mL; IQR, 42.2 to 1305 pg/mL; vs median, 15.6 pg/mL; IQR, 15.6 to 15.6 pg/mL; P < .001) and sICAM-1 (median, 10.1 ng/mL; IQR, 6.3 to 22.5 ng/mL; vs median, 4.1 ng/mL; IQR, 3.3 to 6.0 ng/mL; P < .001). In BRVO patients, there was a significant positive correlation between vitreous fluid levels of sVEGFR-2 or VEGF and sICAM-1, but not between sVEGFR-2 and VEGF. Vitreous fluid levels of all 3 molecules were correlated significantly the with severity of macular edema in BRVO patients. sVEGFR-2 may induce an increase of vascular permeability together with or via sICAM-1, or both with and via sICAM-1, in BRVO patients with macular edema.

CHANGES IN AREAS OF CAPILLARY NONPERFUSION AFTER INTRAVITREAL INJECTION OF BEVACIZUMAB IN EYES WITH BRANCH RETINAL VEIN OCCLUSION

: To study the effect of an intravitreal bevacizumab (IVB) on the retinal ischemia in eyes with a branch retinal vein occlusion. : Fluorescein angiography was performed before and 1 month after the IVB (1.25 mg/0.05 mL) in 58 consecutive eyes of 58 patients with macular edema secondary to a branch retinal vein occlusion. The area of capillary nonperfusion was measured on an early-phase fluorescein angiography image by an area measurement program, and the area was expressed relative to the optic disk area (DA). A blockage of the fluorescence by the retinal hemorrhage was distinguished from nonperfusion by comparisons with retinal photographs. : Thirty-seven of 58 eyes did not have any capillary nonperfusion before the IVB, and capillary nonperfusion developed in 3 of these 37 eyes 1 month after the IVB. The area of nonperfusion in these 3 eyes was 0.13, 0.47, and 0.60 DA. Twenty-one of the 58 eyes had capillary nonperfusion before the IVB, and the mean (±SD) area of nonperfusion was 3.45 ± 4.66 DA before the IVB and 3.45 ± 5.19 DA 1 month after the IVB. This change was not significant (P = 0.36). An increase in the area of capillary nonperfusion of >1.0 DA after the IVB was seen in only 1 of all 58 eyes. : These results suggest that the incidence of a significant increase in the area of capillary nonperfusion (>1 DA) during the 1 month after the IVB is very low in eyes with branch retinal vein occlusion.