Central Retinal Vein Occlusion Patients Research Articles

Evaluation of patients with central retinal vein occlusion using optical coherence tomography angiography

Background Retinal vein occlusion (RVO) is the second most prevalent retinal vascular disorder after diabetic retinopathy, it may be categorized as central, hemi-central, and branch RVO. The most important risk factors are hypertension, diabetes mellitus, and hyperlipidaemia. Aim The objective of the research is to assess the ocular condition of patients with central retinal vein occlusion (CRVO) using optical coherence tomography angiography (OCT-A). Patient and methods This prospective cross-sectional controlled trial was conducted on a total of 44 individuals, who were separated into two distinct groups: group 1: 24 eyes of 24 patients with central RVO, group 2: 20 eyes of 20 healthy persons. Results Foveal avascular zone (FAZ) was significantly larger in both superficial and deep plexi levels in CRVO cases in comparison to the values of the same levels in normal subjects with predominance FAZ enlargement in the deep plexus than superficial plexus. Measurement of vascular density was significantly less in both superficial and deep plexi levels in CRVO cases in comparison to the same levels in normal subjects. Central macular thickness (CMT) detected by OCT was significantly more in CRVO cases in comparison to normal subjects. There were negative correlation between best-corrected visual acuity in decimal and CMT, Increased CMT was associated with diminish best-corrected visual acuity. Conclusion OCTA has the advantage of being a non-invasive method in assessing CRVO patients which makes it more practical than FFA in some clinical situations like patients with chronic kidney disease.

Longitudinal changes in each retinal layer thickness in patients with non-ischemic central retinal vein occlusion

BackgroundTo identify longitudinal changes in each retinal layer thickness in central retinal vein occlusion (CRVO) patients with resolved macular edema (ME).MethodsIn this retrospective observational study, CRVO patients without a recurrence of ME for more than 3 years and normal controls were enrolled. Each retinal layer thickness of the parafoveal area, including ganglion cell complex (GCC), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor layer (PRL), and retinal pigment epithelium (RPE) was measured. After the resolution of ME, three more examinations with a 1-year interval were analyzed.ResultsA total of 98 eyes were enrolled, 50 eyes for the control group and 48 eyes for the CRVO group. The baseline GCC thickness was 114.2 ± 15.6 μm and 104.2 ± 25.4 μm in the control and CRVO groups, respectively, which was significantly different (P = 0.022). The thicknesses of other layers including INL, OPL, ONL, PRL, and RPE were not significantly different at baseline. The reduction rate of GCC, INL, OPL, and ONL was − 3.92, − 1.33, − 0.91, and − 2.31 μm/year in the CRVO group, whereas no significant reductions were observed in the control group. Best-corrected visual acuity was significantly associated with changes in the GCC, OPL, and ONL in the CRVO group.ConclusionsIn patients with CRVO, even in the absence of recurrent ME, retinal damage progresses over time, evidenced by thinning of the inner retina and outer retina including OPL and ONL. These changes may be associated with alterations in visual function.

Artificial intelligence-based extraction of quantitative ultra-widefield fluorescein angiography parameters in retinal vein occlusion

ObjectiveTo examine the association between quantitative vascular parameters extracted from intravenous fluorescein angiography (IVFA) and baseline clinical characteristics of patients with retinal vein occlusion (RVO). MethodsOur prospective single-centre study in Toronto, Canada, recruited patients with a diagnosis of macular edema secondary to RVO presenting with a central macular thickness (CMT) ≥310 μm from 2017 to 2023. IVFA images were captured using an ultra-widefield scanning laser ophthalmoscope and processed using the artificial intelligence-based RETICAD system to extract quantitative measurements of blood flow, perfusion, and blood–retinal barrier (BRB) permeability. Univariable and multivariable regression models were used to investigate associations between quantitative IVFA parameters and baseline best-corrected visual acuity (BCVA), CMT, and macular volume. ResultsThe study included 41 eyes from 41 RVO patients. In the multivariable analysis, BRB permeability was significantly associated with both CMT (p < 0.001) and macular volume (p = 0.005). Subgroup analyses revealed that in central RVO patients, central BRB permeability remained significantly associated with CMT (p = 0.022) and macular volume (p = 0.010); however, there was no association with BCVA (p = 0.921). In branch RVO patients, central BRB permeability was significantly associated with BCVA (p = 0.006) and CMT (p = 0.009), but not with macular volume (p = 0.723). Additionally, both central and peripheral BRB permeability were significantly higher in patients with RVO compared to healthy controls (p < 0.001). ConclusionsOur investigation reveals novel associations between baseline clinical characteristics and quantitative IVFA parameters in RVO patients, which may serve as clinically relevant biomarkers. Future studies should explore these associations in diverse RVO patient populations with extended follow-up.

Changes in wider field swept-source OCT angiography vascular metrics with anti-vascular endothelial growth factor therapy in central retinal vein occlusion.

To investigate the impact of anti-VEGF therapy on vascular metrics in eyes with macular edema secondary to central retinal vein occlusion (CRVO) using wider field swept-source OCT angiography (WF SS-OCTA). We included 23 eyes with macular edema associated with non-ischemic CRVOfrom 22 patients treated with anti-VEGF therapy (median number of injections: 5 [2-9]). Changes in vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ) parameters were measured using WF SS-OCTA. Visual acuity (VA) and central subfield thickness (CST) were also measured. Median CST decreased significantly from 369µm (305-531) to 267µm (243-300, p < 0.001). VD and VSD parameters in 12 × 12mm images showed significant reductions. For instance, VSD in the whole retina decreased from a median of 13.37 (11.22-13.74) to 11.29 (9.36-12.97, p = 0.013). Additionally, a significant increase in FAZ circularity was found, suggesting improved microvascular integrity. Significant inverse correlations were found between the number of anti-VEGF injections and all VSD and VD parameters on the 12 × 12mm images (p < 0.05). Notably, the reductions in VSD and VD on 12 × 12mm angiograms in the deep capillary plexus (DCP) after each injection significantly correlated with increased logMAR VA (worse VA). Anti-VEGF therapy in CRVO patients not only mitigates macular edema but also alters the overall microvascular morphology and functionality as revealed by WF SS-OCTA.

Central retinal vein occlusion in patients with metastatic solid tumors on tyrosine kinase inhibitors: a report of case series and literature review.

Central retinal vein occlusion (CRVO) is a rare adverse effect related to the use of tyrosine kinase inhibitors (TKIs) in patients with metastatic malignancies, which has only been reported in several case reports. We reported the case series of three CRVO patients on regular regimens of TKIs as part of targeted therapies for metastatic malignancies, all of whom were otherwise healthy with no or well-controlled systemic conditions. All these patients received injections of intravitreal dexamethasone implant (IDI) and achieved a fluid-free macula at the end of the visit. In addition, we reviewed the existing literature on this subject and present here an updated analysis of the related TKIs, ocular presentation, treatment, and prognosis. All patients diagnosed with CRVO on TKIs received dexamethasone implant treatment and obtained a fluid-free macula. We would like to raise awareness among our colleague oncologists about the possibility of CRVO related to TKI use and the necessity for patients to be screened regularly by a retinal specialist.

Impact of high-risk optic disc on central retinal vein occlusion in patients with metabolic disorders.

To evaluate the impact of high-risk optic disc (HROD) on central retinal vein occlusion (CRVO) in patients with metabolic disorder(s). Retrospective case-control study. A case-control study involving CRVO patients with metabolic disorder(s) was performed. PART I. All eligible patients with CRVO were included in CRVO group, and a similar number of patients with metabolic disorder(s) without CRVO were matched by sex, age and blood glucose level in the non-CRVO group. Various parameters were compared between groups. The impact of risk factors associated with CRVO was presented as odds ratios (ORs) and 95% confidence interval (95% CI). PART II. All eyes with CRVO that underwent intravitreal treatment (IVT) with a follow-up duration of ≥1 year were divided into non-HROD and HROD groups, and the differences between the two groups were compared. In PART I, a total of 45 and 63 eyes were enrolled in the CRVO and non-CRVO groups, respectively, with a significant statistical difference in HROD (51.16% vs 26.98%, p = 0.010) between them. In further multivariate regression analysis, HROD was the independent risk factor for CRVO (OR = 5.036, 95% CI 1.847-13.729, p = 0.002). In PART II, demographic, follow-up information, treatment, and prognosis showed no significant statistical difference between the two groups (all p > 0.05). HROD was likely to be an independent risk factor for CRVO occurrence in patients with metabolic disorder(s), but it did not affect the treatment and prognosis of CRVO eyes with HROD.

Role of Novel Inflammatory Factors in Central Retinal Vein Occlusion with Macular Edema.

Background and Objectives: To investigate associations among the aqueous humor levels of novel inflammatory factors, including FMS-related tyrosine kinase 3 ligand (Flt-3L), fractalkine, CXC chemokine ligand 16 (CXCL-16), and endocan-1; the severity of macular edema in central retinal vein occlusion (CRVO); and the prognosis of CRVO with macular edema after antivascular endothelial growth factor (VEGF) therapy. Materials and Methods: Aqueous humor was obtained during anti-VEGF treatment with intravitreal ranibizumab injection (IRI) in patients with CRVO and macular edema (n = 19) and during cataract surgery in patients with cataracts (controls, n = 20), and the levels of VEGF and novel inflammatory factors were measured. Macular edema was evaluated by central macular thickness (CMT) and neurosensory retinal thickness (TNeuro), and improvement was evaluated by calculating the percentage change in CMT and TNeuro from before to 1 month after IRI. Results: The levels of VEGF and the novel inflammatory factors were significantly higher in the CRVO group, and the levels of Flt-3L, CXCL-16, and endocan-1 were significantly correlated with each other and with the aqueous flare value. Baseline levels of Flt-3L, CXCL-16, and endocan-1 had a significantly negative correlation with the change in CMT, and the baseline level of CXCL-16 was significantly negatively correlated with the change in TNeuro. Conclusions: Relations among novel inflammatory factors should be further investigated. These findings may help improve understanding of macular edema in CRVO patients and aid the development of new treatments targeting novel inflammatory factors.

Treatment discontinuation patterns of anti-VEGF in retinal vein occlusion

ObjectifPrésenter un rapport sur les tendances réelles en ce qui a trait aux injections d'anti-VEGF (facteur de croissance endothélial vasculaire) dans le traitement de l'occlusion veineuse rétinienne (OVR). NatureÉtude de cohorte rétrospective. ParticipantsPatients présentant une OVR jamais traitée qui ont commencé à recevoir des injections d'anti-VEGF entre 2015 et 2021. MéthodesOnt été passés en revue les dossiers médicaux jusqu'en juin 2022. On a noté les caractéristiques démographiques, le diagnostic, le nombre d'injections, la durée du traitement, la raison de l'abandon du traitement de même que les données initiales et finales (p. ex., date, âge, meilleure acuité visuelle corrigée [MAVC] et épaisseur du sous-champ central). Les analyses statistiques réalisées au moyen du logiciel STATA 17.0 mesuraient les différences entre les données initiales et finales, entre une occlusion d'une branche veineuse rétinienne (OBVR) et une occlusion de la veine rétinienne centrale (OVRC) et entre les sous-groupes d'abandon du traitement. RésultatsAu total, 219 yeux jamais traités ont été inclus (âge : 70,3 ± 13,2 ans; 52,5 % de patientes de sexe féminin). On comptait 99 cas d'OBVR et 120 cas d'OVRC (2482 injections). Le taux d'abandon s’élevait à 76,7 % (168 sur 219), soit 72,7 % des patients (77 sur 99) présentant une OBVR et 75,8 % des patients (91 sur 120) présentant une OVRC. Parmi les raisons motivant l'abandon du traitement, citons les suivantes: patient stable en l'absence de traitement actif (98 yeux), affection concomitante grave ou décès (17 yeux), remplacement du traitement par un corticostéroïde intraoculaire (implant ou injection; 12 yeux), absence de bienfaits visuels (10 yeux), atteinte oculaire concomitante (5 yeux), décision du patient (5 yeux) et départ du patient (5 yeux). Pour ce qui est des 67 yeux restants, 16 (24 %) ont été perdus de vue pendant le suivi. Les motifs d'abandon du traitement étaient différents, selon que les patients présentaient une OBVR ou une OVRC (p = 0,002). La MAVC des patients qui avaient une OVRC était pire au départ (p < 0,0001) et la MAVC finale était également pire (p < 0,0001), bien que des améliorations aient pu être observées dans les 2 groupes (p < 0,0001). Un âge plus jeune, une meilleure MAVC initiale et un diagnostic d'OBVR ont été des facteurs de prédiction indépendants d'une meilleure acuité visuelle finale. ConclusionOn a enregistré un abandon du traitement chez les trois-quarts des patients présentant une OVR sur une période de 7,5 ans. La stabilisation de la maladie a été le principal motif d'abandon : dans presque la moitié (45 %) des cas, l'OVR était stable en l'absence de traitement actif. Les résultats visuels ont été meilleurs en présence d'OBVR que d'OVRC, bien que les patients des 2 groupes aient tiré des avantages de leur traitement.

Benefits of a Laser Chorioretinal Anastomosis Plus Ranibizumab vs Ranibizumab Alone for Central Retinal Vein Occlusion: 4-Year Results

Evaluate what clinical gains can be achieved over conventional treatment with ranibizumab alone for central retinal vein occlusion (CRVO) when causal pathology is additionally successfully addressed with a laser-induced chorio-retinal anastomosis (L-CRA). 2-year extension of prospective, randomized, controlled clinical trial. 58 patients with macular edema secondary to CRVO randomized 1:1 to receive either an L-CRA (29) or sham procedure (29) at baseline and then monthly intravitreal ranibizumab 0.5mg Outcomes (best corrected visual acuity (BCVA), central subfield thickness (CST), injection requirements) were monitored in the monthly pro re nata (PRN) ranibizumab phase from months 7-48. Injection requirements for those with a functioning L-CRA (24 of 29) during the monthly PRN period from 7-24 months, were mean (95% confidence interval [CI]) of 2.18 [1.57, 2.78] injections compared to 7.07 [6.08, 8.06] (p<0.0001) for control (ranibizumab alone). These decreased further over the next 2 years to 0.29 (0.14, 0.61) compared to 2.20 (1.68, 2.88) (p<0.001) for the third year and 0.25 (0.11, 0.56) and 1.84 (1.34, 2.54) for the fourth year (p<0.001). Mean BCVA was statistically different at all follow-up time points from month 7 through to month 48 for the group with the functioning L-CRA compared to the control monotherapy group. This improved to 14.06 letters at month 48 (p=0.009). There was no difference in CST between any of the groups over the 48 months of follow-up. For CRVO patients, addressing causal pathology in addition to conventional therapy, improves BCVA and reduces injection requirements.

The Choroidal Vascularity Indices of Treatment-Naïve Patients with Central Retinal Vein Occlusion and Age-/Sex-Matched Controls

Purpose: To compare the subfoveal choroidal vascularity indices (CVIs) of treatment-naïve patients with central retinal vein occlusion (CRVO) with controls.Methods: Twenty-one eyes of 21 treatment-naïve CRVO patients and 42 age- and sex-matched control eyes (of 42 subjects) lacking any retinal disease were included. The subfoveal CVIs were measured using ImageJ software.Results: The mean subfoveal CVI in eyes with treatment-naïve CRVO at the initial visit was significantly higher than that of control eyes (0.6464 ± 0.0326 vs. 0.6209 ± 0.0434 respectively; &lt;i&gt;p&lt;/i&gt; = 0.024). In contrast, no significant difference in the mean subfoveal CVI was found between CRVO eyes 6 months after initial diagnosis and control eyes (0.6311 ± 0.0600 vs. 0.6209 ± 0.0434 respectively; &lt;i&gt;p&lt;/i&gt; = 0.238). Of the 21 eyes with CRVO, 18 (85.7%) received intravitreal injections (bevacizumab, ranibizumab, aflibercept, or triamcinolone) and four (19.0%) underwent panretinal photocoagulation.Conclusions: The subfoveal CVI of eyes with treatment-naïve CRVO at the initial visit was significantly higher than that of control eyes, but decreased by 6 months. Further studies are needed to determine whether CRVO treatments such as intravitreal injection or panretinal photocoagulation affect choroid hemodynamics.

Real-World Outcomes of Ranibizumab Treatment in French Patients with Visual Impairment due to Macular Edema Secondary to Retinal Vein Occlusion: 24-Month Results from the BOREAL-RVO Study

Introduction: Information about real-world ranibizumab use is needed to optimize treatment of macular edema secondary to retinal vein occlusion (RVO). The BOREAL-RVO study assessed treatment use, effectiveness, and safety of 24-month treatment with ranibizumab 0.5 mg in patients with visual impairment due to macular edema secondary to RVO in a real-world setting. Methods: This was a multicenter, post-authorization, observational study in France, including patients starting ranibizumab for RVO. Primary endpoint was mean change from baseline in best-corrected visual acuity (BCVA) at month 6. Secondary endpoints were mean changes from baseline in BCVA at month 24 and central retinal thickness (CRT) at months 6 and 24, and treatment use in real-world setting. Results: 226 branch RVO (BRVO) and 196 central RVO (CRVO) patients were enrolled; 71.7% and 70.9% completed the 24-month follow-up, respectively. In BRVO, mean (SD) baseline BCVA was 55.2 (18.7) letters, with gains of 14.3 (13.7), 14.1 (16.5), 13.0 (17.5), and 11.4 (20.1) letters at months 3, 6, 12, and 24, respectively. In CRVO, mean (SD) baseline BCVA was 40.4 (25.6) letters, with gains of 16.0 (21.2), 9.5 (25.4), 9.2 (27.7), and 8.3 (23.8) letters at months 3, 6, 12, and 24, respectively. At month 24, 52% of BRVO and 41% of CRVO patients had gains of 15 or more letters. In BRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 550 (175), 315 (104), 343 (122), 335 (137), and 340 (105) μm. In CRVO, mean (SD) CRT values at baseline and months 3, 6, 12, and 24 were 643 (217), 327 (152), 400 (203), 379 (175), and 348 (161) μm. On average, BRVO patients had 3.8 injections for 6.9 visits by month 6, and 7.2 injections for 19.7 visits by month 24. CRVO patients had 2.7 injections for 4.2 visits by month 6 and 7.1 injections for 21.1 visits by month 24. Factors predictive of better BCVA gain at month 6 were age under 60 at baseline, lower baseline BCVA and BCVA gain at month 3. There were no new safety findings. Conclusion: Major improvements in BCVA and CRT were observed at month 3 after the induction phase and then were sustained up to month 24, with a slight decrease, probably due to under-treatment. This study demonstrated ranibizumab to be a safe and effective treatment for BRVO and CRVO in the real-world setting, although more regular or proactive treatment could further improve outcomes.

Comparison Between Intra Vitreal Bevacizumab and Triamcinolone in Reducing Macular Thickness in Central Retinal Vein Occlusion

Objectives: To compare the effect of intra vitreal bevacizumab (IVB) and intra vitreal triamcinolone (IVT) in reducing macular thickness in central retinal vein occlusion. Methods and Materials: This quasi experimental study was conducted at Department of Ophthalmology, Hayat Abad Medical Complex Peshawar in the period from 01 January 2020 to 30 June 2020. Total 40 patients presented with central retinal vein occlusion (CRVO). Patients were divided into two groups, group A received IVB treatment and group B received IVT treatment. The patients were followed up on 6th month post treatment. The primary outcomes of the study were visual acuity and reduction in macular thickness on OCT post treatment. Results: 40 patients were enrolled in the study. The mean age of patients was 60.70±15.49 in group A and in group B 60.40±12.83. There were 13 males and 7 females in group A and 12 males and 8 females in group B. Mean VA at baseline was 1.0825±0.25 logMAR in group A and 0.9745±0.29 logMAR in group B. Mean macular thickness at baseline was 625.40±47.15 µm in group A and 642.05±44.23 µm in group B. Mean VA at 6th month post treatment follow up was 0.4195±0.23 logMAR in group A and in group B was 0.4960±0.27 logMAR. At 6th month follow up macular thickness was 261.80±26.269 µm in group A and 263.80±22.209 µm in group B. Conclusion: Intravitreal injections of bevacizumab and triamcinolone have shown a reduction in macular edema in CRVO patients along with improvement in visual acuity. Keywords: Bevacizumab, Triamcinolone, Macular Edema, Central Retinal Vein Occlusion, Visual Acuity

Vision-related quality of life and subscale items following intravitreal ranibizumab injections for central retinal vein occlusion.

To evaluate the vision-related quality of life (VR-QOL) before and after intravitreal ranibizumab injections (IVR) for central retinal vein occlusion (CRVO) and to investigate subscale items of VR-QOL in detail. A multicenter, open-label, prospective and comparative study. Twenty-three patients with treatment naïve CRVO and 22 age-matched normal controls were included. VR-QOL was assessed by 25-Item Visual Function Questionnaire (VFQ-25) before and up to 12 months post-treatment. The VFQ-25 composite score and 12 subscales were compared between CRVO patients and normal controls. The VFQ-25 composite scores of CRVO patients showed significant improvement throughout the treatment period compared with baseline. The VFQ-25 composite scores both before and after treatment for CRVO were significantly lower than in normal controls. The subscale items, including general health, general vision, near activities, social functioning, mental health, role difficulties, dependency, and peripheral vision in CRVO, were significantly lower than in the normal controls even after treatment. Vision-related QOL was low in patients with CRVO before treatment and improved with IVR. In spite of the improvements, several subscale items remained lower than in normal controls following treatment. Attention should be paid to the patients with CRVO and their decreased visual, social and psychological QOL.

Central corneal thickness, axial length, anterior chamber and optic disc structure in patients with central and branch retinal vein occlusion.

To compare the central corneal thickness (CCT), the structural properties of the anterior chamber and optic disc in patients with central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and controls. In this prospective study, 31 eyes of 31 CRVO patients (group 1) (mean age: 65.7 ± 10.2 male/female:16/15), 42 eyes of 42 BRVO patients (group 2) (mean age: 61.5 ± 9.9, male/female: 21/21), and 41 controls (mean age: 61.2 ± 15.3, male/female:15/26) were enrolled. Intraocular pressure (IOP), corrected IOP (IOPcorr), central corneal thickness (CCT), anterior chamber depth & volume (ACD & ACV), iridocorneal angle (ICA), axial length (AL), retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, cup to disc ratio (C/D), cup & rim volume, the scleral canal diameter (SCD), and mean & pattern deviation in visual field of the eyes with CRVO/BRVO, their fellow eyes and control eyes were evaluated. There was no significant difference in IOP among groups (p:0.239), while IOPcorr was significantly higher in eyes with CRVO compared with eyes with BRVO (p:0.003). Central corneal thickness was significantly thinner in CRVO than both BRVO and controls (p:0.005, p:0.002 respectively). The difference in the RNFL thickness was significant among groups (p:0.019), and it was detected significant between CRVO eyes and controls (p:0.05). Anterior chamber volume was lower in eyes with BRVO than in normal eyes (p:0.009). There was no significant difference in AL, ACD, rim volume, cup volume, GCL thickness, C/D ratio, ICA, and PSD among groups. The patients with CRVO tend to have thinner corneas, and the evaluation of IOP and CCT can be overlooked during retinal follow-up. Intraocular pressure values corrected with CCT should always be take into account to prevent possible optic nerve damage.

Short- and Long-Term Visual Outcomes in Patients Receiving Intravitreal Injections: The Impact of the Coronavirus 2019 Disease (COVID-19)-Related Lockdown.

Purpose: To investigate the short- and long-term impact of COVID-19—related lockdown on the vision of patients requiring intravitreal injections (IVI) for neovascular Age-related Macular degeneration (nvAMD), diabetic retinopathy (DR), central retinal vein occlusion (CRVO), or branch retinal vein occlusion (BRVO). Methods: This is a retrospective study from the Retina department of three Mass Eye and Ear centers. Charts of patients age of ≥ 18 years with any of the abovementioned diagnoses who had a scheduled appointment anytime between 17 March 2020 until 18 May 2020 (lockdown period in Boston, Massachusetts) were reviewed at baseline (up to 12 weeks before the lockdown), at first available follow-up (=actual f/u) during or after the lockdown period, at 3 months, 6 months, and at last available completed appointment of 2020. Results: A total of 1001 patients met the inclusion criteria. Of those patients, 479 (47.9%) completed their intended f/u appointment, while 522 missed it (canceled and “no show”). The delay in care of those who missed it was 59.15 days [standard deviation (SD) ± 49.6]. In these patients, significant loss of vision was noted at actual f/u [Best corrected visual acuity (BCVA) in LogMAR (Logarithm of the Minimum Angle of Resolution)—mean (±SD)—completed: 0.45 (±0.46), missed: 0.53 (±0.55); p = 0.01], which was more prominent in the DR group [Visual acuity (VA) change in LogMAR—mean (±SD); completed: 0.04 (±0.28), missed: 0.18 (±0.44); p = 0.02] and CRVO [completed: −0.06 (±0.27), missed: 0.11 (±0.35); p = <0.001] groups followed by nvAMD [completed: 0.006 (±0.16), missed: 0.06 (±0.27); p = 0.004] and BRVO [completed: −0.02 (±0.1), missed: 0.03 (±0.14); p = 0.02] ones. Overall, a higher percent of people who missed their intended f/u experienced vision loss of more than 15 letters at last f/u compared to those who completed it [missed vs. completed; 13.4% vs. 7.4% in nvAMD (p = 0.72), 7.8% vs. 6.3% in DR (0.84), 15.5% vs. 9.9% in CRVO (p < 0.001) and 9.6% vs. 2% in BRVO (p = 0.48)]. Conclusions: Delay in care of about 8.45 weeks can lead to loss of vision in patients who receive IVI with DR and CRVO patients being more vulnerable in the short-term, whereas in the long-term, CRVO patients followed by the nvAMD patients demonstrating the least vision recovery. BRVO patients were less likely to be affected by the delay in care. Adherence to treatment is key for maintaining and improving visual outcomes in patients who require IVI.

Central retinal thickness changes and risk of neovascular glaucoma after intravitreal bevacizumab injection in patients with central retinal vein occlusion

This retrospective study evaluated changes in the central retinal thickness (CRT) and the risk factors for neovascular glaucoma (NVG) after intravitreal bevacizumab injection under a pro re nata (PRN) regimen for macular oedema in 57 eyes with central retinal vein occlusion (CRVO). The clinical characteristics at the time of NVG diagnosis were assessed, and baseline and final clinical characteristics and mean CRT values at 1-, 3-, and 6-month follow-up evaluations were recorded. The incidence of NVG was 21.1%, with the neovascular group (12 eyes) showing poor baseline and final visual acuity, a higher incidence of baseline ischaemic-type CRVO and subretinal fluid, a higher mean CRT at the 1-month follow-up, and a higher number of intravitreal bevacizumab injections during the 6-month follow-up. Nine eyes with NVG (75%) showed a mean CRT < 300 μm at the time of diagnosis. An ischaemic CRVO and higher CRT at the 1-month follow-up were related to the development of NVG in the multivariate analysis. Thus, NVG development in CRVO patients treated with intravitreal bevacizumab injections was associated with an ischaemic CRVO and elevated CRT at the 1-month follow-up; PRN bevacizumab regimens based on CRT or control of macular oedema did not completely prevent NVG development.

Evaluation of augmentation index and pulse wave velocity measurements in central retinal vein occlusion patients with and without hypertension.

To evaluate arterial stiffness using the pulse wave velocity (PWV) and augmentation index (AI) in central retinal vein occlusion (CRVO) patients. Forty-two CRVO patients (i.e., CRVO group) and 54 healthy controls (i.e., control group) were included in this comparative and cross-sectional study. The PWV, AI and augmentation pressure were measured with a noninvasive, oscillometric method. The mean PWV, AI and augmentation pressure values were significantly higher in CRVO patients than in controls (p = 0.024, p <0.001 and p = 0.001, respectively). The mean augmentation pressure, AI and PWV measurements were not statistically significant between CRVO patients with and without hypertension (p = 0.856 and p <0.526, p = 0.432, respectively). Age, presence of hypertension, AI and PWV were found to be as independent risk factors of CRVO development (OR = 2.21, 95% CI [1.44, 3.38] and OR = 2.40, 95% CI [1.50, 3.86], OR = 3.2, 95% CI [1.70, 5.60] and OR = 5.70, 95% CI [2.00, 18.50], respectively). The AI and PWV values were significantly higher in CRVO patients than in controls. These results indicate that similar abnormalities in the arterial wall structure may play an important role in the pathogenesis of the CRVO and cardiovascular diseases. In addition, our findings show that each patient with RVO should be examined in terms of systemic vascular pathologies.

Ranibizumab versus aflibercept for macular edema secondary to nonischemic central retinal vein occlusion in young adult patients

Purpose The aim of this study was to compare the effect ranibizumab and aflibercept in the treatment of macular edema secondary to nonischemic central retinal vein occlusion (CRVO) in young adults.Patients and methods This is a prospective double-armed clinical trial that enrolled 40 eyes of 40 young adult patients (aged <50 years) with macular edema due to CRVO. The patients were randomized into two groups of 20 patients each. The first group received intravitreal injection of ranibizumab, whereas the second group received intravitreal aflibercept injection. All patients were subjected to measurement of best-corrected visual acuity, fluorescein angiography to detect retinal ischemia, and spectral domain optical coherence tomography to measure the macular edema at baseline and during a 12-month follow-up period. In each group, three intravitreal injections were given with a 1-month interval between injections.Results In group 1, the best-corrected visual acuity had a significant steady increase over time from a baseline value of 48.25±6.4 ETDRS letters to 55.85±10.3 letters at 1 year (P=0.017). Similarly, in group 2, there was also a significant steady increase over time from a baseline value of 55.9±7.2 letters to 60.75±8.4 letters at 1 year (P=0.035), with no statistically significant difference between the two groups (P>0.05). Regarding the central subfield thickness (CST), in the first group, a statistically significant decrease in the CST was reported over time from a baseline value of 557.85±69.7–295.1±55.9 μm at 1 year (P<0.001). Similarly, in the second group, the CST decreased significantly from a baseline value of 570.65±59.2–328.2±72.4 μm at 1 year, with no statistically significant difference between the two groups (P>0.05).Conclusion Ranibizumab and aflibercept showed a comparable promising outcome in the management of macular edema secondary to nonischemic CRVO in patients aged less than 50 years. Further multicentric randomized clinical trials are needed to confirm these results.

Effectiveness and safety of ranibizumab in patients with central retinal vein occlusion: results from the real-world, global, LUMINOUS study

ObjectiveTo evaluate the effectiveness, treatment patterns and long-term safety of ranibizumab 0.5 mg in treatment-naïve patients with central retinal vein occlusion (CRVO) in a real-world setting.MethodsLUMINOUS, a 5-year, global, prospective, multicentre, multi-indication, observational, open-label study, recruited treatment naïve or prior treated patients who were treated as per the local ranibizumab label. Here, we report the mean change in visual acuity (VA; Early Treatment Diabetic Retinopathy Study [ETDRS] letters), treatment exposure over year (Y) 1 and 5-year safety in treatment-naïve CRVO patients.ResultsAt baseline, the mean age of treatment-naïve CRVO patients (n = 327) was 68.9 years, with a mean (Standard deviation [SD]) VA of 40.6 (23.9) letters. At Y1, patients (n = 144) had a mean (SD) VA gain from baseline of 10.8 (19.66) letters, with a mean (SD) of 5.4 (2.65) ranibizumab injections. Patients demonstrated mean (SD) VA gains of 2.7 (19.35), 11.6 (20.56), 13.9 (18.08), 11.1 (18.46) and 8.2 (24.86) letters with 1, 2–3, 4–5, 6–8 and >8 ranibizumab injections, respectively. Mean (SD) VA gains at Y1 in patients receiving loading (67.4%) and no loading dose (32.6%) was 11.9 (20.42) and 8.4 (17.99) letters, respectively. Over five years, the incidence of ocular/non-ocular adverse events (AEs) and serious AEs was 11.3%/8.6% and 1.2%/6.7%, respectively.ConclusionsThese results demonstrate the effectiveness of ranibizumab in treatment-naïve CRVO patients at Y1 with clinically meaningful VA gains and no new safety findings over five years. These findings may help inform routine practice and enable better clinical management to achieve optimal visual outcomes.

The clinical relevance of ultra-widefield angiography findings in patients with central retinal vein occlusion and macular oedema receiving anti-VEGF therapy

AimsTo report, using ultra-widefield angiography (UWFA) the area, distribution, and change in retinal capillary nonperfusion (RCNP) at baseline and 100 weeks in eyes with central retinal vein occlusion (CRVO) receiving anti-VEGF for macula oedema.MethodsProspective longitudinal multi-centre cohort study. Adults with CRVO treated with anti-VEGF therapy for macular oedema underwent UWFA at baseline and week-100. The area, distribution, and change in total, peripheral and posterior pole RCNP were determined.ResultsOf 153 eyes at baseline, mean area of RCNP was 34.3DA and 12 (7.8%) had ≥75DA RCNP. More than 10DA RCNP was present in the temporal periphery in 75.8% of eyes vs. 10.5% in the nasal periphery. At week-100, mean RCNP was 42.1DA with a median change from baseline of 3.3DA 95% CI [0.4, 7.3]; p < 0.01. Of 146 eyes with ≤10DA of posterior pole RCNP at baseline, 16/146 (11.0%) progressed to >10DA at week-100. These eyes had a median increase in total RCNP of 69.7DA [95% CI 27.2–85.4] vs 0DA [0.0–1.4]; p < 0.001 for those who did not, and two developed neovascular glaucoma. Larger baseline area of RCNP and history of glaucoma were risk factors for posterior pole RCNP developing.ConclusionsWith UWFA, significant baseline RCNP was identified in the majority of CRVO patients, notably in the temporal periphery, but large increases over 100 weeks were uncommon. Development of >10DA posterior pole RCNP is a marker for widespread RCNP and in such cases the risk of anterior segment neovascularisation is not abolished by concomitant anti-VEGF therapy.