Diagnosis Of Retinal Vein Occlusion Research Articles

Comparing macular thickness and visual acuity responses retinal vein occlusion versus diabetic macular edema following anti vascular endothelial growth factor therapy: A retrospective analysis

: Vascular growth factor associates Retinal vein occlusion (RVO) and Diabetic Macular Edema (DME). A retrospective analysis using database from a tertiary hospital.: The study aims to evaluate effects of anti-vascular growth factor therapy on patients Diabetic Macular Edema with and retinal vein occlusion,: This study conducted between December 2022 and June 2023 where 30 patients diagnosed with Diabetic macular edema (DME, n=15) or Retinal vein occlusion (RVO, n=15) receiving anti-VEGF were examined. This focused on changes in best corrected visual acuity, central macular thickness and predictors over a period of three months.: Retinal Vein Occlusion (RVO) patients exhibited a more significant improvement in Best Corrected Visual Acuity (BCVA) compared to Diabetic Macular Edema (DME) (25 vs. 10 letters, p = 0.006) after three months. The change in Central Macular Thickness (CMT) also favored RVO (100µm) over DME (40µm, p = 0.012). Final BCVA median was 70 for DME and 65 for RVO (p = 0.461). Considering initial BCVA and CMT, RVO predicted better visual enhancement than DME.: RVO exhibited major BCVA improvement at three months with Anti-Vascular Endothelial Growth Factor. Final vision was indistinguishable for DME and RVO. Anti VEGF stabilizes DME vision. Despite the improvement, early RVO diagnosis and treatment may enhance final vision.

Automated interpretation of retinal vein occlusion based on fundus fluorescein angiography images using deep learning: A retrospective, multi-center study

PurposeFundus fluorescein angiography (FFA) is the gold standard for retinal vein occlusion (RVO) diagnosis. This study aims to develop a deep learning-based system to diagnose and classify RVO using FFA images, addressing the challenges of time-consuming and variable interpretations by ophthalmologists. Methods4028 FFA images of 467 eyes from 463 patients were collected and annotated. Three convolutional neural networks (CNN) models (ResNet50, VGG19, InceptionV3) were trained to generate the label of image quality, eye, location, phase, lesions, diagnosis, and macular involvement. The performance of the models was evaluated by accuracy, precision, recall, F-1 score, the area under the curve, confusion matrix, human-machine comparison, and Clinical validation on three external data sets. ResultsThe InceptionV3 model outperformed ResNet50 and VGG19 in labeling and interpreting FFA images for RVO diagnosis, achieving 77.63%–96.45% accuracy for basic information labels and 81.72%–96.45% for RVO-relevant labels. The comparison between the best CNN and ophthalmologists showed up to 19% accuracy improvement with the inceptionV3. ConclusionThis study developed a deep learning model capable of automatically multi-label and multi-classification of FFA images for RVO diagnosis. The proposed system is anticipated to serve as a new tool for diagnosing RVO in places short of medical resources.

Use of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients With Type 2 Diabetes and the Incidence of Retinal Vein Occlusion in Taiwan.

The purpose of this study was to evaluate the risk of newly diagnosed retinal vein occlusion (RVO) in patients with type 2 diabetes (T2D) using sodium-glucose cotransporter-2 inhibitors (SGLT-2i) compared to dipeptidyl peptidase-4 inhibitors (DPP-4i). Claims data from the National Health Insurance Research Database of Taiwan were used in this nationwide retrospective cohort study. A target trial emulation framework was applied. Patients with T2D with no prior diagnosis of RVO who had newly commenced treatment with SGLT-2i or DPP-4i between May 1, 2016, and December 31, 2020, were included. Potential systematic differences in baseline characteristics between the paired groups were controlled using stabilized inverse probability of treatment weighting. The outcome of interest was incident RVO. The hazard ratio (HR) for SGLT-2i compared with that of DPP-4i was estimated using a Cox regression model. Data from 123,567 and 578,665 patients receiving SGLT-2i and DPP-4i, respectively, were analyzed. The incidence of RVO was lower in patients newly receiving SGLT-2i (0.59 events per 1000 person-years) compared to those receiving DPP-4i (0.77 events per 1000 person-years) over a mean follow-up of 1.61years. SGLT-2i users had a significantly lower risk of developing RVO compared with DPP-4i users (HR = 0.76, 95% confidence interval [CI] = 0.59-0.98). In the individual outcome analysis, SGLT-2i use was significantly associated with a lower risk of branch RVO (HR = 0.71, 95% CI = 0.52-0.96), but not central RVO (HR = 0.84, 95% CI = 0.57-1.24). The risk of developing RVO was lower in patients with T2D receiving SGLT-2i compared with that in those receiving DPP-4i.

Vision-related quality of life in patients with retinal vein occlusion.

This study aims to assess the vision-related quality of life in patients with retinal vein occlusion (RVO) among those referred to Labbafinejad Medical Center and Imam Hossein Hospital between 2019 and 2021. This comparative study included 37 eligible patients diagnosed with various types of RVO, with an average age of 61 ± 9. To ensure data validity, we included 74 age- and sex-matched healthy individuals. Only cases with a definitive diagnosis of RVO, confirmed by two retina specialists (ND and RN), were included. We assessed the vision-related quality of life of our participants using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). All participants underwent interviews. In our study, we examined the vision-related quality of life in different subgroups of RVO patients. Overall, RVO patients had a significantly lower total VRQoL score compared to healthy individuals (P < 0.001), except in the subscale analysis of specific factors such as ocular pain, color vision, and driving, where no statistically significant difference was observed. A statistically significant difference was found in the comparison of subgroups, indicating lower VRQoL in central retinal vein occlusion (CRVO) patients (P = 0.010). Furthermore, a significant correlation was observed between lower VRQoL and decreased vision (P = 0.009) as well as longer disease duration (P = 0.011). Retinal vein occlusion can significantly reduce vision-related quality of life, particularly in more severe cases.

Disparities in Retinal Vein Occlusion Presentation and Initiation of Anti-VEGF Therapy: An Academy IRIS® Registry Analysis

Investigate disparities in retinal vein occlusion (RVO) presentation and initiation of anti-VEGF treatment. Retrospective cohort study. Patients in the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry database (2015-2021) with branch or central RVO and macular edema (ME). The association of demographic characteristics and presenting visual acuity (VA) with anti-VEGF treatment initiation were quantified using multivariable logistic regression. Treatment with ≥ 1 anti-VEGF injection within 12 months after RVO diagnosis. A total of 304 558 eligible patients with RVO and ME were identified. Age at presentation varied by race, ethnicity, sex, and RVO type (all P values < 0.001). Within the first year after RVO presentation, 192 602 (63.2%) patients received ≥ 1 anti-VEGF injection. In a multivariable regression model adjusting for relevant covariates, female (vs. male) patients had lower odds of receiving injections (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.93-0.96; P < 0.0001) as did Black/African American (vs. White) patients (OR, 0.90; 95% CI, 0.88-0.92; P < 0.0001) and Asian (vs. White) patients (OR, 0.95; 95% CI, 0.91-0.99; P= 0.02), whereas older patients (vs. patients aged < 51 years) had higher odds (61-70 years: OR, 1.20; 95% CI, 1.16-1.24; 71-80 years: OR, 1.20; 95% CI, 1.16-1.24; > 80 years: OR, 1.15; 95% CI, 1.11-1.18; all P values < 0.0001). Hispanic (vs. non-Hispanic) patients had a small increased odds of treatment initiation (OR, 1.08; 95% CI, 1.04-1.11; P < 0.0001). Results were similar in the subset of 226 143 patients with VA data. In this subset, patients with presenting VA < 20/40 to 20/200 were most frequently treated in the first year after diagnosis (∼ 70%) and patients with light perception/no light perception (LP-NLP) vision or VA of 20/20 or better were treated least frequently (36.9% and 41.9%, respectively). In this large national clinical registry, 37% of RVO patients with ME had no anti-VEGF treatment documented in the first year after diagnosis. Black/African American, Asian, and female patients and patients with VA of LP-NLP were least likely to receive treatment. Awareness of this undertreatment and these disparities highlight the need for initiatives to ensure all RVO patients receive timely anti-VEGF injections for optimized visual outcomes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Intelligent diagnosis of retinal vein occlusion based on color fundus photographs.

To develop an artificial intelligence (AI) diagnosis model based on deep learning (DL) algorithm to diagnose different types of retinal vein occlusion (RVO) by recognizing color fundus photographs (CFPs). Totally 914 CFPs of healthy people and patients with RVO were collected as experimental data sets, and used to train, verify and test the diagnostic model of RVO. All the images were divided into four categories [normal, central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and macular retinal vein occlusion (MRVO)] by three fundus disease experts. Swin Transformer was used to build the RVO diagnosis model, and different types of RVO diagnosis experiments were conducted. The model's performance was compared to that of the experts. The accuracy of the model in the diagnosis of normal, CRVO, BRVO, and MRVO reached 1.000, 0.978, 0.957, and 0.978; the specificity reached 1.000, 0.986, 0.982, and 0.976; the sensitivity reached 1.000, 0.955, 0.917, and 1.000; the F1-Sore reached 1.000, 0.955 0.943, and 0.887 respectively. In addition, the area under curve of normal, CRVO, BRVO, and MRVO diagnosed by the diagnostic model were 1.000, 0.900, 0.959 and 0.970, respectively. The diagnostic results were highly consistent with those of fundus disease experts, and the diagnostic performance was superior. The diagnostic model developed in this study can well diagnose different types of RVO, effectively relieve the work pressure of clinicians, and provide help for the follow-up clinical diagnosis and treatment of RVO patients.

Predictors of response to a lapse in anti-VEGF treatment in patients with macular edema secondary to retinal vein occlusion

ContexteL’œdème maculaire (OM) secondaire à une occlusion veineuse rétinienne (OVR) est une cause fréquente de perte de vision à l’échelle de la planète. Les injections d'anti-VEGF (facteur de croissance endothélial vasculaire) représentent le traitement de prédilection de l'OM secondaire à une OVR. Or, malgré leur efficacité, elles constituent un fardeau important pour les patients, d'où des taux élevés d'interruption du traitement et de perte de vue des patients pendant le suivi. MéthodesUne sous-analyse des effets de l'interruption du traitement chez des sujets présentant une OVR a réuni 60 patients, qui ont été séparés en 2 groupes : perte de vision et vision stable, selon l’évolution de la vision après une interruption du traitement. On a eu recours à une analyse de régression logistique qui utilisait l’âge, l'indice de masse corporelle (IMC), les antécédents de dyslipidémie et le temps écoulé depuis le diagnostic d'OVR à titre de facteurs de prédiction d'une perte de vision après une interruption du traitement. RésultatsLa durée moyenne de l'interruption du traitement, qui était de 5,6 mois, était similaire dans les 2 groupes (perte de vision et vision stable). Au départ, les patients du groupe perte de vision étaient plus âgés et avaient un IMC plus faible (p < 0,05). L’âge et les antécédents de dyslipidémie étaient associés à une augmentation de la probabilité de perte de vision par des facteurs de 1,23 (fourchette : 1,10–1,45) et de 8,40 (fourchette : 1,62–66,2), respectivement. L'IMC et le temps écoulé depuis le diagnostic d'OVR étaient associés à une diminution de la probabilité de perte de vision par des facteurs de 0,83 (fourchette : 0,69–0,95) et de 0,95 (fourchette : 0,90–0,99), respectivement. Le modèle final avait une spécificité de 87,5 % et une sensibilité de 70,0 %. ConclusionsIl est possible de prédire de manière raisonnablement précise les effets d'une interruption du traitement de l'OM secondaire à une OVR grâce à des données cliniques facilement accessibles, notamment l’âge, l'IMC, le temps écoulé depuis le diagnostic et les antécédents de dyslipidémie. Les professionnels de la santé doivent tenir compte de ces facteurs lorsqu'ils prodiguent des conseils à leurs patients et établissent un calendrier de suivi.

Risk of Stroke, Myocardial Infarction, Deep Vein Thrombosis, Pulmonary Embolism, and Death After Retinal Vein Occlusion

To examine rates of stroke, myocardial infarction (MI), deep vein thrombosis (DVT), pulmonary embolism (PE), and death in patients after retinal vein occlusion (RVO) compared to controls. Retrospective cohort study. An aggregated electronic health records research network, TriNetX, was used to identify patients with diagnosis of RVO and a control group of patients with cataract. Patients were excluded if they had history of stroke, MI, DVT, or PE within 2 years of diagnosis of RVO or cataract. Propensity score matching was performed to control for baseline demographics and medical comorbidities. Main outcomes included relative risk (RR) of death, stroke, MI, DVT, and PE after RVO compared to those in matched controls. A total of 45,304 patients were included in each cohort. There was elevated risk of death in the RVO cohort compared to the control cohort at 1 year (RR=1.30, P < .01), 5 years (RR=1.22, P < .01), and 10 years (RR=1.08, P < .01). There was elevated risk of stroke at 1 year (RR=1.61, P < .01), 5 years (RR=1.31, P < .01), and 10 years (RR=1.18, P < .01). There was elevated risk of MI at 1 year (RR=1.26, P < .01) and 5 years (RR=1.13, P < .01), but not at 10 years (RR=1.06, P=.12). There was mildly elevated risk of DVT at 1 year (RR=1.65, P < .01) but not at 5 years (RR=0.94, P=.94) or 10 years (RR=1.05, P=.37). There was no elevated risk of PE at 1 year (RR=0.98, P=0.80), 5 years (RR=0.95, P=.42), or 10 years (RR=0.85, P =.40). There is an increased rate of death, stroke, and MI after RVO compared to those in matched controls. We emphasize the need for long-term systemic evaluation after RVO.

Estimating the rate of severe visual loss (wipe-out) following cataract surgery, a British Ophthalmological Surveillance Unit (BOSU) study.

A sudden, irreversible reduction in visual acuity ('wipe-out') is a feared complication of cataract surgery. Current literature on wipe-out is limited in quantity and quality, and largely predates modern cataract surgery and imaging techniques. The objectives of our study were to estimate the incidence of wipe-out and to identify potential risk factors. We prospectively collated cases of wipe-out occurring in the UK during a 25-month study period using the British Ophthalmic Surveillance Unit reporting system. A total of 21 potential cases of wipe-out were reported, 5 of which met all inclusion and exclusion criteria. The estimated incidence of wipe-out during the study period was 0.00000298, or approximately 3 cases per million cataract operations. All cases of wipe-out occurred exclusively in patients with advanced glaucoma (mean deviation -21.0 decibels or worse in the operated eye), with an over-representation of black people (40%) in our case series. A prior diagnosis of retinal vein occlusion (60%) and elevated post-operative IOP (40%) were more common among individuals suffering from wipe-out compared to the general population, suggesting these factors may contribute to the pathogenesis of wipe-out. Our study shows that wipe-out is a rare complication, affecting approximately 3 per million undergoing cataract surgery. Patients with advanced glaucoma, black patients, and those with previous retinal vein occlusions may be at greater risk of wipe-out. We hope that the findings of our study will be used to help inform treatment decision-making and the cataract surgery consent process.

Clinical Features and Visual Prognosis of Retinal Vein Occlusion in Those under 50 Years Old

Purpose: To analyze the clinical features and visual prognosis of retinal vein occlusion (RVO) in patients under 50 years of age.Methods: A retrospective analysis of medical records of 36 patients under 50 years of age diagnosed with RVO from January 2016 to October 2021.Results: The mean age was 39.53 ± 9.98 years and 50%, 44.4%, and 5.6% had branch, central, and hemi-central RVO, respectively. Before the RVO diagnosis, systemic disease had been diagnosed in 38.9%. Further, 13.89% of the cases had a new systemic disease diagnosed after the diagnosis of RVO. Hypercholesterolemia was observed in 47.6%. The initial visual acuity (VA), best corrected visual acuity (BCVA), and central subfield thickness (CST) showed significant correlations with the final VA, BCVA, and CST.Conclusions: In patients with RVO under the age of 50 years, the initial VA and CST can be used as indicators to determine whether treatment is necessary by reflecting the final VA and CST. The initial VA and CST can also be used to predict the visual prognosis. Even at a young age, if complications occur, the visual prognosis of RVO may be poor, so an evaluation of the patient’s general condition is essential, especially the blood cholesterol level.

Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion.

To evaluate microvascular morphological characteristics of the retina and optic disc (OD) in retinal vein occlusion (RVO) patients using optical coherence tomography angiography (OCTA), compare the results to age- and gender-matched healthy subjects, and determine correlations between OCTA parameters and best-corrected visual acuity (BCVA) and age. In this retrospective study, right eyes of 53 RVO patients and 51 healthy subjects were compared regarding BCVA, as well as superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), foveal avascular zone (FAZ) parameters, outer retinal and choriocapillaris flow areas, OD whole and peripapillary VDs, and retinal nerve fiber layer thickness (RNFLT). Retinal vein occlusion patients were further divided into subgroups based on therapy and risk factors, and OCTA parameters were compared. Retinal vein occlusion rate or OCTA parameters did not differ significantly by gender (p>0.05). Retinal vein occlusion patients had significantly decreased BCVA, whole, parafoveal and perifoveal SCP and DCP VDs, as well as VDs 300µm area around FAZ (FD-300) than healthy subjects (p<0.001). Their choriocapillaris flow area, RNFLT, whole and peripapillary VDs were also affected. However, FAZ area did not differ significantly between groups. Superior RNFLT (p=0.016) and whole peripapillary VD (p<0.001) differed significantly between laser photocoagulation-treated and non-treated patients. The remaining OCTA parameters revealed no significant differences CONCLUSIONS: The RVO and its therapeutic alternatives may affect both OD and retinal VDs. Given its numerous benefits, it seems that OCTA will be used more frequently in clinics for RVO diagnosis, monitoring, and therapeutic response evaluation.

Risk of retinal vein occlusion following COVID-19 vaccination: a self-controlled case series.

To evaluate the association between COVID-19 vaccination and retinal vein occlusion (RVO). This multicentre self-controlled case series included patients with RVO seen in five tertiary referral centres in Italy. All adults who received at least one dose of the BNT162b2, ChAdOx1 nCoV-19, mRNA-1273 or Ad26.COV2.S vaccine and had a first diagnosis of RVO between January 01, 2021, and December 31, 2021 were included. Incidence rate ratios (IRRs) of RVO were estimated using Poisson regression, comparing rates of events in a 28-day period following each dose of vaccination and in the unexposed control periods. 210 patients were included in the study. No increased risk of RVO was observed after the first dose (1-14 days IRR: 0.87, 95% CI: 0.41-1.85; 15-28 days IRR: 1.01, 95% CI: 0.50-2.04; 1-28 days IRR: 0.94, 95% CI: 0.55-1.58) and second dose of vaccination (1-14 days IRR: 1.21, 95% CI: 0.62-2.37; 15-28 days IRR: 1.08, 95% CI: 0.53-2.20; 1-28 days IRR: 1.16, 95% CI: 0.70-1.90). No association between RVO and vaccination was found in subgroup analyses by type of vaccine, gender and age. This self-controlled case series found no evidence of an association between RVO and COVID-19 vaccination.

Socio-demographic factors and selected clinical characteristics of patients with retinal vein occlusions in transitional Albania

Aim: The aim of our study was to assess the distribution of socio-demographic factors and the clinical profile of individuals diagnosed with retinal vein occlusion (RVO) in Albania, a former communist country in South-eastern Europe which has been undergoing a rapid transition in the past decades. Methods: This study was carried out in 2013-2016 at the Primary Health Care Centre No. 2 in Tirana municipality, which is the capital of Albania. During this timeframe, on the whole, 44 patients were diagnosed with RVO at this primary health care centre (17 women and 27 men; overall mean age: 69.5±11.5 years). The diagnosis of RVO was based on signs and symptoms indicating a quick reduction of the sight (vision), fundoscopy, fluorescein angiography and the optical coherence tomography. Data on socio-demographic factors and clinical characteristics were also gathered for each study participant. Results: The prevalence of glaucoma was considerably higher in men than in women (67% vs. 24%, respectively, P=0.01). Diabetic retinopathy was somehow more prevalent in women than in men (18% vs. 11%, respectively), whereas an opposite finding was noted for the presence of hypertensive retinopathy (6% vs. 11%, respectively). The prevalence of cataract was higher in female patients compared with their male counterparts (18% vs. 7%, respectively, P=0.36). Both macular oedema and papillary oedema were almost equally distributed in men and in women (22% vs. 18% and 4% vs. 6%, respectively). All female patients had comorbid conditions compared to 85% of their male counterparts (P=0.15). The prevalence of hypertension was almost identical in both sexes (52% in men vs. 53% in women), whereas the prevalence of diabetes was somehow higher in men than in women (26% vs. 18%, respectively). Conclusion: This is one of the very few studies informing about the distribution of socio-demographic factors and selected clinical characteristics of individuals diagnosed with RVO in transitional Albania.

Hypermixed Convolutional Neural Network for Retinal Vein Occlusion Classification.

Retinal vein occlusion (RVO) is one of the most common retinal vascular diseases leading to vision loss if not diagnosed and treated in time. RVO can be classified into two types: CRVO (blockage of the main retinal veins) and BRVO (blockage of one of the smaller branch veins). Automated diagnosis of RVO can improve clinical workflow and optimize treatment strategies. However, to the best of our knowledge, there are few reported methods for automated identification of different RVO types. In this study, we propose a new hypermixed convolutional neural network (CNN) model, namely, the VGG-CAM network, that can classify the two types of RVOs based on retinal fundus images and detect lesion areas using an unsupervised learning method. The image data used in this study is collected and labeled by three senior ophthalmologists in Shanxi Eye Hospital, China. The proposed network is validated to accurately classify RVO diseases and detect lesions. It can potentially assist in further investigating the association between RVO and brain vascular diseases and evaluating the optimal treatments for RVO.

Prevalence of homocysteinemia and effect of vitamin supplementation in retinal vein occlusion

ObjectiveThe objective of this study was to determine the prevalence of homocysteinemia in patients with retinal vein occlusion (RVO). We investigated the association of B complex vitamin (BCV) and multivitamin...

Development and Application of an Intelligent Diagnosis System for Retinal Vein Occlusion Based on Deep Learning.

This study is aimed at developing an intelligent algorithm based on deep learning and discussing its application for the classification and diagnosis of retinal vein occlusions (RVO) using fundus images. A total of 501 fundus images of healthy eyes and patients with RVO were used for model training and testing to investigate an intelligent diagnosis system. The images were first classified into four categories by fundus disease specialists: (i) healthy fundus (group 0), (ii) branch RVO (BRVO) (group 1), (iii) central RVO (CRVO) (group 2), and (iv) macular branch RVO (MBRVO) (group 3), before being diagnosed using the ResNet18 network model. Intelligent diagnoses were compared with clinical diagnoses. The specificity of the intelligent diagnosis system under each attention mechanism was 100% in group 0 and also revealed a high sensitivity of over 95%, F1 score of over 97%, and an accuracy of over 97% in this group. For the other three groups, the specificities of diagnosis ranged from 0.45 to 0.91 with different attention mechanisms, in which the ResNet18+coordinate attention (CA) model had the highest specificities of 0.91, 0.88, and 0.83 for groups 1, 2, and 3, respectively. It also provided a high accuracy of over 94% with a coordinate attention mechanism in all four groups. The intelligent diagnosis and classifier system developed herein based on deep learning can determine the presence of RVO and classify disease according to the site of occlusion. This proposed system is expected to provide a new tool for RVO diagnosis and screening and will help solve the current challenges due to the shortage of medical resources.

Evaluation of off-label anti-vascular endothelial growth factor and steroid implant medication uses in macular edema due to retinal vein occlusion in Turkey.

Retinal vein occlusion (RVO) is one of the most common causes of vision loss. Anti-vascular endothelial growth factor (anti-VEGF) drugs, ranibizumab and aflibercept, and corticosteroid implants are approved treatment options for RVO-related macular edema (ME) in Turkey. To the best of our knowledge, there is no data regarding the off-label use of these drugs for RVO in English literature. We aimed to evaluate the clinical and demographic characteristics of off-label drug use applications in Turkey for RVO. Applications made to the Turkish Medicines and Medical Devices Agency between January 1 and December 31, 2018, for the use of off-label drugs (ranibizumab, aflibercept, dexamethasone implant) for the diagnosis of RVO from hospitals across Turkey were retrospectively analysed. Data of the applications, such as demographic characteristics, previous treatment regimens, reasons for applications, applicant hospitals and their regions, were recorded. There were 291 approved applications for RVO. The mean age of the patients was 64.88 ± 10.78 years, 48.8% were male, and 51.2% were female. Of these applications, 44.7% were for aflibercept, 35.7% for ranibizumab and 19.6% for dexamethasone implant. No application was made for bevacizumab since it could be used without needing for an application. The most common reasons for applications were due to dose limitations, failure to complete loading doses, and glaucoma, respectively. In terms of the distribution of the applicant hospitals, public university hospitals ranked first with 72.5%, training and research hospitals ranked second with 14.7% and foundation university hospitals ranked third with 13.1% rates. The practice of drug use in RVO in Turkey has changed as of the beginning of 2019. Stepwise therapy has been accepted by the drug regulatory agency Turkish Medicines and Medical Devices Agency. Utilization of licensed drugs, aflibercept, ranibizumab and dexamethasone has been allowed only after administration of 3 doses of intravitreal bevacizumab. After 3 doses of bevacizumab, the physician may continue either with bevacizumab again or a dexamethasone implant. If there is a reason such as the presence of glaucoma, the physician may skip dexamethasone and switch to aflibercept and ranibizumab, but in this case, dexamethasone cannot be administered to the patient for life. The evaluation of the off-label treatments of RVO, which is one of the most frequently followed diseases in retina clinics, not only contributes to the literature but also provides information regarding the most frequently applied treatments and the physicians' off-label drug preferences for RVO.

Evaluation of Systemic Endothelial Dysfunction in Retinal Vein Occlusions.

Objectives:Our aim in this study was to evaluate the systemic endothelial dysfunction status and carotid intima-media thickness (CIMT) in patients with retinal vein occlusion (RVO).Methods:Seventy-six patients who presented to the clinic with the diagnosis of RVO and 76 age- and gender-matched healthy individuals without a RVO history were included in the study. The patients’ best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measures, and diabetes, hypertension, hyperlipidemia, carotid artery disease, body mass index, and smoking histories were recorded. The endothelial function levels of the patients, pulse wave velocity (PWV), flow-mediated dilation (FMD), and CIMT were measured. Endothelial dysfunction was detected by applying the FMD technique to the brachial artery. CIMT was evaluated by B-mode ultrasonography. Serum hematological parameters were evaluated.Results:BCVA (logMAR) was 1.39±1.30 in patients with RVO and 0.028±1.22 in the control group (p<0.001). CMT was 588.76±104.02 µm in patients with RVO and 265.20±45.11 µm in the control group (p=0.001). Hypertension, diabetes, and hyperlipidemia were found to be significantly higher in patients with RVO (p-value 0.001, 0.002, and 0.001, respectively). There was a significant difference between the groups in terms of FMD, PWV, and CIMT (all of them, p<0.001).Conclusion:The deterioration of FMD and PWV, which are indicators of endothelial dysfunction in patients with RVO, suggests that systemic endothelial dysfunction may play a role in the pathogenesis of RVO. Comprehensive studies with more patient participation are needed.

Novel Association between Opioid Use and Increased Risk of Retinal Vein Occlusion Using the National Institutes of Health All of Us Research Program.

Purpose:To assess for risk factors for retinal vein occlusion (RVO) among participants in the National Institutes of Health All of Us database, particularly social risk factors that have not been well studied, including substance use.Design:Retrospective, case-control study.Participants:Data were extracted for 380 adult participants with branch retinal vein occlusion (BRVO), 311 adult participants with central retinal vein occlusion (CRVO), and 1520 controls sampled among 311 640 adult participants in the All of Us database.Methods:Data were extracted regarding demographics, comorbidities, income, housing, insurance, and substance use. Opioid use was defined by relevant diagnosis and prescription codes, with prescription use > 30 days. Controls were sampled at a 4:1 control to case ratio from a pool of individuals aged > 18 years without a diagnosis of RVO and proportionally matched to the demographic distribution of the 2019 U.S. census. Multivariable logistic regression identified medical and social determinants significantly associated with BRVO or CRVO. Statistical significance was defined as P < 0.05.Main Outcome Measure:Development of BRVO or CRVO based on diagnosis codes.Results:Among patients with BRVO, the mean (standard deviation) age was 70.1 (10.5) years. The majority (53.7%) were female. Cases were diverse; 23.7% identified as Black, and 18.4% identified as Hispanic or Latino. Medical risk factors including glaucoma (odds ratio [OR], 3.29; 95% confidence interval [CI], 2.22–4.90; P < 0.001), hypertension (OR, 2.15; 95% CI, 1.49–3.11; P < 0.001), and diabetes mellitus (OR, 1.68; 95% CI, 1.18–2.38; P = 0.004) were re-demonstrated to be associated with BRVO. Black race (OR, 2.64; 95% CI, 1.22–6.05; P = 0.017) was found to be associated with increased risk of BRVO. Past marijuana use (OR, 0.68; 95% CI, 0.50–0.92; P = 0.013) was associated with decreased risk of BRVO; however, opioid use (OR, 1.98; 95% CI, 1.41–2.78; P < 0.001) was associated with a significantly increased risk of BRVO. Similar associations were found for CRVO.Conclusions:Understanding RVO risk factors is important for primary prevention and improvement in visual outcomes. This study capitalizes on the diversity and scale of a novel nationwide database to elucidate a previously uncharacterized association between RVO and opioid use.

Retinal vein occlusion: drug targets and therapeutic implications

Introduction The pathogenesis of retinal vein occlusion (RVO) is extremely complex and includes several mediators. These mediators represent potential drug targets that can be used in the development of intravitreal drugs. Areas covered PubMed/MEDLINE databases were accessed between April-May 2021 to find the most relevant scientific papers regarding drug targets and therapeutic implications in RVO, focusing on current therapeutic options and potential cornerstones of future advances in treatment. Expert opinion Before the introduction of intravitreal therapies, the visual outcome following a diagnosis of RVO was extremely poor. Anti-VEGF and corticosteroid treatments have radically changed RVO prognosis, helping to preserve patients’ visual function and their quality of life. According to current clinical data, anti-VEGF and corticosteroid drugs are associated with both pros and cons; the present recommendation is to employ anti-VEGF molecules as a first-line treatment. Advances in our understanding of the biomolecular characteristics of RVO offer a solid basis for the development of new therapeutic targets and treatments.