Ischemic Retinal Vein Occlusion Research Articles

Response to treatment of epiretinal neovascularization secondary to ischemic retinal vein occlusion in proliferative MacTel 2

Purpose: To describe a case of unilateral epiretinal neovascularization (ERN) secondary to an old ischemic retinal vein occlusion (RVO) in a patient with bilateral proliferative macular teleangiectasia type 2 (MacTel 2; Toto stage 4) and its response to treatment as documented by multimodal imaging. Methods: Retrospective case report Results: A 75-year-old woman with a six-year-history of MacTel 2 and the consecutive development of proliferative outer retinal neovascularization in both eyes over time presented with an ERN in addition to neovascularization of the optic disc, delayed filling of the retinal veins, peripheral capillary ischemia and intravitreal hemorrhage only in her left eye in September 2023. She was therefore treated with anti-vascular endothelial growth factor (anti-VEGF; aflibercept 2mg) intravitreally. The ERN responded well to a single intravitreal injection of anti-VEGF, while flow in the outer retinal proliferation persisted. Diagnosis and treatment with anti-VEGF were observed via optical coherence tomography angiography. Conclusion: We believe that the ERN formation was a reaction to ischemia of the inner retinal capillary plexus due to a preceding RVO. The herein presented case provides a new perspective on the development and treatment of ERN in MacTel 2.

Central and Peripheral Changes in Retinal Vein Occlusion and Fellow Eyes in Ultra-Widefield Optical Coherence Tomography Angiography.

To explore the central and peripheral retinal and choroidal changes in retinal vein occlusion (RVO) and fellow eyes using ultra-widefield swept-source optical coherence tomography angiography (UWF-SS-OCTA). Fifteen ischemic central RVO (CRVO), 15 branch RVO (BRVO), and 15 age-matched healthy controls were prospectively recruited. Retinal and choroidal parameters, including retinal vessel flow density (VFD) and vessel linear density (VLD), choroidal vascularity volume (CVV), choroidal vascularity index (CVI), and VFD in the large and medium choroidal vessels (LMCV-VFD), were measured in the central and peripheral regions of the 24 × 20-mm UWF-SS-OCTA images. Ischemic CRVO and BRVO eyes showed increased foveal avascular zone area, perimeter, and acircularity index (AI) compared to their fellow eyes and healthy control eyes, and RVO fellow eyes also had larger AI values than controls (P < 0.05). For ischemic CRVO and BRVO eyes versus control eyes, VFD, VLD, CVV, CVI, and LMCV-VFD decreased, but retinal thickness and volume in the superficial capillary plexus, deep capillary plexus, and whole retina increased (P < 0.05). Moreover, RVO fellow eyes also showed significantly decreased retinal VFD, LMCV-VFD, and CVI, as well as increased retinal thickness and volume, compared with control eyes (P < 0.05). Alterations were not consistent throughout the retina, as they involved only the peripheral or central regions in some cases. The affected and unaffected fellow eyes of RVO patients both demonstrated central and/or peripheral structural and vascular alterations in the retina and choroid. Because UWF-SS-OCTA enables visualization and evaluation of the vasculature outside the posterior pole, it presents a promising approach to more fully characterize vascular alterations in RVO.

Impact of flight and equivalent short-term high-altitude exposure on ocular structures and function.

Exposure to high-altitude conditions during flight or similar activities affects many aspects of visual function, which is critical not only for flight safety but for any altitude-related activity. We aimed to summarize the available literature pertaining to ocular changes during flight or equivalent short-term high-altitude exposure (e.g., hypobaric chamber, effortless ascent lasting ≤ 24 h) and to highlight future research priorities. Using the PubMed/MEDLINE and Web of Science/ISI Web of Knowledge databases with structured search syntax, we conducted a systematic review of the literature spanning a 40-year period (January 1, 1983, to October 10, 2023). Articles pertaining to ocular changes during flight or flight-equivalent exposure to altitude were retrieved. The reference lists of retrieved studies were also searched, and citations of these references were included in the results. Of 875 relevant PubMed and ISI publications, 122 qualified for inclusion and 20 more were retrieved from the reference lists of initially selected records, for a total of 142 articles. Reported anterior segment changes included deterioration in tear film stability and increased dry eye incidence, increased corneal thickness, discomfort and bubble formation in contact lens users, refraction changes in individuals with prior refractive surgery, decreased intraocular pressure, and alterations in pupillary reaction, contrast sensitivity, and visual fields. Photoreceptor-visual pathway changes included alterations in both photoreceptors and neuro-transduction, as evidenced in dark adaptation, macular recovery time, reduction in visual field sensitivity, and optic neuritis (likely an element of decompression sickness). Retinochoroidal changes included increases in retinal vessel caliber, retinal blood flow, and choroidal thickness; central serous chorioretinopathy; and retinal vascular events (non-arteritic ischemic optic neuropathy, high-altitude retinopathy, and retinal vein occlusion). The effect of short-term high-altitude exposure on the eye is, in itself, a difficult area to study. Although serious impairment of visual acuity appears to be rare, ocular changes, including tear film stability, contact lens wear, central corneal thickness, intraocular pressure, contrast sensitivity, stability of refractive surgeries, retinal vessels, visual fields, and macula recovery time, should be considered in civilian aviators. Our report provides guidance to climbers and lowlanders traveling to altitude if they have pre-existing ocular conditions or if they experience visual symptoms while at altitude. However, key outcomes have been contradictory and comprehensive studies are scarce, especially those pertaining to the choroid and retina. Such studies could not only deepen our understanding of high-altitude ocular pathophysiology, but could also offer valuable information and treatment possibilities for a constellation of other vision-threatening diseases.

Optical coherence tomography angiography for macular microvessels in ischemic branch retinal vein occlusion treated with conbercept: predictive factors for the prognosis.

To evaluate the predicative factors of visual prognosis using optical coherence tomography angiography (OCTA) in ischemic branch retinal vein occlusion (BRVO) patients with macular edema (ME) after anti-vascular endothelial growth factor (VEGF) treatment. In this retrospective analysis, data from 60 patients (60 eyes) with a definite diagnosis of ischemic BRVO with ME by fundus fluorescein angiography (FFA) were studied. The eyes with ME according to spectral domain optical coherence tomography (SD-OCT) underwent intravitreal conbercept (IVC) and 3+pro re nata (PRN) regimen. The injection times were recorded. Two weeks after injection, fundus laser photocoagulation was performed in the non-perfusion area of the retina. The patients were followed up once a month for 6mo. The best-corrected visual acuity (BCVA), foveal avascular zone (FAZ), and A-circularity index (AI), at 6mo and the baseline were compared. All patients showed significant improvement in BCVA from 0.82±0.32 to 0.39±0.11 logMAR (P<0.001). The mean central macular thickness (CMT) significantly decreased from 476.22±163.54 to 298.66±109.23 µm. Both the FAZ area and AI at 6mo were significantly higher than those at the baseline: the FAZ area increased (0.38±0.02 vs 0.39±0.02 mm2, P<0.05); the AI increased (1.27±0.02 vs 1.31±0.01, P=0.000). The baseline BCVA showed a significantly positive correlation with the baseline FAZ area, FAZ perimeter (PERIM) and AI, final visual gain (FVG) and injection times, respectively (P<0.001). FVG showed a significantly negative correlation with the FAZ area, PERIM, AI and injection times, but a significantly positive correlation with vessel densities (VDs) 300 µm area around FAZ (FD-300; P<0.001). Injection times was positively correlated with the baseline FAZ area, and AI, but inversely correlated with the baseline FD-300 (P<0.001). However macular ischemia was noted in 5 cases during follow-up. Using OCTA to observe macular ischemia and quantify parameters can better predict the final visual prognosis of patients before treatment. The changes in FAZ parameters may influence the visual prognosis and injection times.

Changes in foveal avascular zone area and retinal vein diameter in patients with retinal vein occlusion detected by fundus fluorescein angiography.

To investigate changes in foveal avascular area (FAZ) and retinal vein diameter in patients with retinal vein occlusion (RVO) after intravitreal ranibizumab, and to analyze the correlation between ranibizumab therapy and visual gain. This retrospective study enrolled 95 eyes of 95 patients who had accepted three consecutive monthly ranibizumab injections, including 50 branch RVOs (BRVOs) and 45 central RVOs (CRVOs). BRVOs were divided into ischemia group (n = 32) and non-ischemia group (n = 18), and CRVOs also had ischemia group (n = 28) and non-ischemia group (n = 17). Comprehensive ophthalmic examinations were performed before the first injection and after 6, 12, and 24 months. The FAZ was manually circumscribed on early-phase images of fundus fluorescein angiography. Retinal vein diameters were measured on fundus photographs. After three injections, the FAZ area was significantly enlarged firstly and then reduced in all ischemic RVOs and the non-ischemic BRVOs (p < 0.05), while the retinal vein diameter was significantly reduced firstly and then increased in all groups except for unobstructed branch veins of non-ischemic BRVOs (p < 0.05). The correlation between the FAZ area and best corrected visual acuity was statistically significant in all CRVOs (non-ischemic, r = 0.372; ischemic, r = 0.286; p < 0.01) and ischemic BRVOs (r = 0.180, p < 0.05). Spearman's correlation analysis revealed that the retinal vein diameter was significantly correlated to the larger FAZ area in obstructed branch veins of ischemic BRVOs (r = -0.31, p < 0.01), inferior temporal branch veins of non-ischemic CRVOs (r = -0.461, p < 0.01) and ischemia CRVO groups (superior temporal branch vein, r = -0.226, p < 0.05; inferior temporal branch vein, r = -0.259, p < 0.01). After three consecutive monthly ranibizumab injections, the FAZ area was enlarged and retinal vein diameter reduced with gradual recovery to near baseline from 12 months. These results suggest that ranibizumab therapy can worsen macular ischemia and prevent visual gain in the short term. It has important significance for the treatment and prognosis of RVO, although the natural course of RVO may also affect ischemia and visual gain.

Systemic complications of intravitreal bevacizumab: a case report and literature review

Background: Systemic complications of intravitreal bevacizumab (IVB) injections have been previously reported. We aimed to summarize the systemic complications reported in online primary studies. Moreover, we describe a patient experiencing simultaneous renal and cutaneous drug-induced adverse effects, with exacerbation of chronic renal insufficiency and granulomatous skin lesions, after receiving several IVB injections to manage bilateral ischemic branch retinal vein occlusion (BRVO). Case Presentation: A 69-year-old Hispanic diabetic man with chronic renal insufficiency due to polyclonal gammopathy received several IVB injections to treat bilateral ischemic BRVO. One week after the sixth injection, the patient developed acute-on-chronic renal failure and multiple rounded maculopapular, erythematous, and ulcerated skin lesions. Renal and skin biopsy specimens revealed granulomatous drug-induced responses in both organs, and granulomatous diseases of infectious and oncological sources were ruled out. We performed an electronic search of the PubMed/MEDLINE database with no language or time restrictions using the keywords “intravitreal bevacizumab” or “intravitreal Avastin” combined with “systemic side effects,” “systemic complications,” or “systemic adverse,” or “systemic adverse event.” The search yielded 147 articles published over almost two decades. After screening and assessment, we selected and summarized 40 primary studies that mentioned IVB-related systemic complications. Conclusions: IVB-induced systemic complications, such as arteriothrombotic events, venous thrombotic events, and hypertension, are rare but potentially serious. Care should be taken when administering multiple doses of intravitreal IVB to patients with pre-existing kidney dysfunction. Bevacizumab-related toxicity must be considered in cases of sudden deterioration of renal function and / or unexpected granulomatous skin lesions in oncologic or chronically polymedicated patients.

A Case Report on Neuro-Retinitis

Neuroretinitis is an inflammation of the neural retina and optic nerve. It was originally described by Leber in 1916 as a "stellate maculopathy," but this definition was challenged by Don Gass in 1977, citing that disc oedema precedes macular exudates. Subsequently, Gass confirmed optic disc leakage by fluorescein angiography and suggested the term "neuro retinitis." More recent retinal and optic nerve imaging has supported Gass' description. The condition was renamed Leber’s idiopathic stellate neuroretinitis. Neuroretinitis is characterized by an optic disc vasculature inflammation with fluid exudation into the peripapillary retina. The lipid-rich component of the exudate is further able to penetrate the outer plexiform layer, creating what is clinically seen as a macular star pattern. Only the aqueous phase is then able to pass through the external limiting membrane to accumulate beneath the neurosensory retina. Neuroretinitis is a type of optic neuropathy characterized by an acute unilateral visual loss in the setting of optic disc swelling accompanied by hard exudates characteristically arranged in a star shape around the fovea. It is classified as one form of optic neuritis, the other forms being the more common retrobulbar neuritis and papillitis. Funduscopically, neuroretinitis is often confused with hypertensive, renal and infiltrative retinopathies as well as with papillitis, papilledema, anterior ischemic optic neuropathy and retinal vein occlusion. It is an entity that physicians, paediatricians and neurologists are poorly exposed to since the diagnosis and management are almost exclusively performed by the ophthalmologist. Pathogenesis and aetiology of neuroretinitis are distinctly different from other funduscopic ally-resembling conditions often encountered by neurologists during their training and clinical practice; further, these have different principles of management and prognosis. The prognosis for visual recovery is reported to be excellent, although not uniform. It affects persons of all ages, more often in the third and fourth decades of life, with no gender predilection. Visual acuity at the time of initial examination ranges from 6/6 to light perception (PL). It can manifest either due to systemic infections, autoimmune diseases or as idiopathic.

Effects of Ranibizumab combined with laser photocoagulation on macular volume and best corrected visual acuity in patients with macular edema secondary to ischemic retinal vein occlusion.

To investigate the effects of ranibizumab combined with laser photocoagulation on macular volume and best corrected visual acuity (BCVA) in patients with macular edema secondary to ischemic retinal vein occlusion. The clinical data of 90 patients (90 eyes) with macular edema secondary to ischemic retinal vein occlusion treated in our hospital from June 2018 to December 2021 were retrospectively analyzed. Patients were divided into Groups-A, B, and C according to the type of treatment they received. The Group-A was treated with laser photocoagulation, the Group-B was intravitreally injected with ranibizumab, and the Group-C underwent ranibizumab combined with laser photocoagulation. The efficacy, intraocular pressure, BCVA, central macular thickness (CMT) and adverse reactions were compared among the three groups. The total efficacy of the Group-C was higher than that of the Group-A and B, with statistically significant differences (P< 0.05). Three months after treatment, BCVA was higher while CMT was reduced in the Group-C than those in the Group-A and B (P < 0.05). Six months after treatment, BCVA was higher while intraocular pressure was lower and CMT was thinner in the group C compared with the Group-A and B (P< 0.05). Ranibizumab combined with laser photocoagulation in the treatment of macular edema secondary to ischemic retinal vein occlusion presents significant efficacy, and can effectively reduce macular volume, improve visual acuity and promote the recovery of retinal function.

Characteristics of Hematologic Parameters in Young Patients with Retinal Vein Occlusion

Introduction: The aim of this study was to investigate the characteristics of hematologic parameters in young patients with retinal vein occlusion (RVO). Methods: All participants underwent routine ocular examinations and blood sample tests. Hematologic parameters obtained from a complete blood count, as well as the calculation of specific inflammatory indices, were compared between young patients with RVO and the control subjects. Correlations between hematologic inflammatory biomarkers and aqueous humor inflammatory cytokines were also investigated. Results: A total of 64 patients with RVO and 64 age- and gender-matched control subjects were included in this study. The white blood cell count, neutrophil cell count, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) in young patients with RVO were significantly higher than in the controls (all p < 0.05). Compared to patients with nonischemic RVO, patients with ischemic RVO had higher NLR, SII, and SIRI values (p = 0.032, p = 0.035, and p = 0.039, respectively). The areas under the receiver operator characteristic curve were 0.725, 0.651, 0.649, and 0.634 for the MPV, NLR, SII, and SIRI, respectively. In addition, a higher NLR was related to higher levels of interleukin 6 (IL-6; p = 0.046, R = 0.463), and a higher SII was related to higher levels of IL-6 (p = 0.034, R = 0.488) and vascular endothelial growth factor (p = 0.020, R = 0.528). Conclusion: The NLR, SII, and SIRI were significantly elevated in young patients with RVO, especially in young patients with ischemic RVO. NLR and SII were positively correlated with IL-6 levels in aqueous humor, which indicated that systemic inflammation plays an important role in the onset of RVO in young patients.

Long-term real-world outcomes in retinal vein occlusions: How close are we to the trials?

To assess and analyze the visual outcomes of patients with retinal vein occlusions in a real-world setting with a long-term follow-up of more than 5 years. Retrospective analysis of 56 patients having retinal vein occlusions from a tertiary eye center, with a mean follow-up of 7 years was performed. Primary outcome measures were mean change in best-corrected visual acuity (BCVA) from baseline at 6 months, 1 year, 2 years, 3 years, and final visit (≥5 years), proportion of patients having BCVA better than 20/40 and worse than 20/200, and mean number of injections. Secondary outcome measures were change in central macular thickness (CMT), development of subsequent retinal vein occlusion (RVO) in same eye or the other eye, and development of neovascular complications. The mean change in letter score was + 11.84 in branch RVO (BRVO), +7.14 in non-ischemic central RVO (CRVO), and -9.5 in ischemic CRVO at 1 year, which changed to + 8.57, -5 and - 24, respectively, at the end of follow-up. CMT had improved from 506 ± 98.8 μm, 576.44 ± 149 μm, and 618 ± 178.27 μm, respectively, at baseline to 267 ± 94 μm, 345.20 ± 122.61 μm, and 265.50 ± 107.75 μm, respectively, in BRVO, non-ischemic, and ischemic hemi RVO (HRVO)/CRVO groups. The total mean number of injections given in BRVO, non-ischemic CRVO, and ischemic CRVO groups were 4.6, 6.6, and 4.1, respectively. None of the patients with BRVO developed neovascular glaucoma (NVG). Non-ischemic to ischemic HRVO/CRVO conversion was noted in 4/11 eyes at a mean duration of 12.6 months. NVG was noted in 7/9 eyes (77.8%) in initial ischemic CRVO/HRVO group and 3/4 (75%) converted eyes. Patients with BRVO have good visual outcomes with anti-VEGF, while in CRVO results may vary considerably owing to patient compliance and treatment burden on long-term follow-up in a real-world setting.

Elevated Neutrophil Counts, Triglycerides, Monocyte/High-Density Lipoprotein Ratios, and Lower High-Density Lipoprotein in Patients with Retinal Vein Occlusion

Introduction: The aim of the study was to evaluate associations of peripheral blood immune cells and blood lipid profile levels with retinal vein occlusion (RVO). Methods: This retrospective study included 127 patients with RVO and 108 controls. Patients with RVO were divided into branch RVO (BRVO), central RVO (CRVO), ischemic RVO, or nonischemic RVO groups. Medical records were collected and analyzed. Results: The RVO group had higher mean neutrophil, triglyceride (TG), and monocyte/high-density lipoprotein (HDL) ratio (MHR) levels and lower HDL levels (p = 0.037, p < 0.001, p = 0.004, and p = 0.002, respectively). TG and MHR levels were significantly higher in the BRVO and CRVO groups compared with the control group (p < 0.001 and p = 0.016, respectively), but there was no difference in BRVO and CRVO group (p = 0.972 and p = 0.916, respectively). Mean HDL levels were significantly lower in the BRVO and CRVO groups than in the control group (p = 0.005), but the difference between the BRVO group and CRVO group was not significant (p = 0.290). Neutrophils, TG, and MHR were independent risk factors for RVO. HDL was an independent protective factor for RVO. Age was an independent risk factor for ischemic RVO. Conclusions: Lower HDL, and higher neutrophil, TG, and MHR levels are associated with RVO. Age is an independent risk factor for ischemic RVO.

Comparison of anti-VEGF results between non-ischemic branch retinal vein occlusion and ischemic branch retinal vein occlusion with early sector panretinal photocoagulation

To compare the need for anti-vascular endothelial growth factor (VEGF) in treating macular edema (ME) in patients with non-ischemic branch retinal vein occlusion (BRVO) and patients with ischemic BRVO with early peripheral photocoagulation. Patients with BRVO with ME were included in the retrospective study. The patients were divided into two groups according to peripheral ischemic status: a non-ischemic BRVO group and an ischemic BRVO group. All patients received three initial monthly 0.50mg ranibizumab injections followed by a pro re nata (PRN) regimen. In the ischemic BRVO group, early peripheral laser photocoagulation was applied in the area of capillary nonperfusion as defined by fluorescein angiography. The mean change in central macular thickness (CMT), best-corrected visual acuity (BCVA), and number of injections were evaluated. Fifty-seven eyes of 57 patients were included in the study (32 nonischemic BRVO; 25 ischemic BRVO). Mean follow-up was 20.0 (SD,4.9) months. The mean number of injections from baseline to final visit was 5.3 (SD 3.4) and 4.6 (SD 2.6) for the nonischemic BRVO group and ischemic BRVO group, respectively. This difference was not statistically significant (P=0.48). There was no significant difference in CMT and BCVA between groups. No difference in the need for anti-VEGF therapy was observed between patients with non-ischemic BRVO and patients with ischemic BRVO with early laser photocoagulation.

Efficacy of Formulated Posterior Sub Tenon Triamcinolone in macular Edema secondary to Non–Ischemic Retinal Vein Occlusions

Efficacy of Formulated Posterior Sub Tenon Triamcinolone in macular Edema secondary to Non–Ischemic Retinal Vein Occlusions

Comparison between post treatment vascular density, fractal dimension and choriocapillaris flow in ischemic and non-ischemic retinal vein occlusion using optical coherence tomography angiography

The aim of the study was to compare vascular density (VD), fractal dimension (FD), foveal avascular zone (FAZ) and choriocapillaris flow and using optical coherence tomography angiography (OCTA) before and after Bevacizumab therapy in patients with macular edema associated with ischemic and non-ischemic retinal vein occlusion (RVO). 15 eyes with ischemic RVO and 20 with non-ischemic RVO were included. Each patient had 3 consecutive intravitreal injections of Bevacizumab every month. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and retinal microvasculature were measured using OCTA before and one month after the third injection. The BCVA and FAZ area improved significantly after treatment in both ischemic and non-ischemic cases. Although, in ischemic group, FD, superficial and deep capillary VD decreased with no statistically significant change in the choriocapillaris flow. In the non-ischemic group, there was an increase in the FD, superficial parafoveal, perifoveal VD and choriocapillaris flow with insignificant increase in the DCP VD while the foveal VD showed a statistically significant decrease. In conclusion, anti-VEGF therapy improved the BCVA, retinal FD, VD in non-ischemic case but despite improvement in BCVA it reduced the VD in the ischemic cases.

Long-term outcomes of anti-VEGF therapy for macular edema in retinal vein occlusion

Antiangiogenic therapy (anti-VEGF) is the standard in the treatment of many retinal vascular diseases, including macular edema associated with retinal vein occlusion (RVO). A large evidentiary basis has been collected, consisting of randomized clinical trials in which anti-VEGF therapy demonstrated a significant advantage over laser photocoagulation and placebo in patients with RVO. However, in everyday clinical practice the results are not always comparable to randomized clinical trials. This review presents an analysis of the current studies based on actual clinical practice. Their results helped identify the main aspects of antiangiogenic therapy that could improve the treatment outcomes for patients with RVO. Additionally, the article discusses the predictive factors for therapy outcomes and the effect of anti-VEGF therapy on the development of neovascular complications in patients with ischemic RVO.

The Therapeutic Predicament of Branch Retinal Vein Occlusion in uncontrolled Hypertension in Pakistan

Around the globe, hypertension is a silent pandemic. After diabetic retinopathies, hypertensive retinal vascular diseases are one of the most prevalent. In Pakistan, diagnostic investigations due to their cost are not done on regular screening basis as the financial burden of management is a point at issue. Thus, such conditions can often go undetected or therapeutically compromised. Here is a case of unilateral ischemic branch retinal vein occlusion in a 48-year-old male with a history of uncontrolled hypertension and diabetes. Additional laboratory investigations were carried out including complete lipid profile, serum urea and creatinine levels. Fundus fluorescein angiography and optical coherence tomography was done. The patient was managed on anti-VEGF injections and Argon Laser. Follow-up along with a multi-disciplinary management approach is essential for the best possible prognosis. Keywords: hypertension, central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO)

Short-term effects of intravitreal Conbercept injection combined with laser photocoagulation on macular edema secondary to ischemic retinal vein occlusion.

To observe changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), and central choroidal thickness (CCT) of patients with macular edema (ME) secondary to ischemic retinal vein occlusion (iRVO) following intravitreal Conbercept injection. This retrospective study included 33 eyes from 33 patients who received intravitreal injections of Conbercept for ME secondary to iRVO. Treatments were performed on a 3+pro re nata (3+PRN) basis. All of the patients were examined by fundus fluorescein angiography and spectral domain optical coherence tomography at the first visit. Laser photocoagulation was performed in the nonperfusion area of the retina of all eyes after the first injection. BCVA, CMT, and CCT were observed before and after 6mo of treatment. The number of injections necessary to achieve improved vision was also noted. Following Conbercept treatment, the mean BCVA significantly improved from 0.81±0.39 at baseline to 0.41±0.25 and 0.43±0.29 logMAR in the third and sixth months, respectively (both P=0.000). The CMT of the patients at baseline was 556.75±98.57 µm; 304.78±68.53 and 306.85±76.77 µm 3 and 6mo after treatment, respectively (both P=0.000 vs baseline). The CCTs of the patients at baseline, 3 and 6mo after treatment were 304.63±57.83, 271.31±45.53, and 272.29±39.93 µm, respectively (P=0.026 and 0.035 vs baseline). No severe adverse event relevant to the therapy was noted, and the average number of injections delivered was 3.35. Intravitreal Conbercept injection combined with laser photocoagulation appears to be a safe and effective treatment for ME secondary to iRVO in the short-term.

Standardization of OCT Angiography Nomenclature in Retinal Vascular Diseases: First Survey Results

To develop a consensus nomenclature for OCT angiography (OCTA) findings in retinal vascular diseases. Online survey using the Delphi Method. Members of The Retina Society, the European Society of Retina Specialists, and the Japanese Retina and Vitreous Society. An online questionnaire on OCTA terminology in retinal vascular diseases was sent to members of The Retina Society, the European Society of Retina Specialists, and the Japanese Retina and Vitreous Society. The respondents were divided into 2 groups ("experts" vs. "users") according to the number of their publications in this field. The respondents who had more than 5 publications in the field of OCTA and retinal vascular diseases were considered the OCTA "experts" group. Consensus and near consensus on OCTA nomenclature. The complete responses of 85 retina specialists were included in the analysis. Thirty-one were categorized as "experts." There was a consensus in both groups that OCTA parameters such as foveal avascular zone (FAZ) parameters, areas of nonperfusion, and presence of neovascularization (NV) should be implemented in the identification and staging of diabetic retinopathy (DR) and that OCTA can be applied to differentiate between ischemic and nonischemic retinal vein occlusion (RVO). Diabetic macular ischemia (DMI) also can be assessed via OCTA. Further, there was consensus that the terminology should differ on the basis of the underlying causes of decreased vascular flow signal. There was disagreement in other areas, such as which terms should be applied to describe decreased OCTA signal from different causes, the definition of wide-field OCTA, and how to quantify DMI and area of decreased flow signal. These discrepancies form the basis for the upcoming expert Delphi rounds that aim to develop a standardized OCTA nomenclature. Although there was agreement in some areas, significant differences were found in many areas of OCTA terminology among all respondents, but also between the expert and user groups. This indicates the need for standardization of the nomenclature among all specialists in the field of retinal vascular diseases.

Prediction of Retinal Ischemia with Optical Coherence Tomography Angiography in Branch Retinal Vein Occlusion

Abstract Herein, we aimed to assess the ability of optical coherence tomography angiography (OCT-A) to show ischemic and non-ischemic differentiation in two patients with ischemic and non-ischemic branch retinal vein occlusion (BRVO). Two patients aged 67 and 39 presented to our hospital with an acute vision loss. Fundus Fluorescein Angiography (FFA) revealed non-ischemic inferior temporal BRVO in the first case ((67-year-old) and ischemic inferior temporal BRVO in the second case (39-year-old). Ischemic case showed similar retinal non-perfusion areas on OCT-A compared to FFA images. The OCT-A is a promising method in evaluating non-ischemic, ischemic differentiation and complication management of BRVO.

Phenotyping of retinal neovascularization in ischemic retinal vein occlusion using wide field OCT angiography.

Abnormal retinal neovascularization caused by ischemic retinal vein occlusion (RVO) is a frequent cause of visually significant vitreous hemorrhage. The early detection of new vessels may be challenging and often requires the use of invasive tests such as fundus fluorescein angiography (FA). We demonstrate the use of wide-field optical coherence tomography angiography (WF-OCTA) in the detection and characterization of neovascularization secondary to ischemic RVO. We conducted a retrospective observational case series of patients diagnosed with ischemic RVO between August 2018 and March 2019, who underwent WF-SS-OCTA imaging (PLEX Elite 9000, Carl Zeiss Meditec). We performed real-life montage imaging, covering the involved area and compared the findings of WF-SS-OCTA to standard clinical examination and when available, ultrawide-field fluorescein angiography (UWF-FA, Optos 200TX). In the included 39 eyes with ischemic RVO, neovascularization elsewhere (NVE) was encountered in 16 of 39 eyes (41%) on WF-OCTA and were characterized as sea-fan type vessels and nodular type vessels, based on their appearance and localization. NVE was identified in 4/39 eyes on standard clinical examination, equating to a detection rate of 10.3%. All were of a sea-fan morphology. In one case, NVE found on WF-OCTA was not observed on UWF-FA, which was a nodular type. Neovascularization of the disc (NVD) was detected in one eye. WF-OCTA may become a useful noninvasive tool in the detection of neovascularization in patients with ischemic RVO. Furthermore, the characterization of different morphologies of neovascularization detected by WF-OCTA could be of clinical relevance.