Retinal Vein Occlusion Group Research Articles

Fractional amplitude of low-frequency fluctuations in retinal vein occlusion: a resting-state fMRI study

Objective: To investigate the altered spontaneous brain activity in patients with retinal vein occlusion (RVO) during the resting state. Methods: A case-control study. Forty-five patients with RVO [24 males and 21 females; age, (51.24±5.86) years] diagnosed from May 2018 to July 2019 in Renmin Hospital of Wuhan University were recruited in the RVO group. Meanwhile, forty-three healthy controls [19 males and 24 females; age, (49.79±7.31) years] who were closely matched in age and sex to patients with RVO were recruited in the healthy control group. Each subject underwent a whole-brain resting-state functional magnetic resonance imaging scan to detect the values of fractional amplitude of low-frequency fluctuations (fALFF). The altered spontaneous brain activity between RVO patients and healthy controls were analyzed. The intra-and inter-group comparisons of two sets of fALFF values were conducted using one-sample t-test and two-sample t-test, respectively. Results: Compared with the healthy control group, the fALFF values of RVO patients were significantly changed. The fALFF values of left cerebellum (-0.68±0.48, t=3.8081), right cerebellum (-0.79±0.47, t=4.590), right brainstem (-0.57±0.50, t=3.964) and left insula (-0.22±0.27, t=3.587) increased, while the fALFF values of right calcarinesulcus (0.60±0.72, t=-3.521), right thalamus (-0.68±0.43, t=-3.846) and left lingual gyrus (-0.12±0.33, t=-3.876) decreased. The differences were statistically significant (voxel-level P<0.01, Gaussian random field correction, cluster-level P<0.05). Conclusions: Patients with RVO have abnormal spontaneous neural activity in multiple brain areas, including visual pathways and emotion-cognition processing regions. Moreover, there may be compensatory brain function enhancement in local brain areas. The results provide new insights into the understanding of the mechanism for the occurrence and development of RVO.(Chin J Ophthalmol, 2020, 56:266-271).

Assessment of platelet-to-lymphocyte ratio in patients with retinal vein occlusion.

Purpose:To investigate platelet-to-lymphocyte ratio (PLR) in retinal vein occlusion (RVO) patients.Methods:In this study, we retrospectively reviewed data of 32 patients with RVO (RVO group) and 32 age- and sex-matched participants without RVO (control group) between January 2017 and March 2019. The PLR was determined by dividing the platelet count by the lymphocyte count.Results:Age and gender were comparable between the groups (p = 0.204 and p = 0.800, respectively). PLR was significantly elevated in the RVO group compared with the control group (137 (113–164) vs 101 (86–129), p = 0.001)). In the receiver operator characteristics curve analysis, the optimal cut-off value of PLR for predicting RVO was 123, with 69% sensitivity and 72% specificity.Conclusion:We report that PLR are elevated in RVO, suggesting that PLR may be a useful marker for RVO.

The comparison of the relationships about the presence of branch retinal vein occlusion and endothelial functions between diabetic and non-diabetic patients.

The aim of this study was to investigate the endothelial functions in both patients with diabetics and non-diabetics with branch retinal vein occlusion by using pulse wave analysis and flow-mediated dilatation methods. This cross-sectional study included a total of 136 participants (47 diabetic patients with branch retinal vein occlusion, 43 non-diabetic patients with branch retinal vein occlusion, and 46 otherwise healthy subjects). Evaluation of endothelial functions was performed by flow-mediated dilatation and pulse wave analysis methods. Stiffness index, reflection index (RI), and pulse propagation time were calculated. The mean stiffness index and RI were significantly higher in the diabetic branch retinal vein occlusion group compared with the non-diabetic branch retinal vein occlusion and the healthy controls (for stiffness index: 11.5 ± 2.8 vs. 10.1 ± 2.5 and 8.3 ± 2.0, P < 0.001; and for RI: 75.1 ± 11.7 vs. 65.4 ± 8.4 and 60.2 ± 18.8, P < 0.001, respectively), whereas the pulse propagation time was significantly lower in the diabetic group (156.4 ± 32.3 vs. 174.4 ± 46.5 and 205.0 ± 58.5, P < 0.001, respectively). There was a significant negative correlation between visual acuity and stiffness index (r = -0.512, P < 0.001). Besides, there was also a significant positive correlation between visual acuity and pulse propagation time (r = 0.398, P < 0.001). This study demonstrated that the stiffness index and RI values were higher in patients with branch retinal vein occlusion compared to the healthy subjects.

Altered spontaneous brain activity patterns in patients with retinal vein occlusion indicated by the amplitude of low-frequency fluctuation: A functional magnetic resonance imaging study.

The aim of the present study was to explore the amplitude of low-frequency fluctuations (ALFF; a measurement of spontaneous brain activity) in different brain regions of patients with retinal vein occlusion (RVO) and its association with vision changes measurements. A total of 24 RVO patients (12 males and 12 females) and 24 healthy controls (HCs, 12 males and 12 females) were recruited, and they were closely matched regarding age, gender and education level (classified according to nine-year compulsory education in China and higher education, all including primary school, junior school, high school and university). ALFF values of different brain regions were gathered and analyzed, and statistical analysis software was used to explore the correlations between the average ALFF signals and clinical features. The ability of ALFF values to distinguish between subjects with RVO and HCs was analyzed by receiver operating characteristic (ROC) curves. The results indicated that the subjects from the RVO group had higher ALFF values than the HCs in the posterior lobe of the left cerebellum, inferior temporal gyrus, cerebellar anterior lobe, right cerebellum posterior/anterior lobe, and lower ALFF values in the medial frontal gyrus, right precuneus, left middle frontal gyrus, right angular gyrus and right superior frontal gyrus. The ROC curve analysis of each brain region indicated that the accuracy of the area under the ROC curves regarding the prediction of RVO was excellent. The best-corrected visual acuity (VA) in the left eye was positively correlated with the ALFF value of the right precuneus (r=0.767, P=0.004) and the best-corrected VA in the right eye was positively correlated with the ALFF value of the left middle frontal gyrus (r=0.935, P<0.001). The central subfield retinal thickness in the left eye was negatively correlated with the ALFF value of the right precuneus (r=−0.895; P<0.001). The duration of RVO in the right eye was positively correlated with the ALFF value of the left middle frontal gyrus (r=0.868; P<0.001). In conclusion, the present results indicate that RVO is associated with dysfunction of diverse brain regions, including language- and movement-associated areas, which may reflect the underlying pathogenic mechanisms of RVO (trial registry no. CDYFY-LL-2017025).

Retinal Vein Occlusion is Associated with Low Blood High-Density Lipoprotein Cholesterol: A Nationwide Cohort Study

To investigate association between the development of retinal vein occlusion (RVO) and blood high-density lipoprotein cholesterol (HDL-C). A retrospective, nationwide, population-based cohort study. This study was set in the Republic of Korea and included 23,149,403 people ≥20 years of age who underwent the Korean National Health Screening Program examination between January 2009 and December 2012. Among them, the RVO group was composed of patients with an initial diagnosis of RVO made between 2009 and 2015 (n = 117,639). The earliest claim with an RVO diagnostic code was considered as the incident time. The predictive value of HDL-C level for RVO was analyzed using hazard ratios. The primary outcome measure was the incident cases of RVO. Subjects with RVO were generally older; had high body mass index, waist circumference, fasting blood glucose, blood pressure, total and low-density lipoprotein cholesterol, and triglyceride values, and low glomerular filtration rate and HDL-C values; and were more likely to experience diabetes mellitus and hypertension compared with the non-RVO group. The fully adjusted hazard ratio of RVO was 1.12 (95% confidence interval 1.10-1.14) in the lowest quartile of HDL-C versus in the highest quartile. The association between the development of RVO and HDL-C was higher those with a younger age, male sex, current smoking habit, diabetes mellitus, and hypercholesterolemia. In addition, we observed a significant synergistic effect of low HDL-C level with obesity and hypertension. This is the first nationwide population-based epidemiologic study evaluating the association between HDL-C level and the risk of RVO development. A significant association between low HDL-C and RVO development was found.

Impact of Intravitreal Dexamethasone Implant on Vessel Diameters in Patients with Retinal Vein Occlusion.

Purpose To investigate the vasomotor responses and diameter of retinal vessels in patients with macular edema secondary to retinal vein occlusion (RVO) who were treated with intravitreal dexamethasone implant. Methods We enrolled 17 eyes of 17 patients with macular edema secondary to RVO. All patients were evaluated through optical coherence tomography and dynamic and static retinal vessel analysis, using the Dynamic Vessel Analyzer (Imedos, Jena, Germany) before administration (baseline) and 1 week, 1 month, and 2 months after administration of intravitreal dexamethasone. Measurements of patients were compared to those of 17 eyes of age- and sex-matched control subjects. Results In static analysis, arteriovenous ratio (AVR) in control subjects was 0.86 (0.80–0.88). In RVO patients, baseline AVR was 0.71 (0.54–0.84) and significantly lower than that in control subjects (p=0.016). Baseline AVR in the RVO group was significantly lower than AVR at month 1 and month 2 (p=0.001 and p < 0.001, respectively). CRVE in healthy control subjects was 183.59 ± 21.79 measurement units (MU) which was significantly different from CRVE of RVO eyes at baseline (207.00 ± 26.35 MU) (p=0.008). Static analysis showed a significant decrease of central retinal vein equivalent (CRVE) from baseline to 1 week, 1 month, and 2 months (p < 0.001, p < 0.001, and p < 0.001, respectively). CRAE in the control group was 176.24 ± 22.45 MU. CRAE in the RVO group was significantly lower at baseline, week 1, month 1, and month 2 compared to that in the control group (p=0.008, p=0.003, p=0.013, and p=0.011, respectively). Dynamic analysis showed that maximum venous and arterial dilations did not statistically differ from baseline to 1 week, 1 month, or 2 months. Conclusion Using the Dynamic Vessel Analyzer, we found that retinal veins in patients with RVO were significantly larger compared to those in the control group, and intravitreal dexamethasone treatment reduced the diameters of these veins.

Aqueous semaphorin 3A level correlates with retinal macular oedema and ganglion cell degeneration in patients with retinal vein occlusion

To investigate the semophorin 3A (SEMA3A) level in aqueous humor of patients with retinal vein occlusion (RVO) and explore the correlation of SEMA3A with macular oedema and ganglion cell degeneration in RVO. This comparative study prospectively included 41 consecutive patients (41 eyes) with RVO who had intravitreal anti-VEGF injections from March 2014 to March 2015 for cystoid macular oedema (CME) or neovascular glaucoma (NVG). The patients were divided into three groups according to the fluorescein angiograghy (FFA): central retinal vein occlusion (CRVO) group (n=15), branch retinal vein occlusion (BRVO) group (n=15) and NVG group (secondary to CRVO, n=11). The patients who had undergone cataract surgery (n=16) during the same period served as controls. The SEMA3A concentration in aqueous humor collected before the initial anti-VEGF injection was determined by enzyme-linked immunosorbent assay (ELISA). Central retinal thickness (CRT), cube volume (CV) and ganglion cell-inner plexiform layer (GC-IPL) thickness was analysed by spectral-domain optical coherence tomography (SD-OCT). Semaphorin 3A level in CRVO group (1.52±1.23ng/ml) and NVG group (1.67±0.98ng/ml) were significantly higher than the control group (0.66 ± 0.58ng/ml; both p<0.05). Moreover, SEMA3A level in CRVO group was higher than BRVO group (1.52±1.23ng/ml versus 0.53±0.37ng/ml; p<0.05). SEMA3A level was positively correlated with CRT and CV in both BRVO group (CRTr=0.6535, p=0.0082; CVr=0.5190, p=0.0474) and CRVO group (CRTr=0.6270, p=0.0124; CVr=0.6898, p=0.0044). In RVO patients, the GC-IPL thickness of affected eyes were significantly reduced compared with the normal follow eyes (CRVOt=4.55, p=0.006; BRVOt=4.54, p=0.004). Meanwhile, negative correlation of SEMA3A level with GC-IPL thickness was found in both BRVO group (r=-0.5906, p=0.0205) and CRVO group (r=-0.6100, p=0.0157). Semaphorin 3A level is increased in aqueous humor of RVO patients. Positive correlation of CRT as well as negative correlation of GC-IPL thickness with SEMA3A may suggest a pathological role of SEMA3A in macular oedema and ganglion cell degeneration during RVO.

Axial length, a risk factor for retinal vein occlusion: A case control study.

To evaluate the role of axial length in cases of retinal vein occlusion. The case-control study was conducted at Layton Rahmatullah Benevolent Trust Eye Hospital, Karachi, from March to August 2018, and comprised patients with retinal vein occlusion and age-matched controls. Axial length of both eyes of all the subjects was calculated. The length of the affected eye was compared with that of the contralateral unaffected eye and also with the controls. Data was analysed using SPSS 21. There were 70 subjects; 35(50%) in each of the two groups. Among the cases, 16(46%) were males and 19(54%) were females. The overall mean age of the group was 37}4.2 years. Among the controls, 21(60%) were males and 14(40%) were females. The mean age of the group was 36.5}4.5 years. Also, among the cases, 23(66%) had unilateral central retinal vein occlusion and 12(34%) had branch retinal vein occlusion. Mean axial length was 0.80mm shorter in central retinal vein occlusion patients and controls (p=0.01). Branch retinal vein occlusion group did not show statistical significance on comparing with fellow eyes (p=0.18) and with controls (p=0.07). Axial length was found to be a local predisposing factor to develop retinal vein occlusion.

Central retinal vein occlusion associated with platelet activation

Purpose:The aim of this article is to determine and compare the platelet activation by three main platelet activation parameters: mean platelet volume, platelet distribution width, and plateletcrit in patients with central retinal vein occlusion and control subjects.Methods:This study included 30 patients with nonischemic central retinal vein occlusion and 30 control subjects. The levels of mean platelet volume, platelet distribution width, and plateletcrit were measured in all groups.Results:The mean serum level of mean platelet volume was 10.01 ± 0.89 fl in central retinal vein occlusion group and 8.74 ± 1.45 fl in control group. The mean serum level of platelet distribution width was 14.31 ± 1.49% and 11.65 ± 1.81% in central retinal vein occlusion group and control group, respectively. Mean serum plateletcrit value was 0.27 ± 0.07% in central retinal vein occlusion group and 0.23 ± 0.07% in control group. Mean platelet volume, platelet distribution width, and plateletcrit levels were significantly higher in central retinal vein occlusion patients than controls (p < 0.05).Conclusion:Subclinical platelet activation reflected by mean platelet volume, platelet distribution width, and plateletcrit may have an impact on the genesis of vessel occlusion in central retinal vein occlusion. The results may be important for the clinical management of patients with central retinal vein occlusion.

Automated macular segmentation with spectral domain optical coherence tomography in the fellow eyes of patients with unilateral retinal vein occlusion.

To assess the change in the macular layers in the fellow eyes of unilateral retinal vein occlusion (RVO) patients and to evaluate whether certain layers are more affected based on RVO type. This retrospective study included 87 fellow eyes of patients with unilateral RVO (26 central, 61 branch) and 105 eyes of 105 subjects without RVO. Spectral domain optical coherence tomography was used for automatized retinal segmentation. The thicknesses of retinal nerve fiber layer (RNFL), ganglion cells, inner plexiform, inner nuclear, outer plexiform, outer nuclear, photoreceptor layers, overall inner retinal layers and retinal pigment epithelium (RPE) were documented. Inner plexiform layer was thinner in inferior sector in RVO group compared with the control group (p = 0.047). The subgroup analysis showed that the retina was thinner in RVO group compared with the controls without systemic diseases in some sectors of the following layers: inferior retina, RNFL, ganglion cell layer, inner plexiform layer, inner retinal layers and RPE (p < 0.05). Retinal thickness was decreased in the fellow eyes of branch RVO group compared to that in the central RVO group in the some sectors (p < 0.05). The fellow eyes of unilateral RVO patients did not show major structural differences compared with the controls; however, they revealed significant sectoral thinning in many retinal layers when compared with the eyes of healthy subjects without systemic diseases. Central macula was thinner in the fellow eyes of patients with branch RVO compared to that in central RVO.

Risk of Ischemic Stroke, Hemorrhagic Stroke, and All-Cause Mortality in Retinal Vein Occlusion: A Nationwide Population-Based Cohort Study.

Purpose To investigate whether the risk of subsequent stroke, ischemic stroke, hemorrhagic stroke, and all-cause mortality is increased among retinal vein occlusion (RVO) patients compared to non-RVO patients. Methods From the entire population of the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2013, a total of 22919 subjects with RVO were enrolled in the RVO group, and 114595 propensity score (PS)-matched non-RVOs were enrolled in the comparison group. PS matching was based on age, gender, obesity, diabetes, hypertension, hyperlipidemia, coronary artery disease, atrial fibrillation, hyperviscosity syndrome, Charlson comorbidity index, glaucoma, and the use of antithrombotic drugs. A multivariate Cox regression analysis was used to estimate the adjusted hazard ratios (HRs) with a 95% confidence interval (CI) for each of the clinical outcomes, including stroke, ischemic stroke, hemorrhagic stroke, and all-cause mortality. Furthermore, we divided the RVO group into the branch retinal vein occlusion (BRVO) group and the central retinal vein occlusion (CRVO) group and separately compared their subsequent risks of the clinical outcomes with those of the comparison group. Results After adjusting for PS, the RVO group had a significantly higher risk of stroke (adjusted HR = 1.36; 95% CI: 1.32–1.40), ischemic stroke (adjusted HR = 1.36; 95% CI: 1.32–1.40), and hemorrhagic stroke (adjusted HR = 1.34; 95% CI: 1.24–1.44). However, the all-cause mortality did not exhibit significant differences. Furthermore, both the BRVOs and CRVOs had a significantly higher risk of subsequent stroke, ischemic stroke, and hemorrhagic stroke than did the comparisons, whereas all-cause mortality was similar among the groups. Conclusions People with RVO are at a significantly greater risk of developing stroke, ischemic stroke, and hemorrhagic stroke. However, RVO does not significantly increase the risk of all-cause mortality.

10-year fundus tessellation progression and retinal vein occlusion.

To access the 10-year fundus tessellation progression in patients with retinal vein occlusion. The Beijing Eye Study 2001/2011 is a population-based longitudinal study. The study participants underwent a detailed physical and ophthalmic examination. Degree of fundus tessellation was graded by using fundus photographs of the macula and optic disc. Progression of fundus tessellation was calculated by fundus tessellation degree of 2011 minus degree of 2001. Fundus photographs were used for assessment of retinal vein occlusion. The Beijing Eye Study included 4403 subjects in 2001, 3468 subjects was repeated in 2011. Assessment of retinal vein obstruction and fundus tessellation progression were available for 2462 subjects (71.0%), with 66 subjects fulfilled the diagnosis of retinal vein occlusion. Of the 66 participants, 59 participants with unilateral branch retinal vein occlusion, 5 participants with unilateral central retinal vein occlusion, 1 participant with bilateral branch retinal vein occlusion, and 1 participant with branch retinal vein occlusion in one eye and central retinal vein occlusion in the other eye. Mean degree of peripapillary fundus tessellation progression were significantly higher in the whole retinal vein occlusion group (0.33±0.39, P<0.001), central retinal vein occlusion group (0.71±0.8, P=0.025) and branch retinal vein occlusion group (0.29±0.34, P=0.006) than the control group (0.20±0.26). After adjustment for age, prevalence of tilted disc, change of best corrected visual acuity, axial length, progression of peripapillary fundus tessellation was associated with the presence of retinal vein occlusion (P=0.004; regression coefficient B, 0.094; 95%CI, 0.029, 0.158; standardized coefficient B, 0.056). As a corollary, after adjusting for smoking duration, systolic blood pressure, anterior corneal curvature, prevalence of RVO was associated with more peripapillary fundus tessellation progression (P<0.001; regression coefficient B: 1.257; OR: 3.517; 95%CI: 1.777, 6.958). Peripapillary fundus tessellation progresses faster in individuals with retinal vein occlusion. This may reflect the thinning and hypoperfusion of choroid in patients with retinal vein occlusion.

One year clinical observation of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema secondary to retinal vein occlusion

Objective To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods Thirty-nine patients (39 eyes) with ME secondary to RVO were enrolles in this study. Of the patients, 27 were male and 12 were female. The mean age was (41.9±16.3) years. The mean course of disease was (5.0±5.3) months. The best corrected visual acuity (BCVA), intraocular pressure and optical coherence tomography (OCT) were performed. BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. Central macular thickness (CMT) was measured by OCT. The mean BCVA was (13.4±15.3) letters. The mean intraocular pressure (IOP) was (14.1±2.8) mmHg (1 mmHg=0.133 kPa). The mean CMT was (876.1±437.9) μm. Of the 39 eyes, 33 were central RVO, 6 were branch RVO. Patients were categorized into ischemic (18 eyes)/nonischemic (21 eyes) groups and previous treatment (22 eyes)/treatment naive (17 eyes) groups. All eyes underwent intravitreal 0.7 mg Ozurdex injections. BCVA, IOP and CMT were assessed at 1, 2, 3, 6, 9, 12 months after injection. Three months after injection, intravitreal injections of Ozurdex, triamcinolone acetonide or ranibizumab could be considered for patients with ME recurrence or poor treatment effects. Change of BCVA, IOP and CMT were evaluated with paired t test. The presence of ocular and systemic adverse events were assessed. Results BCVA, IOP significantly increased and CMT significantly decreased at 1 month after injection compared to baseline in all groups (t=3.70, 3.69, 4.32, 3.08, 4.25, 6.09, 6.25, 4.02, 5.49, 8.18, 6.54, 5.73; P 0.05); BCVA of non-ischemic RVO group and treatment naive group significantly increased compared to baseline (t=2.27, 2.30; P<0.05); IOP significantly increased and CMT significantly decreased in all groups (t=0.30, 0.13, 4.60, 3.26, 0.64, 1.53, 3.00, 4.87; P<0.05). Twenty-seven eyes (69.2%) experiences ME recurrence (4.5±1.5) months after injection. Most common side-effect was secondary glaucoma. 41.0% eyes had IOP more than 25 mmHg, most of which were lowered to normal range with use of topical IOP lowering drugs. Four eyes (10.3%) presented with significant cataract progression and needed surgical treatment, all were central RVO eyes. No serious ocular or systemic adverse events such as vitreous hemorrhage, retinal detachment or endophthalmitis were noted. Conclusions Intravitreal injection of Ozurdex for patients with ME secondary to RVO is effective in increasing BCVA and lowering CMT in the first few months. Significant treatment effect could be seen at 1 month after injection and was most significant at 2 months after injection. The long-term vision of eyes in non-ischemic RVO group and treatment naive group are better. 69.2% eyes experience ME recurrence at 4 months after injection. Short term adverse events were mostly secondary glaucoma and long term adverse events are mostly cataract progression. Key words: Dexamethasone/therapeutic use; Retinal vein occlusion/drug therapy; Macular edema/drug therapy

Intravitreal anti-VEGF agents, oral glucocorticoids, and laser photocoagulation combination therapy for macular edema secondary to retinal vein occlusion: preliminary report.

To evaluate the efficacy and safety of combined anti-vascular endothelial growth factor (VEGF) agents, oral glucocorticoid, and laser photocoagulation therapy for macular edema (ME) secondary to retinal vein occlusion (RVO). This study included 16 eyes of 16 patients with RVO-associated ME. Patients were initially treated with oral prednisone and an intravitreal anti-VEGF agent. Two weeks later, patients underwent standard laser photocoagulation. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and retinal vessel oxygenation were examined over 12mo. Patients received 1.43±0.81 anti-VEGF injections. Mean baseline and 12-month logMAR BCVA were 0.96±0.51 (20/178) and 0.31±0.88 (20/40), respectively, in eyes with central retinal vein occlusion (CRVO) (P<0.00), and 1.02±0.45 (20/209) and 0.60±0.49 (20/80), respectively, in eyes with branch retinal vein occlusion (BRVO) (P<0.00). At 12mo, CRT had significantly decreased in eyes with CRVO (P<0.00) and BRVO (P<0.00). Venous oxygen saturation had significantly increased in eyes with CRVO (P<0.00) and BRVO (P<0.00). No examined parameters were significantly different between the 2 RVO groups. No serious adverse effects occurred. Anti-VEGF, glucocorticoid, and photocoagulation combination therapy improves visual outcome, prolongs therapeutic effect, and reduces the number of intravitreal injections in eyes with RVO-associated ME.

RANIBIZUMAB FOR RETINAL VEIN OCCLUSION: Predictive Factors and Long-Term Outcomes in Real-Life Data.

The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with retinal vein occlusion (RVO), either central retinal vein occlusion or branch retinal vein occlusion, treated with intravitreal ranibizumab and to determine the predictive factors of the final visual outcome. This retrospective study included 54 treatment-naive patients with macular edema due to RVO (25 with central retinal vein occlusion and 29 with branch retinal vein occlusion), who were treated with intravitreal ranibizumab (3 monthly injections and pro re nata). Predictive factors for visual outcome were assessed. In addition, the best-corrected visual acuity change and the percentage of patients with edema resolution were evaluated. The mean follow-up time was 47.4 ± 11.1 months. At the end of the follow-up, patients with central retinal vein occlusion gained +6.9 letters (∼1 Snellen line), whereas patients with branch retinal vein occlusion gained +15.1 letters (3 Snellen lines). Forty-eight percent of patients in central retinal vein occlusion group and 69.0% in branch retinal vein occlusion group presented resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, the presence of intraretinal fluid, the duration of RVO >3 months, the ischemic type of RVO, the cystoid type of edema, and the external limiting membrane and ellipsoid zone disruption. The various predictive factors that determine the visual outcome and possibly define the patients' prognosis after ranibizumab treatment in RVO have been studied. The long follow-up period showed that ranibizumab seems to be safe and effective in the treatment of the disease.

Investigation of methylenetetrahydrofolate reductase C677T and factor V Leiden mutation as a genetic marker for retinal vein occlusion.

PURPOSE:Thromboembolic phenomenon is one of the causes of retinal vein occlusion (RVO) which is in fact a multifactorial disease. Therefore, we aimed to study methylenetetrahydrofolate reductase gene polymorphism (MTHFR C677T) and factor V Leiden as genetic risk factors of RVO.MATERIALS AND METHODS:A total of 50 (19 males and 31 females) cases of RVO were compared with 50 age- and sex-matched (21 males and 29 females) controls. Complete ocular examination was done for all samples. The diagnosis of RVO was made clinically; however, fundus fluorescein angiography and optical coherence tomography were performed when needed. Serum homocysteine levels were estimated by automatic chemiluminescence analyzer, whereas MTHFR C677T and factor V Leiden mutations were detected by polymerase chain reaction–restriction fragment length polymorphism method.RESULTS:The mean age of RVO cases and controls was 54.62 ± 13.92 years and 58.72 ± 11.20 years, respectively. 48.3% of cases and 51.7% of controls were diabetic. 65.3% of cases were hypertensive proving hypertension as a strong risk factor (P = 0.003) of RVO. Serum homocysteine was also found significantly high (P = 0.025) with mean values of 19.98 ± 9.03 μmol/L and 16.98 ± 8.29 μmol/L in cases and controls, respectively. The MTHFR genotype (CT) was found in 83.3% patients of central RVO group and 78.6% cases of branch RVO group that was significantly associated with high serum homocysteine levels. Factor V Leiden mutation was absent in all individuals.CONCLUSION:Hyperhomocysteinemia is an important risk factor for RVO, especially in patients with MTHFR C677T gene polymorphism.

Retinal Ven Tıkanıklığı ve Bir Oksidatif Stres Belirteç Olan Tiyol-Disülfit Dengesi Arasında İlişki Var Mıdır?

Objective: In this study, it is aimed to investigate the dynamic thiol-disulfide homeostasis which is an indicator of oxidative stress in retinal vein occlusion patients. Material and Methods: Thirty nine retinal vein occlusion patients and 38 age-gender matched control subjects were included in the study. Exclusion criteria for retinal vein occlusion group were: ocular history and symptoms exceeding 3 weeks, any other history of ocular disease except the retinal vein occlusion, any previous ocular surgeries or lasers, any previous treatment or intra-vitreal injection for the retinal vein occlusion, any other systemic disease except the arterial hypertension. The control group included patients without any ocular or systemic diseases. Native thiol, total thiol, disulfide levels were studied in the serum samples of all participants and native/total thiol and disulfide/total thiol ratios were calculated as percentage. Results: Total thiol, native thiol, disulfide, native/total thiol and disulfide/total thiol ratio were not significantly different between the retinal vein occlusion and the control groups. In the control group, age was inversely correlated with the total thiol level, but not with the other serum parameters. In the retinal vein occlusion group, there was no correlation among the age and the serum parameters but the body mass index (BMI) was inversely correlated with the total thiol level. Conclusion: There was not any significant difference between the retinal vein occlusion patients and the control subjects for the thiol-disulfide homeostasis.

Association between retinal vein occlusion and an increased risk of acute myocardial infarction: A nationwide population-based follow-up study.

ObjectiveTo investigate a possible association between retinal vein occlusion (RVO) and an increased risk of developing acute myocardial infarction (AMI).DesignA population-based retrospective cohort study using the entire population of the Taiwan National Health Insurance Research Database (NHIRD) from 1st January, 2001 to 31st December, 2013.MethodsA total of 37921 subjects with RVO were enrolled in the RVO group, and 113763 subjects without RVO were enrolled in the comparison group. The comparison group consisted of randomly selected individuals who were propensity score (PS)-matched with the RVO group at a ratio of 1:3, based on age, gender, obesity, stroke, hyperviscosity syndrome, glaucoma, and the use of antithrombotic drugs. A log-rank test was used to compare the cumulative hazard of AMI between the two groups. A multivariate Cox regression analysis was used to estimate the adjusted hazard ratios (HRs) of AMI, adjusted for PS, diabetes, hypertension, hyperlipidemia, congestive heart failure, and chronic renal failure.ResultsThe mean age of the cohort was 62.4±13.2 years. RVO patients had significantly higher proportions of diabetes, hypertension, hyperlipidemia, congestive heart failure, and chronic renal failure than the comparisons. The mean follow-up period was 5.52 years in the RVO group and 5.55 years in the comparison group (p = 0.16). A log-rank test comparing the cumulative hazard curves of AMI for the two groups revealed a significant difference (p<0.0001). In the multivariate Cox regression after adjustment for PS and confounders, the RVO group had a significantly higher risk of AMI (adjusted HR = 1.21; 95% CI: 1.13 to 1.30). When the RVO group was divided into central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) and analyzed separately, both groups had significantly higher adjusted HRs for developing AMI than the comparison group. Moreover, the CRVO group had a significantly higher risk of AMI than the BRVO group.ConclusionsPeople with RVO are at significantly greater risk of developing AMI than individuals without RVO.

Health care claims for primary open-angle glaucoma and retinal vein occlusion from an 11-year nationwide dataset

To evaluate the risk of retinal vein occlusion (RVO) development after primary open-angle glaucoma (POAG) and the risk of POAG development after RVO, we conducted a nationwide, population-based 11-year longitudinal study. National registry data were collected from the Korean National Health Insurance Research Database, comparing 1 025 340 (~2.2%) subjects who were selected from 46 605 433 Korean residents in 2002. Each sampled patients was tracked until 2013. POAG developed in 0.92% of the RVO group (n = 6 826) and in 0.22% of the comparison group. RVO developed in 0.99% of the POAG group (n = 4 138) and in 0.37% of the comparison group. RVO was associated with an increased risk of POAG development (hazard ratio [HR], 3.25; 95% confidence interval [CI], 2.39–4.42) and POAG was associated with an increased risk of RVO development (HR, 5.05; 95% CI, 3.94–6.47). Comorbidity of systemic hypertension and diabetes mellitus further increased the risk of POAG development in the RVO group (HR, 3.58 and HR, 5.98, respectively). Patients with RVO exhibit a significantly higher risk of POAG development and patients with POAG exhibit a significantly higher risk of RVO development, based on an 11-year follow-up period.

Retinal Vein Occlusion as the Surrogate Marker for Premature Brain Aging in Young Patients.

We investigated cerebral small vessel disease (SVD) in patients with incidental retinal vein occlusion (RVO). This retrospective, case-control, observational trial included 125 patients with RVO who underwent brain magnetic resonance imaging (MRI) and 1105 age-matched controls who underwent comprehensive medical interviews and MRI. Underlying cardiovascular diseases and MRI findings were investigated in the patients with RVO according to age (<60 or ≥60 years) and RVO occlusion level (central or branch). The characteristics of underlying cardiovascular disease and MRI findings were compared between the younger patients with RVO and age-matched controls. The cerebrovascular burden also was assessed in the younger patients with RVO. The mean age of the patients with RVO was 63.9 ± 12.1 years and the predominant underlying disease was hypertension (72/125, 58%). The older RVO group had a longer history of hypertension and less smoking history. The prevalence of cerebral SVD in the RVO group was 54% (68/125), and was significantly higher in older than in younger patients with RVO (62% [53/86] vs. 38% [15/39], P = 0.016). However, the latter had a significantly higher prevalence of cerebral SVD than their age-matched controls (38% [15/39] vs. 4% [47/1105], P < 0.001). There was no difference in prevalence of cerebral SVD between the central and branch RVO groups (P = 0.478). Cerebral SVD presented frequently in patients with RVO and was magnified in young patients, suggesting that RVO is a surrogate marker for cerebral SVD.