Retinal Vein Occlusion Patients Research Articles

Maximum carotid intima-media thickness and NT-pro BNP in association with retinal vein occlusion

The purpose is to clarify the relationship between patients with retinal vein occlusion (RVO), maximal intima-media complex thickness (Max IMT), and N-terminal pro-brain natriuretic peptide (NT-proBNP), which is useful in assessing atherosclerosis. This was a retrospective observation, single center study. The patients were 86 RVO patients (male: female = 43:43, mean age 63.3 years), 25 with central retinal vein occlusion (CRVO) and 61 with branch retinal vein occlusion (BRVO), classified as ≧50 years old and <50 years old, Max IMT≧1.1 and less, NT-pro BNP≧55 and less. Results showed that Max IMT ≧1.1 was significantly more common in both the CRVO and BRVO groups at ≧50 years, and NT-pro BNP ≧55 was significantly more common in the CRVO group. Max IMT≧1.1 was seen in 80% of the BRVO group and in 85% of patients aged ≧50 years. Sixty-eight percent of patients in the CRVO group had Max IMT≧1.1, but none of those < 50 years had Max IMT≧1.1. Forty-eight percent of RVO patients had NT-pro BNP≧55, and significantly more patients had Max IMT≧1.1 than those who did not have NT-pro BNP more than 55 (p = 0.02). Multiple regression analysis with Max IMT as the dependent variable showed that age and NT-pro BNP were significantly associated with RVO (p = 0.015, 0.022). RVO patients were more likely to have a Max IMT≧1.1, which was associated with atherosclerosis. Max IMT and NT-pro BNP were also associated with RVO patients, so NT-pro BNP may be a marker of RVO.

Development of high-performance point-of-care aqueous VEGF detection system and proof-of-concept validation in RVO patients.

To develop a sensitive point-of-care testing (POCT) aqueous vascular endothelial growth factor (VEGF) detection system, and assess its role for predicting the response to anti-VEGF treatment in macular edema secondary to retinal vein occlusion (RVO-ME) patients. An automatic point-of-care aqueous humor Magnetic Particle Chemiluminescence Enzyme Immuno-Assay (MPCLEIA) VEGF detection system was developed. The predictive values of aqueous cytokine levels, in combination with imaging parameters, on anatomical treatment response (ATR, the relative central macular thickness change [ΔCMT/bl-CMT]) were analyzed. The automatic MPCLEIA system was able to provide results in 45 min with only 20 μL sample. Among the 57eyes with available pre- and post-treatment evaluation, ATR significantly correlated with levels of interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1 (MCP-1) and VEGF measured by Luminex xMAP platform, and VEGF measured by MPCLEIA. Optimal cut-off values for these biomarkers were 13.26 ng/L, 23.57 ng/L, 1,110.12 ng/L, 105.52 ng/L, and 85.39 ng/L, respectively. Univariate analysis showed significant associations between ATR category (good response if ATR≤-25 % or poor response otherwise) and IL-6, IL-8, MCP-1, VEGF-xMAP, and VEGF-MPCLEIA (p<0.05). Multivariate logistic regression revealed that ATR category was significantly associated with aqueous VEGF-MPCLEIA (p=0.006) and baseline(bl)-CMT (p=0.008). Receiver operating characteristics analysis yielded an AUC of 0.959 for the regression model combining VEGF-MPCLEIA and bl-CMT, for predicting ATR category. Our novel MPCLEIA-based automatic VEGF detection system enables accurate POCT of aqueous VEGF, which shows promise in predicting the treatment response of RVO-ME to anti-VEGF agents when combined with bl-CMT.

Choroidal Vascularity Index and Treatment Outcomes in Branch Retinal Vein Occlusion Patients with Macular Edema

Purpose: To explore the association between the visual and anatomical outcomes and the choroidal vascularity index (CVI) post-intravitreal injection in patients with macular edema associated with branch retinal vein occlusion (BRVO).Methods: We conducted a retrospective review of medical records of 50 patients (27 eyes treated with anti-vascular endothelial growth factor and 23 eyes treated with a dexamethasone implant) with BRVO and macular edema who underwent intravitreal injections from January 2017 to October 2020. We measured the central macular thickness (CMT), subfoveal choroidal thickness, and CVI of the BRVO eyes and the fellow eyes using optical coherence tomography and then analyzed the correlation between these measurements and visual and anatomical outcomes.Results: After six months of treatment, the best corrected visual acuity improved, and CMT decreased. Multiple linear regression analysis revealed that factors associated with best corrected visual acuity improvement at six months were fellow eye CVI (standardized β = 0.346, p = 0.008), ellipsoid zone integrity (standardized β = 0.398, p = 0.001), and initial best corrected visual acuity (standardized β = 0.590, p &lt; 0.001). Initial CMT (standardized β = 0.563, p &lt; 0.001) was the only factor associated with the decrease in CMT at six months.Conclusions: In cases of severe macular edema, accurate evaluation of choroidal vessels can be challenging due to shadowing. We discovered that a larger CVI in the fellow eye was associated with greater visual improvement in patients with BRVO and macular edema. CVI could be a prognostic factor for predicting treatment outcomes in BRVO patients, suggesting that the choroidal vascular status may play a role in the pathophysiology of BRVO.

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.

Treatment discontinuation patterns of anti-VEGF in retinal vein occlusion

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

The Incidence, Time to Development, and Risk Factors for Fellow Eye Retinal Vein Occlusions.

Little is known about factors affecting risk or time to development of fellow eye retinal vein occlusion (RVO). The purpose of this study was to examine the incidence and risk factors for fellow eye RVO. This was a retrospective case-control study comparing unilateral and fellow eye RVO patients. This study was exempt by the Cleveland Clinic Institutional Review Board. Out of 1,083 patients, fellow eye RVO had a cumulative incidence of 3.6% (95% CI 2.61, 4.94) with a median time to development of 18 months (95% CI 6.0, 28.0). Fellow eye disease was associated with multiple characteristics including chronic kidney disease (odds ratio [OR] 3.78, 95% CI 1.89 to 7.55) and diabetic retinopathy (3.18, 1.57 to 6.44). While fellow eye RVO is relatively rare, it typically occurs within the first few years following initial diagnosis. Multiple characteristics were associated with fellow eye disease and time to onset. [Ophthalmic Surg Lasers Imaging Retina 2023;54:471-476.].

Outcomes of anti-VEGF treatment for macular edema secondary to central retinal vein occlusion in patients with poor baseline visual acuity

ObjectifPrésenter les résultats visuels de l'administration intravitréenne d'un anti-VEGF (facteur de croissance endothélial vasculaire) dans le traitement d'un œdème maculaire secondaire à une occlusion de la veine rétinienne centrale (OVRC) en présence d'une acuité visuelle initiale de ≤ 23 lettres ETDRS. NatureÉtude d'observation de cohorte rétrospective. MéthodesCette étude, menée au sein d'un seul établissement, portait sur 173 yeux de 173 patients qui ont reçu des injections mensuelles d'anti-VEGF pendant 3 mois consécutifs pour traiter un œdème maculaire secondaire à une OVRC et dont la meilleure acuité visuelle corrigée (MAVC) se chiffrait à ≤ 23 lettres ETDRS. Le principal paramètre de mesure était l'acuité visuelle au mois 3 et au mois 12. RésultatsAu mois 3, la MAVC s’était améliorée pour atteindre 34,1 lettres ETDRS (intervalle de confiance [IC] à 95 % : 30,7–37,5), soit un gain de 25,0 lettres (IC à 95 % : 22,0–28,5; p < 0,001). L’épaisseur moyenne du sous-champ central avait diminué de 519 μm (IC à 95 % : 475,5–567,0; p < 0,001). La plupart des patients (67,6 %) ont bénéficié d'un gain de > 15 lettres ETDRS. Au total, 160 patients ont été suivis pendant 12 mois, et la MAVC moyenne était de 31,2 lettres ETDRS (IC à 95 % : 27,5–34,9) à la fin de cette période. Le tiers des yeux qui n'avaient pas répondu à la première injection (gain de < 5 lettres) ont bénéficié d'un gain d'au moins 15 lettres après 3 injections consécutives. ConclusionsL'injection d'anti-VEGF en présence d'une OVRC dans le contexte d'une faible acuité visuelle initiale se traduit par une amélioration significative de la vision; il est quand même possible d'obtenir une amélioration modérée en dépit d'une réponse médiocre après une seule injection.

Increased intraocular inflammation in retinal vein occlusion is independent of circulating immune mediators and is involved in retinal oedema.

We aim to understand the link between systemic and intraocular levels of inflammatory mediators in treatment-naïve retinal vein occlusion (RVO) patients, and the relationship between inflammatory mediators and retinal pathologies. Twenty inflammatory mediators were measured in this study, including IL-17E, Flt-3 L, IL-3, IL-8, IL-33, MIP-3β, MIP-1α, GRO β, PD-L1, CD40L, IFN-β, G-CSF, Granzyme B, TRAIL, EGF, PDGF-AA, PDGF-AB/BB, TGF-α, VEGF, and FGFβ. RVO patients had significantly higher levels of Flt-3 L, IL-8, MIP-3β, GROβ, and VEGF, but lower levels of EGF in the aqueous humor than cataract controls. The levels of Flt-3 L, IL-3, IL-33, MIP-1α, PD-L1, CD40 L, G-CSF, TRAIL, PDGF-AB/BB, TGF-α, and VEGF were significantly higher in CRVO than in BRVO. KEGG pathway enrichment revealed that these mediators affected the PI3K-Akt, Ras, MAPK, and Jak/STAT signaling pathways. Protein-Protein Interaction (PPI) analysis showed that VEGF is the upstream cytokine that influences IL-8, G-CSF, and IL-33 in RVO. In the plasma, the level of GROβ was lower in RVO than in controls and no alterations were observed in other mediators. Retinal thickness [including central retinal thickness (CRT) and inner limiting membrane to inner plexiform layer (ILM-IPL)] positively correlated with the intraocular levels of Flt-3 L, IL-33, GROβ, PD-L1, G-CSF, and TGF-α. The size of the foveal avascular zone positively correlated with systemic factors, including the plasma levels of IL-17E, IL-33, INF-β, GROβ, Granzyme B, and FGFβ and circulating high/low-density lipids and total cholesterols. Our results suggest that intraocular inflammation in RVO is driven primarily by local factors but not circulating immune mediators. Intraocular inflammation may promote macular oedema through the PI3K-Akt, Ras, MAPK, and Jak/STAT signaling pathways in RVO. Systemic factors, including cytokines and lipid levels may be involved in retinal microvascular remodeling.

High Variation in Inner Retinal Reflectivity Predicts Poor Visual Outcome in Patients With Central Retinal Vein Occlusion: SCORE2 Report 21.

To assess the association of a novel spectral domain optical coherence tomography biomarker with 6-month visual acuity in in the Study of COmparative Treatments for REtinal Vein Occlusion 2. Spectral domain optical coherence tomography volume scans were evaluated for inner retinal hyperreflectivity, quantified by optical intensity ratio (OIR) and OIR variation. Baseline visual acuity letter score (VALS), baseline OCT biomarkers, and month 1 OIR were correlated with VALS at month 6. Regression trees, a machine learning technique yielding readily interpretable models, were used to assess for variable interaction. Only baseline VALS correlated positively with month 6 VALS in multivariate regression. Regression trees detected a novel functional and anatomical interaction in a subgroup. Among patients with a baseline VALS worse than 43, those with an OIR variation at month 1 of more than 0.09 had a mean of 13 fewer letters of vision at 6 months compared with patients with an OIR variation of 0.09 or less. Baseline VALS was the strongest predictor of month 6 VALS. Regression tree analysis detected an interaction effect, in which higher OIR variation at month 1 predicted worse 6-month VALS in patients with low VALS at baseline. OIR variation may serve as a predictor for poor visual outcome despite treatment of macular edema secondary to retinal vein occlusion in patients with poor vision at baseline. Pixel heterogeneity in three-dimensional OCT data may serve as measure of disruption of the retinal laminations, and this factor may carry visually prognostic value.

Risk of retinal vein occlusion in colorectal cancer patients receiving anti-vascular endothelial growth factors – a population-based cohort study

BackgroundAnti−vascular endothelial growth factors (VEGFs) treatment has been associated with an increased risk of thromboembolic events. Therefore, the use of anti−VEGFs for patients with colorectal cancers (CRC) has raised concerns about the potential risk of retinal vein occlusion (RVO), an ocular disease caused by embolism or venous stasis. This study aims to evaluate the risk of RVO in patients with CRC treated with anti−VEGFs.MethodWe conducted a retrospective cohort study using the Taiwan Cancer Registry and National Health Insurance Database. The study cohort comprised patients newly diagnosed with CRC between 2011 and 2017, who received anti-VEGF treatment. For each patient in the study cohort, a control group comprising four patients newly diagnosed with CRC, but not receiving anti-VEGF treatment, was randomly selected. A washout period of 12 months was implemented to identify new cases. The index date was defined as the date of the first prescription of anti-VEGF drugs. The study outcome was the incidence of RVO, as identified by ICD-9-CM (362.35 and 362.36) or ICD-10-CM codes (H3481 and H3483). Patients were followed from their index date until the occurrence of RVO, death or the end of the study period. Covariates, including patients' age at index date, sex, calendar year of CRC diagnosis, stage of CRC and comorbidities related to RVO, were included. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with adjustments for all covariates to compare the risk of RVO between the anti-VEGF and control groups.ResultsWe recruited 6285 patients in the anti-VEGF group and 37,250 patients in the control group, with mean ages of 59.49 ± 12.11 and 63.88 ± 13.17 years, respectively. The incidence rates were 1.06 per 1000 person-years for the anti-VEGF group, and 0.63 per 1000 person-years for the controls. There was no statistically significant difference in RVO risk between the anti-VEGF and control groups (HR: 2.21, 95% CI: 0.87–5.61).ConclusionOur results indicated no association between use of anti-VEGF and occurrence of RVO among CRC patients, although the crude incidence rate of RVO was higher in patients receiving anti-VEGF, compared to control patients. Future study with larger sample size is required to confirm our findings.

Evaluation of Cystoid Macular Edema in Patients with Retinal Vein Occlusion, Makkah Eye Hospital, Aden, Yemen

Background: Cystoid macular edema (CMO) represents a common pathologic sequel of the retina. This study aimed to study the occurrence of cystoid macular edema in patients with retinal vein occlusion. Materials and methods: We reviewed retrospectively the medical records of 54 retinal vein occlusion patients in Makkah eye hospital in Aden, from January to December 2021. The collected data analyzed by SPSS version 22. Chi-square test was used and a p-value less than 0.05 was determined as statistically significant. Results: The total study patients with retinal vein occlusion (RVO) were 54, (males 63.0% and females 37.0%). The mean age was 58.2 ± 12.7 years. The most side involvement of branch retinal vein occlusions (BRVO) was in the right eyes with (25%) and of central retinal vein occlusions (CRVO) in (30%), (p &gt; 0.05).The total number of eyes with RVO was 60 eyes, of which 26 eyes were with BRVO and 34 eyes with CRVO. In eyes with BRVO (35.0%) developed CMO while in eyes affected by CRVO, (31.7%), (p &lt; 0.05). We found higher intra-ocular pressure (IOP) &gt; 21 mmHg in CRVO with (18.4%) while in BRVO were in (8.3%), (p &gt; 0.05).There was a positive correlation between hypertension and RVO (P &lt; 0.05) and there was no significant relation in this study between glaucoma and occurrence of RVO (p &gt; 0.05). The visual acuity after receiving the Avastin injections improved in all visual acuity groups. Conclusion: In this study, males were predominant. The CRVO was the commonest type of RVO. Some patients with CRVO and BRVO developed CMO. The relation between values of BRVO and CRVO related to the occurrence of CMO was statistically significant (p &lt; 0.05). Keywords: Evaluation, cystoid macular edema, retinal vein occlusion, Aden, Yemen

Retinal vein occlusion in patients with primary angle closure: a prospective case–control study

ObjectifComparer la prévalence de la fermeture de l'angle dans des yeux présentant une occlusion veineuse rétinienne (OVR) et dans des yeux témoins, d'une part, et vérifier s'il existe une association entre la fermeture de l'angle et l'OVR, d'autre part. Patients et méthodesCette étude cas-témoins prospective qui a été réalisée à l'insu regroupait des patients ayant des antécédents d'OVR (cas cliniques) et des sujets témoins appariés pour l’âge et l'erreur de réfraction. Ont été analysées les caractéristiques cliniques des patients et les images des structures de l'angle obtenues par tomographie par cohérence optique (OCT) du segment antérieur. RésultatsAinsi, 88 patients (44 par groupe) ont été inclus dans notre étude. L’âge moyen des sujets dans les groupe OVR et témoin était de 59,8 ± 11,6 ans et de 60,8 ± 9,0 ans, respectivement (p = 0,667). Il n'y avait pas de différence statistiquement significative entre les 2 groupes quant aux caractéristiques cliniques, notamment la pression intraoculaire (p = 0,837) et la classification de Shaffer (p = 0,620). Aucune des caractéristiques des structures de l'angle visibles dans les images de l'OCT du segment antérieur ne différait significativement d'un groupe à l'autre. Le nombre de diagnostics de fermeture de l'angle relevés dans le groupe OVR (1 cas de fermeture primaire de l'angle et 7 suspicions de fermeture primaire de l'angle) et dans le groupe témoin (6 suspicions de fermeture primaire de l'angle) ne différait pas de manière significative (p = 0,560). La profondeur de la chambre antérieure (PCA) était moins prononcée dans les yeux atteints d'OVR (2,72 ± 0,31 mm) que dans les yeux controlatéraux exempts d'OVR (2,76 ± 0,31 mm; p = 0,014). ConclusionsCette étude prospective à l'insu comprenant des cas-témoins appariés n'a pas mis au jour de différence significative quant aux mesures cliniques ni aux images des structures de l'angle obtenues à l'OCT du segment antérieur dans des yeux présentant une OVR, comparativement à des yeux témoins. Cela dit, la PCA était légèrement moins prononcée dans les yeux atteints d'OVR que dans les yeux controlatéraux exempts d'OVR. D'après l'ensemble des résultats obtenus, il est peu probable qu'il existe une association entre les mécanismes à l'origine de la fermeture primaire de l'angle et l'OVR. Cependant, la PCA moins prononcée observée en présence d'OVR pourrait accroître le risque de blocage pupillaire intermittent ou permanent.

A study on oxidized-LDL cholesterol in normolipidemic retinal vein occlusion

Background: Oxidized low-density lipoprotein (ox-LDL) has been implicated in atherosclerotic cardiovascular disease. Arteriolosclerosis is an important causative factor for retinal vein occlusion (RVO). Till, date there is dearth of literature on ox-LDL and RVO. Aims and Objectives: The objectives of this study were to see whether ox-LDL cholesterol is an independent risk factor in RVO with normal lipid profile. Materials and Methods: Lipid profiles and ox-LDL levels were assayed in 122 adult unilateral RVO cases and 142 age and sex matched controls in this 1 year old case–control study. Results: ox-LDL cholesterol levels were significantly elevated in RVO cases than controls (54.5±6.1 in cases vs. 36.6±5.6 in controls, P&lt;0.01), although serum lipid profiles were normal in both cases and controls. Conclusion: The ox-LDL-induced atherosclerosis may be responsible for the retinal venous occlusion in absence of other risk factors. Hence, screening for ox-LDL in RVO patients should be worth considering especially in patients with normal lipid profiles.

Состояние хориокапилляров у пациентов с парацентальной острой срединной макулопатией

Purpose. To evaluate with optical coherence tomography angiography the status of the choriocapillaris in the eyes of patients with resolved paracentral acute middle maculopathy (PAMM). Method. Nine patients with unilateral resolved PAMM, 14 age-matched healthy individuals, and 16 age-matched patients with unilateral retinal vein occlusion (RVO) were included. The choriocapillaris flow area, and the number of choriocapillaris flow voids was compared between the eyes of healthy individuals, both eyes of the PAMM patients, and the fellow eyes of unilateral RVO patients. Results. The number of choriocapillaris flow voids in the unaffected eyes of PAMM patients was statistically significantly higher than in the eyes of healthy individuals (p &lt; 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.022). The choriocapillaris flow area in the unaffected eyes of PAMM patients was statistically significantly lower than in the eyes of healthy individuals (p &lt; 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.019). There was no difference in the status of the choriocapillaris between two eyes of PAMM patients. Conclusion. Eyes of patients with resolved PAMM have a substantial decrease of choriocapillaris perfusion. Keywords: paracentral acute middle maculopathy; choriocapillaris; vessel density; optical coherence tomography angiography; retinal vein occlusion

Outcomes in patients with retinal vein occlusion with good baseline visual acuity.

Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) are first-line therapy for macular oedema in retinal vein occlusion (RVO). Appropriate management for RVO with good visual acuity at diagnosis has not been evaluated. The purpose of this study is to analyse the visual and anatomic outcomes from anti-VEGF treatment among RVO patients with good vision at baseline. This retrospective cohort study evaluated patients diagnosed with macular oedema secondary to RVO from January 2012 to February 2021 at a tertiary ophthalmic centre. Patients had a Snellen acuity of 20/32 or better at diagnosis. Three cohorts were compared: patients with no anti-VEGF treatment, delayed anti-VEGF treatment (initial injection >30 days post-diagnosis) and immediate anti-VEGF treatment (initial injection ≤30 days post-diagnosis). Central subfield thickness (CST) and best visual acuity (BVA) were collected at diagnosis and 6-, 12- and 24-month follow-up appointments. Among 131 eyes, mean BVA values among treatment groups did not differ at 6-, 12- or 24-month follow up visits (P = 0.521, 0.426, 0.356, respectively). The percentage of eyes with at least a 5-letter BVA decrease at 24 months was 24.1%, 65.0% and 30.8% in the no treatment, delayed and immediate treatment groups respectively (P = 0.010). There was no significant difference in the percentage of eyes with at least a 10% decrease in CST at 24 months among groups (P = 0.095). Close observation with initiation of treatment in patients with good visual acuity with macular oedema secondary to RVO as indicated has similar outcomes in the setting of routine clinical practice.

Impact of statin treatment on cardiovascular events in patients with retinal vein occlusion: a nested case-control study in Korea.

Retinal vein occlusion (RVO) is associated with an increased risk of future cardiovascular events. Statin therapy is a key cornerstone in prevention for patients at high cardiovascular risk. However, little is known about the role of statin therapy for patients with RVO. This study evaluated whether statin treatment in patients with RVO was associated with a lower risk of cardiovascular events. A population-based, nested case-control study was conducted with a cohort of newly diagnosed RVO patients without prior cardiovascular disease between 2008 and 2020 using a nationwide health claims database in Korea. From this cohort of RVO patients, we identified cases of cardiovascular events (stroke or myocardial infarction) after RVO and matched controls based on sex, age, insurance type, antiplatelet use, and underlying comorbidities using 1:2 incidence density sampling. Using a cohort of 142,759 patients with newly diagnosed RVO, we selected 6,810 cases and 13,620 matched controls. A significantly lower risk of cardiovascular events (adjusted odds ratio, 0.604; 95% confidence interval, 0.557 to 0.655) was observed in RVO patients with statin treatment than in those without statin treatment. Statin treatment was associated with a reduced risk for both stroke and myocardial infarction after RVO. Longer statin treatment after RVO was associated with a lower risk for cardiovascular events. Statin treatment was associated with a lower risk for future cardiovascular events in patients with newly diagnosed RVO. Further studies are warranted to clarify the potential cardiovascular preventive role of statins in patients with RVO.

Visual outcome in patients of branch retinal vein occlusion (BRVO) with macular edema after one injection of intravitreal biosimilar ranibizumab

: This study aims to determine the effects of intravitreal biosimilar ranibizumab injection on best corrected visual acuity (BCVA) and central macular thickness (CMT) in patients of branch retinal vein occlusion (BRVO) with macular edema. : A retrospective, unmasked, and data-based study was conducted on 50 patients of BRVO with macular edema, who presented to our OPD over a period of 2 years. Cases in our study received one intravitreal injection of biosimilar Ranibizumab (0.5 mg/0.05 ml) at presentation and were followed up one month after injection. The data was collected from patients and available records. The data regarding BCVA and CMT (by Optical Coherence Tomography) before and 1 month after treatment was recorded and analyzed statistically.: In this study, we included fifty eyes of fifty patients. The mean patients’ age (in years) was 53.08 ± 9.58. There were 24 (48%) male and 26 (52%) female patients. The baseline mean BCVA ± SD (logMAR) was 0.79 ± 0.16 and mean CMT ± SD (in µm) was 688.14 ± 98.41 before treatment. Mean BCVA (logMAR) and mean CMT (in µm) after one biosimilar ranibizumab injection, at 1-month follow-up, were 0.33 ± 0.13 and 307.18 ± 34.97 respectively. We used paired t-test to compare mean BCVA and mean CMT before and after injection, and we found a statistically significant difference (p-value of &amp;#60;0.001) for both. None of the patients experienced any significant ocular and systemic adverse effects on post-op day 1, and at 1 month.: Intravitreal biosimilar ranibizumab is an effective and safe therapy for patients of BRVO with macular edema and results in improvement of BCVA and decrease in CMT. Biosimilar injection has also reduced the cost of treatment leading to an increase in patients’ compliance.

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.

Flavoprotein fluorescence elevation is a marker of mitochondrial oxidative stress in patients with retinal disease.

Recent studies of glaucoma, age-related macular degeneration, and diabetic retinopathy have demonstrated that flavoprotein fluorescence (FPF) can be utilized non-invasively as an indicator of mitochondrial oxidative stress in the retina. However, a comprehensive assessment of the validity and reliability of FPF in differentiating between healthy and diseased eyes across multiple disease states is lacking. Here, we evaluate the sensitivity and specificity of FPF in discriminating between healthy and diseased eyes in four leading causes of visual impairment worldwide, one of which has not been previously evaluated using FPF. We also evaluate the association between FPF and visual acuity. A total of 88 eyes [21 eyes of 21 unaffected controls, 20 eyes from 20 retinal vein occlusion (RVO) patients, 20 eyes from 20 diabetic retinopathy (DR) patients, 17 eyes from 17 chronic exudative age-related macular degeneration (exudative AMD) patients, and 10 eyes from 10 central serous retinopathy (CSR) patients] were included in the present cross-sectional observational study. Eyes were imaged non-invasively using a specially configured fundus camera OcuMet Beacon® (OcuSciences, Ann Arbor, MI). The macula was illuminated using a narrow bandwidth blue light (455 - 470 nm) and fluorescence was recorded using a narrow notch filter to match the peak emission of flavoproteins from 520 to 540 nm. AUROC analysis was used to determine the sensitivity of FPF in discriminating between diseased eyes and healthy eyes. Nonparametric Kruskal-Wallis Tests with post-hoc Mann Whitney U tests with the Holm-Bonferroni correction were performed to assess differences in FPF intensity, FPF heterogeneity, and best corrected visual acuity (BCVA) between the five groups. Spearman rank correlation coefficients were calculated to assess the relationship between FPF and BCVA. AUROC analysis indicated that FPF intensity is highly sensitive for detecting disease, particularly for exudative AMD subjects (0.989; 95% CI = 0.963 - 1.000, p=3.0 x 107). A significant difference was detected between the FPF intensity, FPF heterogeneity, and BCVA in all four disease states compared to unaffected controls (Kruskal-Wallis Tests, p = 1.06 x 10-8, p = 0.002, p = 5.54 x 10-8, respectively). Compared to healthy controls, FPF intensity values were significantly higher in RVO, DR, exudative AMD, and CSR (p < 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). Spearman rank correlation coefficient between FPF intensity and BCVA was ρ = 0.595 (p = 9.62 x 10-10). Despite variations in structural retinal findings, FPF was found to be highly sensitive for detecting retinal disease. Significant FPF elevation were seen in all four disease states, with the exudative AMD patients exhibiting the highest FPF values compared to DR, CSR, and RVO subjects. This is consistent with the hypothesis that there is elevated oxidative stress in all of these conditions as previously demonstrated by blood studies. FPF intensity is moderately correlated with the late-in disease-marker BCVA, which suggests that the degree of FPF elevation can be used as a metabolic indicator of disease severity.

ApoB, non-HDL-C, and LDL-C Are More Prominent in Retinal Artery Occlusion Compared to Retinal Vein Occlusion

ABSTRACT Purpose To evaluate and compare the blood lipid profile in retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Methods We included 82 RAO patients and 95 RVO patients in this retrospective case–control study. Controls were matched to RAO or RVO patients at a 1:1 ratio, respectively. Associated lipid variates were analyzed in multivariable logistic regression models. Results LDL-C (OR = 1.69), non-HDL-C (OR = 1.87), and ApoB (OR = 11.72) individually significantly increased the risk of RAO. ApoA1 was associated with RVO (OR = 0.02), and with 75.8% sensitivity and 67.4% specificity. TG (OR = 1.61), LDL-C (OR = 1.69), non-HDL-C (OR = 1.91), and ApoB (OR = 12.12) each significantly increased the risk of RAO when compared with RVO. Conclusions ApoB, non-HDL-C, and LDL-C may be potential biomarkers in RAO patients. Low ApoA1 is an independent risk factor for the development of RVO.