Serous Retinal Detachment Group Research Articles

Effect of a single intravitreal bevacizumab injection on different optical coherence tomographic patterns of diabetic macular oedema

The aim of this study is to compare the therapeutic effect of a single intravitreal bevacizumab (IVB) injection in eyes with diabetic macular oedema (DMO) of different patterns determined by optical coherence tomography (OCT). Medical records of patients who had a single IVB injection for DMO were analysed retrospectively. Eyes with a clinically significant DMO and a central foveal thickness (CFT) of 250 μm or more determined by OCT were included in the analysis. Best-corrected visual acuity (BCVA), CFT and total macular volume values before and after the injection were recorded. Eyes were divided into sponge-like diffuse retinal thickening (DRT), cystoid macular oedema (CMO) and serous retinal detachment (SRD) groups according to the morphology on OCT. A total of 92 eyes (42 with DRT, 31 with CMO and 19 with SRD) were included in the study. There was no statistically significant variation between three groups regarding the change in BCVA (P=0.695). CMO and SRD groups had greater reductions in their mean CFT, and the amount of reduction showed statistically significant variation between three groups (P=0.048). However, no statistically significant difference was found between groups in terms of percentage of change in CFT (P=0.278). CMO and SRD subtypes are associated with a greater reduction in the CFT than the DRT subtype. Although the change in BCVA was not significantly different between groups, the DRT group showed markedly better visual improvement in proportion to the decrease in CFT.

Influence of Pars Plana Vitrectomy on Macular Sensitivity and Morphology in Patients with Branch Retinal Vein Occlusion and Serous Retinal Detachment

To evaluate the influence of serous retinal detachment (SRD) on the outcome of pars plana vitrectomy (PPV) for macular edema in patients with branch retinal vein occlusion (BRVO). In an interventional case series, 20 patients (20 eyes) with BRVO and macular edema underwent PPV, including 12 patients with SRD and eight with cystoid macular edema (CME). Microperimetry of the macular region and optical coherence tomography were performed before and 6 months after PPV. In both the CME and SRD groups, the mean macular thickness and macular volume decreased significantly from baseline to 3 and 6 months after PPV (all P < .01), while visual acuity improved significantly in both groups (both P < .01). However, mean macular sensitivity only increased significantly in the SRD group (P < .05). PPV achieves greater improvement of macular sensitivity in BRVO patients with SRD than in those with CME.

Clinical Implications of Serous Retinal Detachment in Branch Retinal Vein Occlusion and Response After Primary Intravitreal Bevacizumab Injection

To evaluate the impact of macular serous retinal detachment (SRD) and its relationship to treatment outcome after primary intravitreal bevacizumab (IVB) injection in patients with branch retinal vein occlusion (BRVO) and macular edema (ME). Seventy-three patients with ME secondary to BRVO who received primary IVB (2.5 mg/0.1 mL) were included in this study. The specific ME patterns were investigated using optical coherence tomography (OCT) examination. Visual acuity (VA), central macular thickness (CMT), and macular volume at baseline; at 1, 3, and 6 months; and at final visit after primary IVB were retrospectively analyzed and compared between patients with and without SRD. SRD was found in 25 patients (34.2%). The baseline CMT was significantly thicker in patients with SRD than in those without it (648.4±200.5 μm vs. 440.3±119.6 μm, P<0.001). Six months after primary IVB injection, a greater reduction in CMT change from baseline was observed in the SRD group (412.5±227.2 μm) than in the group without SRD (118.5±175.2 μm) (P<0.001). The improvement of logarithm of the minimum angle of resolution VA was also greater in the SRD group than in the group without SRD (-0.64±0.52 and -0.28±0.62 respectively, P=0.015). Logistic regression analysis showed that the presence of SRD was an independent factor for visual improvement in BRVO (P=0.027). Patients with SRD had greater functional and morphological improvements at 6 months after primary IVB therapy. The results of this study suggest that the presence of SRD observed on OCT may be an indicator of favorable clinical response after IVB injections and that in BRVO patients with SRD, bevacizumab may be a good alternative for treatment.

Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

BackgroundThe influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO).MethodsTwenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (−) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded.ResultsIn both the SRD (−) group and the SRD (+) group, the mean macular thickness within the central 4° field and the 10° and 20° fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P <0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P <0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4° field and the 10° and 20° fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P <0.05). The trend profiles of macular thickness within the 10° and 20° fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4° field and the 10° and 20° fields of the occluded region.ConclusionsThese results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.

VITREOUS INFLAMMATORY FACTORS AND SEROUS MACULAR DETACHMENT IN BRANCH RETINAL VEIN OCCLUSION

To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Visual function and serous retinal detachment in patients with branch retinal vein occlusion and macular edema: a case series

BackgroundThe influence of serous retinal detachment (SRD) on retinal sensitivity in patients with branch retinal vein occlusion (BRVO) and macular edema remains unclear. This is despite the frequent co-existence of SRD and cystoid macular edema (CME) in BRVO patients on optical coherence tomography (OCT) and the fact that CME is the most common form of macular edema secondary to BRVO. We investigated visual function (visual acuity and macular sensitivity), macular thickness, and macular volume in patients with BRVO and macular edema.MethodsFifty-three consecutive BRVO patients (26 women and 27 men) were divided into two groups based on optical coherence tomography findings. Macular function was documented by microperimetry, while macular thickness and volume were measured by OCT.ResultsThere were 15 patients with SRD and 38 patients with CME. Fourteen of the 15 patients with SRD also had CME. Visual acuity was significantly worse in the SRD group than in the CME group (P = 0.049). Also, macular thickness and macular volume within the central 4°, 10°, and 20° fields were significantly greater in the SRD group (P = 0.008, and P = 0.007, P < 0.001 and P < 0.001, and P < 0.001 and P < 0.001, respectively). However, macular sensitivity within the central 4°, 10°, and 20° fields was not significantly worse in the SRD group than in the CME group.ConclusionsSRD itself may decrease visual acuity together with CME, because nearly all SRD patients also had CME. SRD does not seem to influence macular function on microperimetry.

Vitreous inflammatory factors and serous retinal detachment in central retinal vein occlusion: a case control series

BackgroundThis study investigated whether the vitreous fluid levels of soluble vascular endothelial growth factor receptor-2 (sVEGFR-2), pigment epithelium-derived factor (PEDF), and soluble intercellular adhesion molecule 1 (sICAM-1) were associated with the occurrence of serous retinal detachment (SRD) in patients with central retinal vein occlusion (CRVO).MethodsWe recruited 33 patients with CRVO and macular edema, as well as 18 controls with nonischemic ocular diseases. Eighteen of the 33 patients with CRVO showed SRD on optical coherence tomography of the macula (defined as subretinal accumulation of fluid with low reflectivity), while the other 15 patients only had cystoid macular edema (CME, defined as hyporeflective intraretinal cavities). Retinal ischemia was evaluated by measuring the area of capillary non-perfusion using fluorescein angiography and the public domain Scion Image program, while central macular thickness (CMT) was examined by optical coherence tomography. Vitreous fluid samples were obtained during pars plana vitrectomy and levels of the target molecules were measured by enzyme-linked immunosorbent assay.ResultsIschemia was significantly more common in the SRD group (17/18 patients) than in the CME group (5/15 patients) (P < 0.001). The vitreous fluid level of sICAM-1 increased significantly across the three groups from the control group (4.98 ± 1.73 ng/ml) to the CME group (15.4 ± 10.1 ng/ml) and the SRD group (27.1 ± 17.7 ng/ml) (ptrend< 0.001). The vitreous fluid level of sVEGFR-2 also showed a significant increase across the three groups (1083 ± 541 pg/ml, 1181 ± 522 pg/ml, and 1535 ± 617 pg/ml, respectively, ptrend = 0.019). On the other hand, the vitreous fluid level of PEDF showed a significant decrease across the three groups (56.4 ± 40.0 ng/ml, 24.3 ± 17.3 ng/ml, and 16.4 ± 12.6 ng/ml, respectively, ptrend< 0.001).ConclusionsHigher levels of inflammatory factors (sICAM-1 and sVEGFR-2) and lower levels of anti-inflammatory PEDF were observed in macular edema patients with SRD, suggesting that inflammation plays a key role in determining the severity of CRVO.

AQUEOUS VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS ARE ASSOCIATED WITH SEROUS MACULAR DETACHMENT SECONDARY TO BRANCH RETINAL VEIN OCCLUSION

The purpose of this study was to determine whether aqueous levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) are associated with developments of serous retinal detachment (SRD) secondary to branch retinal vein occlusion. We recruited 102 patients with branch retinal vein occlusion and 10 controls. We divided patients into two groups according to optical coherence tomography images of the macula. Forty-six of 102 patients showed SRD defined as being subretinal fluid accumulation with low reflectivity, and the remaining 56 patients presented only cystoid macular edema (CME) defined as being hyporeflective intraretinal cavities. We measured the extent of vascular leakage (disk areas) by digital fluorescein angiography and evaluated the retinal ischemia defined as capillary nonperfusion. Aqueous concentrations of VEGF and pigment epithelium-derived factor were measured by enzyme-linked immunosorbent assay and compared between the two groups. The incidence of major branch retinal vein occlusion was higher in the SRD group (38 of 46, 83%) than in the CME group (32 of 56, 66%, P = 0.01). The incidences of ischemic vein occlusion and macular ischemia was similar between the SRD group (18 of 46 and 20 of 46) and the CME group (20 of 56 and 24 of 56), whereas vascular leakage areas were larger in the SRD group than in the CME group (P = 0.02). Aqueous VEGF levels were higher in the SRD group than in the CME group (P < 0.001), whereas aqueous pigment epithelium-derived factor levels were similar. Vascular endothelial growth factor levels were positively correlated with pigment epithelium-derived factor levels (P < 0.001). Our results indicate that excessive increase in vascular permeability because of VEGF upregulation may contribute to the development of SRD secondary to branch retinal vein occlusion.