Association of Retinal Inner Layer Disorganization With Ultra-Widefield Fluorescein Angiographic Features and Visual Acuity in Branch Retinal Vein Occlusion

Abstract

BACKGROUND AND OBJECTIVE: To assess the impact of the disorganization of retinal inner layers (DRIL) on visual acuity (VA) and its correlation with ischemic index (IsI) on ultra-widefield fluorescein angiography (UWFFA) in eyes with acute, treatment-naïve branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: Retrospective, longitudinal study of BRVO eyes with 1 year of follow-up or more. Area of intraretinal cysts, DRIL length, extent of disruption of external limiting membrane (ELM), and ellipsoid zone (EZ) were graded on the central 1,000 μm of foveal optical coherence tomography (OCT) scan. Baseline IsI was calculated on UWFFA. RESULTS: Thirty eyes of 30 patients with a mean follow-up of 25.4 months ± 11.0 months were evaluated. At baseline, 50% had DRIL (mean 443.1 μm ± 460.4 μm). DRIL length at baseline was predictive of worse VA at 12 months ( P = .029), and DRIL length at 12 months was predictive of worse final VA( P = .011). In multivariate analyses, DRIL length was associated with final VA ( P = .008) after controlling for other OCT parameters. There was no association between baseline IsI on UWFFA and DRIL. CONCLUSIONS: DRIL served as an independent OCT biomarker predictive of worse VA during a period of 2 years in acute, treatment-naïve BRVO. Development of DRIL was influenced by presence of CME, intraretinal cyst area, and extent of ELM and EZ disruption, but not by severity of baseline IsI. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:354–364.]

Potential Prognostic Indicators for Patients With Retinal Vein Occlusion

“…Rayess et al showed that a higher initial subfoveal choroidal thickness was a positive predictor of favorable visual outcomes in patients with BRVO by univariate analysis but not multivariate analysis ( 68 ). In contrast Yu et al ( 69 ) reported that choroidal thickness did not impact VA at any time point in patients with BRVO. However, another study examined in detail the choroidal change of RVO ( 70 ).…”

Predictors of Visual Recovery in Patients with Macular Edema Secondary to Central Retinal Occlusion After Treatment with Conbercept

“…[16,17] Previous studies have noted that vision recovery was limited even though retinal thickness was reduced to normal levels after treatment. [18,19] The reason for this is not clear. It is known that macular edema was noted mostly in the outer nuclear layer, causing photoreceptor cell loss and fovea dysfunction.…”

“…It is known that macular edema was noted mostly in the outer nuclear layer, causing photoreceptor cell loss and fovea dysfunction. [19] Akagi-Kurashige et al found that macular photoreceptor abnormalities of RVO patients could cause a decrease in parafoveal cone density and disrupt the cone mosaic spatial arrangement. [20] Therefore, the assessment of the retinal layers, especially those consisting of photoreceptor layers, is useful for evaluating visual prognosis.…”

Predictors of visual recovery in patients with macular edema secondary to central retinal vein occlusion after treatment with Conbercept

“…Previous studies have noted that vision recovery was limited even though retinal thickness was reduced to normal levels after treatment [ 22 , 23 ]. The reason for this is not clear.…”

“…The reason for this is not clear. It is known that macular edema was noted mostly in the outer nuclear layer, causing photoreceptor cell loss and fovea dysfunction [ 23 ]. Akagi-Kurashige et al found that macular photoreceptor abnormalities of RVO patients could cause a decrease in parafoveal cone density and disrupt the cone mosaic spatial arrangement [ 24 ].…”