Observation on the blood flow changes around the optic disc before and after the combined treatment of anti-vascular endothelial growth factor and Dexamethasone intravitreal implant for central retinal vein occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

Xu Min ¹ ,  Shi Yanyun ²

1. The First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China;
2. Shanxi Provincial Eye Hospital, Taiyuan 030002, China;

Corresponding author：

Shi Yanyun, Email: shiyanyun.yk@126.com

Keywords：

Central retinal vein occlusion; Anti-vascular endothelial growth factor drugs; Dexamethasone intravitreal implant; Optical coherence tomography angiography; Peripapillary vascular density

DOI：

10.3760/cma.j.cn511434-20250116-00023

Video：

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??? To observe changes in peripapillary blood flow before and after combined treatment with anti-vascular endothelial growth factor (VEGF) drugs and Dexamethasone intravitreal implant (DEX) in patients with central retinal vein occlusion (CRVO). Methods A prospective clinical study. Thirty-three eyes of 33 patients with newly diagnosed non-ischemic CRVO and macular edema (ME) were enrolled from Shanxi Eye Hospital between April 2023 and April 2024. All patients underwent best-corrected visual acuity (BCVA) and swept-source optical coherence tomography angiography (SS-OCTA) examinations. The treatment regimen consisted of three intravitreal injections of ranibizumab and one DEX implant. SS-OCTA was used to scan a 3×3 mm area centered on the optic disc to measure peripapillary retinal nerve fiber layer (RNFL) thickness and blood flow density in the superficial vascular complex (SVC), deep vascular complex (DVC), and radial peripapillary capillaries (RPC). Changes in SVC, DVC, and RPC blood flow density and RNFL thickness were evaluated at 3 and 6 months post-treatment. Shapiro-Wilk test was used to assess normality, and Spearman’s rank correlation coefficient was applied for correlation analysis. Results Compared with before treatment, the blood flow density changes of SVC and RPC showed a downward trend at 3 and 6 months after treatment. Among them, the difference was statistically significant at 6 months after treatment (Z=-2.592, -2.070, P=0.012, 0.042), while there was no statistically significant difference at 3 months after treatment (P＞0.05). The blood flow density of DVC showed an upward trend at 3 and 6 months after treatment, but the differences were not statistically significant (P＞0.05). The results of the correlation analysis showed that the thickness of RNFL was negatively correlated with the blood flow density of DVC (r=-0.768, P＜0.001). It was positively correlated with the blood flow densities of SVC and RPC (r=0.288, 0.398; P=0.040, 0.004). Conclusion Anti-VEGF drugs combined with DEX treatment can significantly improve the perioptic disc blood flow distribution in eyes with CRVO, manifested as a decrease in blood flow density of SVC and RPC, while a compensatory increase in blood flow of DVC. The thickness variation of RNFL is closely related to the blood flow density of different vascular layers.

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15.	Campochiaro PA, Hafiz G, Shah SM, et al. Ranibizumab for macular edema due to retinal vein occlusions: implication of VEGF as a critical stimulator[J]. Mol Ther, 2008, 16(4): 791-799. DOI: 10.1038/mt.2008.10.
16.	Moussa M, Leila M, Bessa AS, et al. Grading of macular perfusion in retinal vein occlusion using en-face swept-source optical coherence tomography angiography: a retrospective observational case series[J/OL]. BMC Ophthalmol, 2019, 19(1): 127[2019-06-10]. https://pubmed.ncbi.nlm.nih.gov/31182069/. DOI: 10.1186/s12886-019-1134-x.
17.	Seknazi D, Coscas F, Sellam A, et al. Optical coherence tomography angiography in retinal vein occlusion: correlations between macular vascular density, visual acuity, and peripheral nonperfusion area on fluorescein angiography[J]. Retina, 2018, 38(8): 1562-1570. DOI: 10.1097/IAE.0000000000001737.
18.	Suzuki N, Hirano Y, Tomiyasu T, et al. Retinal hemodynamics seen on optical coherence tomography angiography before and after treatment of retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2016, 57(13): 5681-5687. DOI: 10.1167/iovs-16-20648.

1. Romano F, Lamanna F, Gabrielle PH, et al. Update on retinal vein occlusion[J]. Asia Pac J Ophthalmol (Phila), 2023, 12(2): 196-210. DOI: 10.1097/APO.0000000000000598.
2. Coscas G, Dhermy P. Retinal venous occlusions[J]. Bull Mem Soc Fr Ophtalmol, 1978, 90: 1-30.
3. Green WR, Chan CC, Hutchins GM, et al. Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases[J]. Trans Am Ophthalmol Soc, 1981, 79: 371-422.
4. Haymore JG, Mejico LJ. Retinal vascular occlusion syndromes[J]. Int Ophthalmol Clin, 2009, 49(3): 63-79. DOI: 10.1097/IIO.0b013e3181a8db88.
5. Jonas J, Paques M, Monés J, et al. Retinal vein occlusions[J]. Dev Ophthalmol, 2010, 47: 111-135. DOI: 10.1159/000320076.
6. Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, et al. Guidelines for the management of retinal vein occlusion by the European society of retina specialists (Euretina)[J]. Ophthalmologica, 2019, 242(3): 123-162. DOI: 10.1159/000502041.
7. Nicolai M, Franceschi A, Turris S, et al. Papillary vessel density changes after intravitreal anti-VEGF injections in hypertensive patients with central retinal vein occlusion: an angio-OCT study[J/OL]. J Clin Med, 2019, 8(10): 1636[2019-10-06]. https://pubmed.ncbi.nlm.nih.gov/31590449/. DOI: 10.3390/jcm8101636.
8. Tservakis I, Koutsandrea C, Papaconstantinou D, et al. Safety and efficacy of dexamethasone intravitreal implant (Ozurdex) for the treatment of persistent macular edema secondary to retinal vein occlusion in eyes previously treated with anti-vascular endothelial growth factors[J]. Curr Drug Saf, 2015, 10(2): 145-151. DOI: 10.2174/1574886309666140805142245.
9. Nicholson L, Talks SJ, Amoaku W, et al. Retinal vein occlusion (RVO) guideline: executive summary[J]. Eye (Lond), 2022, 36(5): 909-912. DOI: 10.1038/s41433-022-02007-4.
10. Spaide RF, Fujimoto JG, Waheed NK, et al. Optical coherence tomography angiography[J]. Prog Retin Eye Res, 2018, 64: 1-55. DOI: 10.1016/j.preteyeres.2017.11.003.
11. Ip MS, Oden NL, Scott IU, et al. Month 12 outcomes after treatment change at month 6 among poor responders to Aflibercept or Bevacizumab in eyes with macular edema secondary to central or hemiretinal vein occlusion: a secondary analysis of the SCORE2 study[J]. JAMA Ophthalmol, 2019, 137(3): 281-287. DOI: 10.1001/jamaophthalmol.2018.6111.
12. Liang X, Shen B, Ou Z, et al. Comparison of intravitreal ranibizumab monotherapy vs. ranibizumab combined with dexamethasone implant for macular edema secondary to retinal vein occlusion[J/OL]. Front Med (Lausanne), 2022, 9: 930508[2022-09-12]. https://pubmed.ncbi.nlm.nih.gov/36172537/. DOI: 10.3389/fmed.2022.930508.
13. Fan L, Zhu Y, Sun X, et al. Patients with unilateral retinal vein occlusion show reduced radial peripapillary capillary density in their fellow eyes[J/OL]. BMC Ophthalmol, 2021, 21(1): 448[2021-12-27]. https://pubmed.ncbi.nlm.nih.gov/34961508/. DOI: 10.1186/s12886-021-02192-y.
14. 王良艳, 刘超群, 刘建亮, 等. 视网膜静脉阻塞视盘区量化OCTA的临床研究[J]. 国际眼科杂志, 2020, 20(12): 2163-2166. DOI: 10.3980/j.issn.1672-5123.2020.12.30.Wang LY, Liu CQ, Liu JL, et al. Clinical study of retinal vein occlusion papillary area with quantified OCTA[J]. Int Eye Sci, 2020, 20(12): 2163-2166. DOI: 10.3980/j.issn.1672-5123.2020.12.30.
15. Campochiaro PA, Hafiz G, Shah SM, et al. Ranibizumab for macular edema due to retinal vein occlusions: implication of VEGF as a critical stimulator[J]. Mol Ther, 2008, 16(4): 791-799. DOI: 10.1038/mt.2008.10.
16. Moussa M, Leila M, Bessa AS, et al. Grading of macular perfusion in retinal vein occlusion using en-face swept-source optical coherence tomography angiography: a retrospective observational case series[J/OL]. BMC Ophthalmol, 2019, 19(1): 127[2019-06-10]. https://pubmed.ncbi.nlm.nih.gov/31182069/. DOI: 10.1186/s12886-019-1134-x.
17. Seknazi D, Coscas F, Sellam A, et al. Optical coherence tomography angiography in retinal vein occlusion: correlations between macular vascular density, visual acuity, and peripheral nonperfusion area on fluorescein angiography[J]. Retina, 2018, 38(8): 1562-1570. DOI: 10.1097/IAE.0000000000001737.
18. Suzuki N, Hirano Y, Tomiyasu T, et al. Retinal hemodynamics seen on optical coherence tomography angiography before and after treatment of retinal vein occlusion[J]. Invest Ophthalmol Vis Sci, 2016, 57(13): 5681-5687. DOI: 10.1167/iovs-16-20648.

Chinese Journal of Ocular Fundus Diseases

Latest ArticlesObservation on the blood flow changes around the optic disc before and after the combined treatment of anti-vascular endothelial growth factor and Dexamethasone intravitreal implant for central retinal vein occlusion

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