Retinal vein occlusion (RVO) is one of the most common retinal vascular diseases causing blindness, macular edema (ME) is often secondary to it, which causes serious visual impairment to patients. Imaging biomarkers in the changes of retina and choroid of ME secondary to RVO (RVO-ME) have important clinical value in the evaluation of condition, curative effect and visual acuity prediction of patients with RVO-ME. Among them, the disorganization of the retinal inner layers, the integrity of external limiting membrane and ellipsoid zone, and the change of central macular thickness are reliable indexes to evaluate the prognosis of visual acuity; hyperreflective foci, subretinal fluid and intraretinal fluid can be used as important parameters to reflect the level of inflammation; prominent middle limiting membrane and paracentral acute middle maculopathy are the objective basis for judging the degree of retinal ischemia; the changes of choroidal vascular index and choroidal thickness also have potential advantages in evaluating the progress of the disease. Accurately grasp the characteristics of biological markers of RVO-ME related optical coherence tomography is conducive to its reasonable and accurate use in the clinical diagnosis and treatment of RVO-ME, and helpful to further explore the pathogenesis of the disease.
Objective To explore the clinical application value of multifocal oscillatory potentials (MOPs) in retinal vein occlusion (RVO). Methods MOPs were tested using VERIS 4.0 visual evoked response imaging system for 19 cases (19 eyes) of RVO，among them 8 cases of central retinal vein occlusion (CRVO) and 11 cases of branch retinal vein occlusion (BRVO). Twenty normal subjects were as normal control group. The stimulative visual angles subtended ±26.6°horizontally and ±22.1°vertically. The filter setting was bandpass 100～1000 Hz. The retinal responses from 103 hexagons were recorded in 4 min (8 segments). Results In normal control group, OP-1, OP-2 and OP-3 were recorded during 37 ms for first order and 47 ms for second order first slice in whole test field and 5 ring retinal regions, the oscillatory wave shapes of second order were clearer than those of first order. In RVO groups, 91.6% latencies of OP-1, OP-2 and OP-3 were delayed, and 70.8% amplitudes of OP-1, OP-2 and OP-3 were reduced. The delay of the latencies and the decrease of the amplitude in CRVO were more markedly than those in BRVO. Conclusion MOPs can be effectively and quantitatively used to evaluate the retinal function of the different location in RVO. (Chin J Ocul Fundus Dis,2002,18:20-22)
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)/non-ischemic (21 eyes) groups and previous treatment (22 eyes)/treatment naïve (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). Two months after injection, change of BCVA, IOP and CMT was most significant (t=4.93, 6.80, 6.71, 5.53, 4.97, 5.89, 5.13, 7.68, 7.31, 8.67, 8.31, 5.82; P＜0.05). Twelve months after injection, there was no statistical difference regarding BCVA of ischemic RVO group and previous treatment group, compared to baseline (t=1.86, 0.67; P＞0.05); BCVA of non-ischemic RVO group and treatment naïve group significantly increased compared to baseline (t=2.27, 2.30; P＜0.05); there was no statistical difference regarding IOP in all groups (t=0.30, 0.13, 0.64, 1.53; P＞0.05);however, CMT significantly decreased in all groups (t=4.60, 3.26, 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 naïve 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.
ObjectivesTo evaluate the therapeutic effect of argon laser photocoagulation combined with intravitreous injection of triamcinolone acetonide (TA) on ischemic central retinal vein occlusion (CRVO).MethodsArgon laser photocoagulation combined with intravitreous injection of TA was performed on 17 patients (17 eyes) with CRVO between December 2003 and July 2004.ResultsDuring the follow-up of 4-10 months, the visual acuity improved in 16 patients, including alleviated or even disappeared cystoid macular edema (CME) in 5, and recurred macular edema in 5 with decreased visual acuity after 3 months. Six patients had increased ocular pressure after intra-ocular injection which alleviated after treated suitably. No neovascularization in angle or secondary neovascular glaucoma was found.ConclusionArgon laser photocoagulation combined with intravitreous injection of TA may improve the visual acuity and reduce complications in ischemic CRVO, though macular edema may recur in some cases. (Chin J Ocul Fundus Dis, 2005,21:224-225)
Objective To investigate the clinical characteristics of retinalve in occlusion caused by systemic lupus erythematosus (SLE).Methods Visual acuities, fundus examination, antinuclear antibody (ANA), anti-double-stranded DNA（anti-dsDNA）, complement 3 (C3), complement 4 (C4) and erythrocyte sedimentation rate (ESR) were detected in 9 patients (12 eyes) with retinal vein occlusions caused by SLE. Fundus fluorescein angiography (FFA) was performed on 3 patients. Patients with other ocular or general lesions were analyzed.Results Central re tinal vein occlusion (CRVO) in 6 patients (8 eyes) and branch retinal vein occlusion (BRVO) in 3 (4 eyes) were found. The results of FFA showed that 5 eyes of 3 patients had extensive leakage of retinal vein and capillary. Four contralateral eyes of 6 patients with unilateral retinal vein occlusion had SLE fundus alte rations such as cotto-wool spot and retinal hemorrhage. Four patients had xerotic keratitis or ulcerative blepharitis and 8 had general lesions. Positive ANA and anti-dsDNA, and ESR gt;50 mm/h were detected in all the patients. Decreasing C3 in 6 patients and C4in 5 were found. Conclusions SLE is one of the general conditions causing retinal vein occlusion. Visual acuity and barrier of retinal vein and capillary are damaged seriously in patients with retinal vein occlusion caused by SLE, which may be accompanied with other ocular or general lesions. It is suggested that retinal vein occlusion is relative with SLE activity. (Chin J Ocul Fundus Dis，2003，19：201-268)
Full thickness macular hole (FTMH) is a rare complication of retinal vein occlusion (RVO). These have different characteristics, and may associate with complications of RVO, such as cystoid macular edema and epiretinal membrane, and treatments like intravitreal injection. Although anatomical closure is often obtained with vitrectomy and inner limiting membrane peeling, visual improvement is often variable. Regularly follow-up, medical examination, and vitrectomy can improve the outcomes of patients. In the future, randomized controlled clinical trials with larger sample size are still needed to further explore the pathogenesis, clinical characteristics and treatment methods of FTMH after RVO, so as to improve the clinical prognosis of these patients.
Retinal vein occlusion (RVO) is a vascular disease characterized by intraretinal hemorrhage, edema and hard exudation, which is caused by increased retinal vein pressure. OCT angiography (OCTA) has been widely used in the diagnosis of retinal vascular diseases including RVO by virtue of non-invasive, high resolution and stratified display of superficial, deep retinal vessels and quantification of retinal vessel density and non-perfusion area size. OCTA can provide information of retinal microvascular structure and blood perfusion under the condition of disease, it also can be used to evaluate the effect of treatment and changes of retinal circulation during the course of disease follow-up. Although OCTA cannot replace fundus angiography completely, it has brought us more information about the pathogenesis, disease progression and prognostic factors of RVO. It is believed that with the progress of technology, OCTA will bring us a new chapter in the study of retinal vascular diseases including RVO.
Retinal vein occlusion (RVO) is one of the most important retinal vascular diseases in China that leads to severe loss of vision. In recent years, the emergence of various emerging imaging technologies and new drugs has not only deepened our understanding of the natural course of this disease, but also significantly changed the traditional treatment mode of retinal laser photocoagulation as the gold standard, thereby significantly improved the visual prognosis. However, currently in various regions and levels of hospitals in China, the diagnosis and treatment of RVO still rely mainly on their own experience. The awareness and knowledge of RVO among ophthalmologists in various regions still need to be improved. A standardized clinical diagnosis and treatment pathway is needed in order to meet the needs of most RVO patients. Led by the Fundus Disease Group of the Ophthalmology Branch of the Chinese Medical Association and the Fundus Disease Professional Committee of the Ophthalmology Branch of the Chinese Medical Association, based on the existing evidence-based evidence at home and abroad, and following the principles of consensus formulation, Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China has been compiled. The consensus systematically and comprehensively elaborated a standardized diagnosis and treatment pathway for RVO. Interpreting the key points in this consensus is helpful to highlight the core ideas, and improve the utilization of this consensus by ophthalmologists from all levels of hospitals.
Retinal vein occlusion (RVO) is the second visual threatening retinal disorders followed by diabetic retinopathy in the elderly. In the past decades, increasing knowledge of the natural history, aetiology and risk factors, medical management investigation, together with the support of high level evidence-based medical evidence and the results of real-world clinical trials play key roles in guiding the clinical practice. However, without understanding the pathogenesis and pathogeny of the disease, it is difficult to implement a comprehensive, precise and personalized treatment strategy for the RVO patients. It is of significance in the clinic to discuss the pathological process of RVO, analyze the etiological characteristics of the disease, reveal the clinical outcomes, which aim to facility the optimal treatment and follow-up procedure for the patients.
ObjectiveTo observe the differences of macular microvascular structure between recurrent and non-recurrent macular edema (ME) secondary to central retinal vein occlusion (CRVO) after intravitreal injection of ranibizumab (IVR), and to preliminarily analyze the correlation between recurrence and ME. MethodsA prospective clinical observational study. Forty-five patients (45 eyes) diagnosed as CRVO with ME were included in this study in Tianjin Medical University Eye Hospital from January 2020 to December 2021. There were 22 males (22 eyes) and 23 females (23 eyes). All cases were unilateral. The average age was 61.11±10.88 years old. All patients received IVR treatment once a month for 3 consecutive months. ME were regressive after the initial three treatments. The patients were divided into recurrent group (21 cases, 21 eyes) and non-recurrent group (24 cases, 24 eyes) based on ME recurrence at 6 months after ME resolution. All patients underwent best corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography angiography (OCTA). OCTA was used to scan the macula in the area of 3 mm×3 mm, and the vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP), fovea and parafovea before and after treatment was measured. Foveal retinal thickness, foveal avascular zone (FAZ) area, perimeter of FAZ (PERIM), avascular index of FAZ (AI), VD within 300 μm width of FAZ range (FD-300). Foveal VD included superficial and deep retinal VD (SFVD, DFVD); parafoveal VD included superficial and deep retinal VD (SPFVD, DPFVD). Taking the initial three treatments as the observation time point, the changes of the parameters of the two groups were compared. Comparison between the recurrent and non-recurrent group was performed by two independent sample t-tests. Receiver operating characteristic (ROC) curve analysis was used to measure the area under the curve (AUC) of VD for predicting the recurrence of ME. ResultsThere were no significant differences in age (t=1.350), IOP (t=1.929), SFVD (t=－1.716), DFVD (t=－1.143), CRT (t=－1.207) and AI (t=1.387) between the recurrent and non-recurrent group (P＞0.05). There were significant differences in times of anti-VEGF therapy (t=5.912), BCVA (t=5.003), SVD (t=－4.617), SPFVD (t=－4.110), DVD (t=－5.503), DPFVD (t=－4.772), FAZ area (t=2.172), PERIM (t=2.606) and FD-300 (t=－3.501) between the recurrent and non-recurrent group (P＜0.05). ROC curve analysis showed that the AUC of DVD in predicting the recurrence of ME was highest, with 0.921, and the threshold was 37.65%. The sensitivity and specificity were 91.7% and 85.7%, respectively. ConclusionsThe SVD, SPFVD, DVD, DPFVD and FD-300 in the recurrence group are significantly lower than those in the non-recurrence group, while the FAZ area and PERIM are significantly higher than those in the non-recurrence group. DVD≤37.65% can be used as the best threshold for predicting the recurrence of ME.