Extrafoveal traction in retinal vein occlusion using spectral domain optical coherence tomography

The Use of Inner Retinectomy to Relieve Inner Retinal Foreshortening Causing Retinal Detachment in the Setting of Branch Retinal Vein Occlusion

A 61-year-old Japanese woman presented with impairment of her left vision due to macular schisis secondary to branch retinal vein occlusion. Her left vision was 20/50, and schisis was observed inferotemporally. She underwent phacoemulsification and aspiration, implantation of the intraocular lens, and removal of the epiretinal membrane and internal limiting membrane. Her visual acuity stabilized ~20/50 for two and a half years after the initial surgery. However, she developed macula-involving retinal detachment, and her visual acuity declined to counting fingers. She underwent pars plana vitrectomy and removal of the residual vitreous cortex together with the inner retina within the area of vein occlusion. After the removal of silicone oil and the addition of an encircling buckle, the retina remained attached and visual acuity improved to 20/60 at one year after the final surgery. The combination of rhegmatogenous and tractional detachment in the area of schisis was suspected, and vitrectomy with inner retinectomy was effective.

Surgical Therapy for Macular Edema: What We Have Learned through the Decades

Macular edema is a leading cause of functional visual loss in retinal vascular or ocular inflammatory diseases. Because persistent macular edema can lead to irreversible retinal damage, multi-approached treatment should be considered to achieve complete resolution of macular edema. With an enhanced understanding of its pathophysiology, numerous therapeutic options have been developed for the management of macular edema over the decades. Although medical therapies account for the mainstay of treatment, surgical approaches with vitrectomy can play an important role in the management of macular edema, depending on its mechanism of fluid accumulation. The index review focuses on the efficacy of surgical therapy for macular edema secondary to various ocular diseases including diabetic retinopathy, uveitis, and retinal vein occlusion, and consequently provides the evidences that may expand the knowledge and support the employment of surgical options.

Strategy for the management of macular edema in retinal vein occlusion: the European VitreoRetinal Society macular edema study

Objective. To compare the efficacy of different therapies in the treatment of macular edema associated with retinal vein occlusion (RVO). Design. This is a nonrandomized, multicenter collaborative study. Participants. 86 retina specialists from 29 countries provided clinical information, including choice of treatment and outcome, on 2,603 patients with macular edema including 738 cases of RVO. Methods. Reported data included the type and number of treatments performed, visual acuities, and other clinical and diagnostic findings. Main Outcome Measures. The mean increase in visual acuity and mean number of treatments performed. Results. 358 cases of central retinal vein occlusion (CRVO) and 380 cases of branch retinal vein occlusion (BRVO) were included in this investigation. Taking all RVO cases together, pars plana vitrectomy with internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than other therapies. Those treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injection alone showed the second greatest improvement in vision. Dexamethasone intravitreal implant alone and intravitreal triamcinolone alone both resulted in modest visual gains. Conclusions. In the treatment of macular edema in RVO, vitrectomy with ILM peeling may achieve visual improvement and may be a good option for certain cases. Anti-VEGF injection is the most effective of the nonsurgical treatments.

Branch retinal vein occlusion and vitreovascular traction: a preliminary spectral domain OCT case-control study

OBJECTIVE

Branch retinal vein occlusion (BRVO) typically occurs at an arteriovenous (AV) crossing site. Although the pathogenesis is unclear, vitreovascular traction might have a significant role in some BRVO cases. The purpose of present study was to determine the incidence of vitreoretinal traction at the obstruction site in patients diagnosed with BRVO.

METHODS

In this prospective observational case–control study, 32 consecutive BRVO patients were studied with spectral-domain optical coherence tomography (SD-OCT) to detect the presence of vitreovascular traction or vitreous adherence at the occlusion site.

RESULTS

SD-OCT directed to the occlusion site revealed a vitreovascular traction at this point in eight eyes (25 %). Fourteen eyes (43.75 %) were associated with an adherence of posterior hyaloids without signs of retinal traction, whereas ten eyes (31.25 %) had neither vitreoretinal adherence nor vitreous traction. Regarding either the same vessel segment of the fellow eye, none of the cases revealed vitreovascular traction in the correspondent AV crossing site; 12 cases (37.5 %) presented vitreoretinal adherence; and the remaining 20 cases (62.5 %) showed neither traction nor adhesion. Thus, vitreovascular traction in the occlusion site was significantly associated with BRVO (p = 0.024, chi-squared test). B-scan ultrasonography showed that the posterior vitreous cortex remains more frequently attached in eyes with BRVO compared to unaffected fellow eyes (p = 0.041, chi-squared test).

CONCLUSIONS

A common firm vitreous adhesion at the obstruction site is reported herein, pointing out the possible role of vitreovascular traction in the etiology of some cases of BRVO. Likewise, although not all BRVO cases can be explained by this pathogenic mechanism, an attached posterior vitreous cortex might be a cofactor in the origin of this entity.

Spectral-domain optical coherence tomography in subjects over 60 years of age, and its implications for designing clinical trials

Aims

To study the variability of central retinal thickness (CRT), its concordance to the fellow eye, and the implications for designing future clinical trials using spectral-domain optical coherence tomography (SD-OCT).

Methods

Cross-sectional retrospective analysis of European Genetic Database. 632 eyes of 316 subjects over 60 years of age without macular pathology were examined using SD-OCT.

Results

Mean CRT was 280.22 µm and 281.02 µm for the right and left eyes, respectively. There was a strong concordance for all measured values between right and left eyes. Men had significantly thicker CRT than women. Variation up to 23 µm difference between both eyes was seen. To detect a change of at least 30 µm in CRT, a sample size of 90 or 176 per group is needed for a single-arm or double-arm study, respectively (α=0.05, power=0.80, no loss to follow up, assuming SD in future studies=100 µm).

Conclusions

Clinical trials using CRT as an endpoint are feasible in terms of sample size needed.