Occlusions veineuses rétiniennes

Anti-VEGF reduces inflammatory features in macular edema secondary to retinal vein occlusion

AIM

To investigate the anti-inflammatory effect of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in patients with macular edema secondary to retinal vein occlusion (RVO-ME).

METHODS

Twenty-eight eyes from twenty-eight treatment-naïve patients (14 males and 14 females) with RVO-ME were included in this retrospective study. The retinal vein occlusion (RVO) was comprised of both central retinal vein occlusion (CRVO, n=14) and branch retinal vein occlusion (BRVO, n=14). Intravitreal injection of anti-VEGF reagents were administered monthly for three consecutive months, in which 18 patients were injected with ranibizumab and 10 patients were injected with conbercept. All eyes were imaged with optical coherence tomography angiography (OCTA) at baseline and 1wk after monthly intravitreal anti-VEGF injection. The visual acuity (VA), central macular thickness (CMT), the number of hyperreflective foci (HRF) recognized as an inflammatory sign in OCT images, and non-perfusion area (NPA), were compared before and after anti-VEGF treatments.

RESULTS

The mean interval between baseline and follow-up was 29.4±0.79 (range, 27-48)d. Compared with the baseline, the VA improved (logMAR 1.5±0.1 vs 0.8±0.1, P<0.05) and CMT decreased (460±34.0 µm vs 268.8±12.0 µm, P<0.05), significantly, after anti-VEGF treatment. The number of HRF was decreased significantly (76.5±4.8 vs 47.8±4.3, P<0.05) after anti-VEGF treatment.

CONCLUSION

Anti-VEGF therapy is effective in treating RVO-ME. The mechanisms for the decreased HRF and the reduction of NPA by anti-VEGF therapy merits further exploration.

Retinal and choroidal blood flow variations after an endurance exercise: A real-life pilot study at the Paris Marathon

OBJECTIVES

To collect information about the retinal blood flow variations and other choroidal and retinal parameters during a prolonged effort such as marathon running.

DESIGN

Non-randomized prospective cohort study.

METHODS

Patients were recruited through an information campaign at the Rothschild Foundation Hospital (Paris, France). A first visit (V1) was planned in the month before the marathon. All participants underwent blood pressure measurement, fundus photography, spectral domain-optical coherence tomography (SD-OCT) and OCT-angiography (OCT-A). A second visit (V2) was scheduled within one hour of crossing the finish line. The same tests were repeated, using the same equipment.

RESULTS

Of the 31 runners who were included, 29 finished the marathon and attended V2. At baseline, various ophthalmological abnormalities were found in 45.2% of the 58 eyes, among which almost a third concerned the optic nerve and a quarter the pachychoroid spectrum. A significant decrease in retinal vascular plexus density was found between V1 and V2 (p<0.01). While median macular and retinal nerve fiber layer (RNFL) thicknesses significantly increased after the marathon (p<0.01), median choroidal thickness significantly decreased (p<0.01). Both systolic and diastolic blood pressures significantly decreased (p<0.01 and p=0.021 respectively).

CONCLUSIONS

Prolonged physical effort impacts the structure and vascularization of the retina and the choroid. Hypoxia and dehydration due to such an effort may induce a low ocular blood flow rate resulting in a choroidal thinning, contrasting with a transient subclinical ischemic edema of the inner retina and optic nerve head.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03864380.

Wide-Field Fluorescein Angiography in the Diagnosis and Management of Retinal Vein Occlusion: A Retrospective Single-Center Study

Background

The aim of this retrospective study was to evaluate the role of wide-field fluorescein angiography (WF-FA) in the diagnosis and management of retinal vein occlusion (RVO) at a single center in Poland.

Material/Methods

This study included 106 patients (112 eyes) diagnosed with RVO (102 eyes) or impending RVO (10 eyes) (54% women and 46% men, aged 26 to 86 years). The medical records of the participants were reviewed in search of documentation on ocular and systemic diseases. Results of FA of central and peripheral retina and optical coherence tomography (OCT) scans, which had been used to establish treatment indications, were analyzed. WF-FA was performed with Spectralis HRA+OCT or Optos Tx200.

Results

Actual RVO was found in 102 eyes. Of those cases, 46.1% were CRVO (central retinal vein occlusion), 40.2% branch retinal vein occlusion, 11.8% small tributary vein occlusion, and 1.9% hemispheric retinal vein occlusion. Neovascularization on an optic disc, neovascularization elsewhere, and veno-venous collateral vessels were observed in 32.3%, 17.4%, and 41.2% of the eyes, respectively. Peripheral ischemic zones were present in 59.8% of the eyes, in 20.6% of which, ischemia was not observed in the posterior pole. Dye leaks limited to peripheral vessels, peripheral vascular amputations, and central macular edema in OCT were observed in 17.6%, 43.1%, and 63.7% of the eyes, respectively. Retinal laser photocoagulation was conducted on 73.5% of the eyes.

Conclusions

Decision-making about management of patients with RVO should be done after physical examination and analysis of central and peripheral retina FA. In 20.6% of patients, assessment of the peripheral retina resulted in a change in treatment. The first changes suggestive of progression of thrombotic disease to the ischemic form appeared on the periphery in images from WF-FA.

Assessment of Spontaneous Retinal Arterial Pulsations in Acute Central Retinal Vein Occlusions

Central retinal vein occlusion (CRVO) is a common retinal disease. Recent works mentioned spontaneous retinal arterial pulsations (SRAPs) as a feature of some CRVOs. This is a retrospective study on patients presenting with CRVO who were followed up for at least 6 months. The objective was to identify SRAP in the acute phase of the disease and determine their relationship with patients' characteristics and visual prognosis. A 10-second infrared film centered on the optic disc was recorded within a month of the onset of symptoms, and SRAPs were detected in two-thirds of the cases. Patients with SRAP were significantly younger than those without SRAP. Mean central macular thickness was significantly higher in the absence of SRAP, which was translated into a more severe macular edema; however, this difference faded with time. BCVA tended to be higher in the presence of SRAP at the 6-month follow-up when adjusted to baseline. This study demonstrates that SRAPs are a frequent finding, easily detected by infrared fundus video recording, and associated with a younger age and lesser macular edema.

Intravitreal injection of conbercept combined with retinal photocoagulation on macular edema secondary to branch retinal vein occlusion

Effects of Conbercept combined with retinal photocoagulation on macular edema secondary to branch retinal vein occlusion (BRVO) were investigated. A total of 98 patients (98 eyes) with macular edema secondary to BRVO were collected. The central macular thickness (CMT), incidence rate of complications after treatment and best corrected visual acuity (BCVA) were recorded. Also the factors affecting visual recovery of patients were analyzed. At 1 week, 1 month, 3 months and 6 months after treatment, the BCVA in both groups was significantly superior to that before treatment (P<0.05). In the combination group and laser group, the logarithm of the minimum angle of resolution (logMAR) of BCVA increased from 0.84±0.47 to 0.34±0.10 and from 0.89±0.49 to 0.45±0.14, and CMT declined from 559.5±152.7 to 267.8±19.8 µm and from 570.3±172.6 to 314.7±18.4 µm. It was observed that at 1 week, 1 month, 3 months and 6 months after treatment, the BCVA in combination group was obviously better than that in laser group (P=0.008, P<0.001, P=0.004, P<0.001, respectively), while CMT in combination group was obviously smaller than that in laser group (P=0.009, P=0.002, P<0.001, P<0.001). Conbercept with retinal photocoagulation can effectively improve the visual acuity and reduce the CMT. The visual recovery of patients after treatment is related to the BCVA before treatment, decreased value of CMT at 1 month after treatment and integrity of external limiting membrane (ELM).

[Recurrence of macular edema complicating central retinal vein occlusion: Consider follow-up fluorescein angiography]

PURPOSE

The goal of our study is to highlight, through a series of 4 cases, the importance of retinal fluorescein angiography in monitoring the retinal periphery in retinal vein occlusions, particularly in cases of recurrent macular edema.

OBSERVATIONS

This is a series of 4 patients aged between 50 and 90 years with ischemic central retinal vein occlusions in 2 cases and branch retinal venous occlusions in 2 cases. Fluorescein angiography was performed in two of our patients, and optical coherent tomography in all cases, showing cystoid macular edema with an average macular thickness of 439μm. All patients received a complete etiological assessment and intravitreal anti-VEGF injections with an initially favorable course in all cases. A recurrence with aggravation of the edema compared to the initial appearance was observed in all cases, with a delay varying between 9 and 16 months (mean 11.25 months). Fundus examination revealed an increased number of retinal hemorrhages in each case, with the appearance of cotton wool spots in one case, suggesting ischemic conversion. This was confirmed by performing fluorescein angiography, which revealed large areas of retinal ischemia. Retinal photocogulation of the ischemic areas was thus indicated, along with a second series of intravitreal injections.

CONCLUSION

Macular edema is the principal cause of visual acuity decline in retinal vein occlusions; its prognosis is similar to that of retinal venous occlusions in general, hampered by the possibility of ischemic conversion. The diagnosis of retinal vein occlusion is clinical and does not require angiography. This remains, however, a useful exam to better analyze the retinal periphery as well as for the detection of various modalities during spontaneous progression.

LncRNAs in ocular neovascularizations

The prevalence of eye diseases worldwide is dramatically increasing and represents a major concern in underdeveloped and developed regions. Ocular diseases, previously associated with a higher depression risk, also impose a substantial economic burden on affected families, thus early detection and/or accurate treatment in order to avoid and prevent blindness should be emphasized. Ocular neovascularization (NV), the leading cause of blindness in a variety of eye diseases, is a pathologic process characterized by the formation, proliferation and infiltration of anomalous, tiny and leaky fragile blood vessels within the eye. Genetics have been suspected to play an important role in the occurrence of eye diseases, with the detection of a numbers of specific gene mutations. Long non-coding RNA (lncRNAs) are novel class of regulatory molecules previously associated with various biological processes and diseases, however the nature of the relation and pathways by which they might contribute to the development of corneal, choroidal and retinal NV have not yet been completely elucidated. In this review, we focus on the regulation and characteristics of lncRNAs, summarize results from ocular NV-related studies and discuss the implication of lncRNAs in ocular NV development.

[Retinal vein occlusion in a young patient: Where does intraocular hypertension come from?]

INTRODUCTION

Retinal vein occlusion presents as an acute, painless and unilateral sight loss. We report two cases of retinal vein occlusion (CRVO) in which the etiology was unusual.

CASE REPORTS

Case 1. A 54-year-old woman without any significant past medical history presented with an acute loss of vision. Medical history taking revealed the practice of yoga with headstand posture like "Sirsana". Case 2. A 35-year-old woman presented with an acute loss of vision related to a retinal vein occlusion. The investigation found prolonged and repeated vomiting the days before the retinal vein occlusion.

CONCLUSION

Cardiovascular assessment is recommended in the investigation of CRVO. Furthermore, especially in young patients, a situation causing an increase of intraocular pressure as the practice of yoga with taking reverse "head down" body positions or even repeated vomiting efforts may be the cause of slower circulation of blood flow in the retinal veins.