Perimetric sensitivity and retinal thickness in eyes with macular edema resulting from branch retinal vein occlusion

Radiation effects on retinal layers revealed by OCT, OCT-A, and perimetry as a function of dose and time from treatment

Optical coherence tomography (OCT) has become a key method for diagnosing and staging radiation retinopathy, based mainly on the presence of fluid in the central macula. A robust retinal layer segmentation method is required for identification of the specific layers involved in radiation-induced pathology in individual eyes over time, in order to determine damage driven by radiation injury to the microvessels and to the inner retinal neurons. Here, we utilized OCT, OCT-angiography, visual field testing, and patient-specific dosimetry models to analyze abnormal retinal layer thickening and thinning relative to microvessel density, visual function, radiation dose, and time from radiotherapy in a cross-sectional cohort of uveal melanoma patients treated with 125I-plaque brachytherapy. Within the first 24 months of radiotherapy, we show differential thickening and thinning of the two inner retinal layers, suggestive of microvessel leakage and neurodegeneration, mostly favoring thickening. Four out of 13 eyes showed decreased inner retinal capillary density associated with a corresponding normal inner retinal thickness, indicating early microvascular pathology. Two eyes showed the opposite: significant inner retinal layer thinning and normal capillary density, indicating early neuronal damage preceding a decrease in capillary density. At later time points, inner retinal thinning becomes the dominant pathology and correlates significantly with decreased vascularity, vision loss, and dose to the optic nerve. Stable multiple retinal layer segmentation provided by 3D graph-based methods aids in assessing the microvascular and neuronal response to radiation, information needed to target therapeutics for radiation retinopathy and vision loss.

Comparison between blue-on-yellow and white-on-white perimetry in patients with branch retinal vein occlusion

This study aimed to compare blue-on-yellow (B/Y) perimetry with white-on-white (W/W) perimetry in eyes with branch retinal vein occlusion (BRVO). The following measurements were performed in 29 eyes of 29 patients with resolved BRVO: W/W and B/Y perimetries using 10-2 test grid, retinal volume (RV) using optical coherence tomography (OCT), and vessel densities (VD) of the superficial capillary layer (VDs) and deep capillary layer (VDd) using OCT angiography (OCTA). First, the difference in the retinal sensitivity (RS) between BRVO-affected and unaffected areas was compared between RS_B/Y and RS_W/W in the parafoveal and extrafoveal areas. Moreover, the structure–function relationship between vessel density and RS was compared between B/Y and W/W perimetries (RS_B/Y and RS_W/W, respectively). The difference in RS between BRVO-affected and unaffected areas was significantly larger with RS_B/Y than with RS_W/W in both the parafoveal and extrafoveal areas. In the parafoveal area, VDs, VDd, and RV were significantly correlated with both RS_W/W and RS_B/Y. In contrast, in the extrafoveal area, only VDd was included in the optimal models. Our findings suggest that RS_B/Y more strongly reflects the anatomical structure and BRVO-affected area.

The usefulness of the retinal sensitivity measurement with a microperimetry for predicting the visual prognosis of branch retinal vein occlusion with macular edema

Purpose

To evaluate the usefulness of the retinal sensitivity in branch retinal vein occlusion (BVO) with macular edema (ME) following the anti-vascular endothelial growth factor (anti-VEGF) treatment.

Methods

Best-corrected visual acuity (BCVA), microperimetry, and optical coherence tomography (OCT) measurements were carried out in 20 patients with BVO with ME, at baseline and 1 month after the anti-VEGF treatment. The relationships among BCVA, mean retinal sensitivity (MS), macular volume (MV), central retinal thickness (CRT), integrity of ellipsoid zone (EZ), mean retinal sensitivity in the most affected quadrant (qMS), and macular volume in the most affected quadrant (qMV) were investigated. In addition, the relationships among the change in BCVA at 1 month (ΔBCVA1m), mean sensitivity in the most affected quadrant at 1 month (ΔqMS1m), MV in the most affected quadrant at 1 month (ΔqMV1m), and CRT at 1 month (ΔCRT1m) were analyzed. The optimal model for BCVA at 3 months after the treatment (BCVA3m) was identified.

Results

There was not a significant difference in BCVA (paired Wilcoxon test, p = 0.058) between at baseline and after the treatment, but there were significant differences in MS, MV, CRT, qMS, and qMV (p < 0.05). There was a significant relationship between ΔqMS1m and ΔMV1m, ΔCRT1m, and ΔqMV1m, respectively. ΔMS1m or ΔqMS1m and BCVA at baseline and ΔBCVA1m were selected as explanatory variables in the optimal model for BCVA3m.

Conclusion

Retinal sensitivity was related to retinal structure, whereas this was not the case with BCVA. In addition, retinal sensitivity was useful to predict BCVA after anti-VEGF therapy.

Combined Nonmydriatic Spectral-Domain Optical Coherence Tomography and Nonmydriatic Fundus Photography for the Detection of Age-Related Macular Degeneration Changes

BACKGROUND AND OBJECTIVE

Nonmydriatic fundus photography (FP) has been a suboptimal tool for detecting age-related macular degeneration (AMD) changes. This study sought to enhance the detection of AMD changes by combining nonmydriatic FP with nonmydriatic spectral-domain optical coherence tomography (SD-OCT).

PATIENTS AND METHODS

The study population included 249 patients aged 65 years and older who were assessed for AMD changes using standard mydriatic biomicroscopic fundus examination. Each eye then underwent nonmydriatic FP in one session followed 1 week later with nonmydriatic FP coupled with nonmydriatic SD-OCT. Images were interpreted for detection of AMD changes, and findings were compared to the original mydriatic biomicroscopic examination.

RESULTS

Nonmydriatic FP had 64% sensitivity, 97% specificity, and a kappa value of 0.67 in detecting AMD changes compared with the traditional mydriatic biomicroscopic examination. Combined nonmydriatic FP and nonmydriatic SD-OCT increased sensitivity to 91.5%, specificity to 98.6%, and kappa to 0.91.

CONCLUSION

The addition of nonmydriatic SD-OCT to nonmydriatic FP enhances the detection of AMD changes.

Foveal sensitivity and visual acuity in macular thickening disorders

PURPOSE

To study the relationship between foveal sensitivity and visual acuity in eyes with macular disorders exhibiting macular thickening.

METHODS

We studied the relationship between foveal sensitivity, obtained as the "foveal threshold" by use of Humphrey perimetry, and best-corrected visual acuity, converted to the logarithm of the minimum angle of resolution (logMAR), for 117 eyes with epiretinal membrane (ERM), 197 eyes with retinal vein occlusion associated with macular edema (RVOME), and 158 eyes with central serous chorioretinopathy (CSC).

RESULTS

Foveal sensitivity and logMAR correlated significantly for the eyes with ERM, RVOME, and CSC. Although mean foveal sensitivity was no different among the three diseases, mean logMAR was lower in eyes with CSC, i.e., visual acuity was better, than in those with ERM or RVOME (P < 0.001).

CONCLUSIONS

Light sense (foveal sensitivity) is related to spatial resolution (logMAR) at the center of the fovea, in eyes with ERM, RVOME, and CSC at different strengths depending on the disease. Less pronounced reduction of visual acuity compared with foveal sensitivity in eyes with CSC could explain the tendency of these patients to complain of dimness rather than acuity loss.

Influence of ischemia on visual function in patients with branch retinal vein occlusion and macular edema

Visual function and retinal morphology were investigated to elucidate the influence of ischemia in patients with branch retinal vein occlusion (BRVO) and macular edema. In 41 consecutive patients with BRVO aged 68.9 ± 10.0 years (22 women and 19 men), the area of capillary nonperfusion was measured by fluorescein angiography. Retinal thickness and retinal volume were measured by optical coherence tomography, and mean retinal sensitivity was calculated for each of 9 macular subfields. Mean visual acuity and macular sensitivity within the central subfield were not significantly correlated with the nonperfused area. However, the macular sensitivity within the central 5 subfields and all 9 subfields showed significant negative correlations with the nonperfused area. Also, macular thickness and volume within all 9 subfields were significantly correlated with the nonperfused area. In conclusion, evaluation of both the fovea and the entire macular region may be important in patients with ischemic BRVO.

Visual prognosis and vitreous molecules after vitrectomy for macular edema with branch retinal vein occlusion

This study investigated whether vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor (PEDF) influence the visual prognosis of patients with macular edema and branch retinal vein occlusion (BRVO). In 47 consecutive patients (47 eyes) undergoing vitrectomy, retinal thickness was examined by optical coherence tomography. Best-corrected visual acuity and the vitreous fluid levels of VEGF, sICAM-1, and PEDF were also determined. Patients were followed for at least 6 months after surgery. Vitreous fluid levels of VEGF and sICAM-1 were significantly lower in the patients with more marked improvement of visual acuity after vitrectomy, while PEDF was significantly higher. VEGF and sICAM-1 levels were significantly higher in patients with greater postoperative improvement of macular edema, while PEDF was significantly lower. In BRVO patients, vitreous fluid levels of VEGF, sICAM-1, and PEDF may influence both the response of macular edema to vitrectomy and the visual prognosis.

Influence of macular microcirculation and retinal thickness on visual acuity in patients with branch retinal vein occlusion and macular edema

PURPOSE

To investigate perifoveal capillary blood flow velocity and retinal thickness at the central fovea in patients with branch retinal vein occlusion (BRVO) and macular edema and to assess their relation with visual acuity and visual prognosis.

METHODS

Eighteen patients with BRVO and 16 healthy volunteers were compared. Perifoveal capillary blood flow velocity was measured on fluorescein angiograms with a scanning laser ophthalmoscope by the tracing method. Retinal thickness was measured at the central fovea by optical coherence tomography. Best-corrected visual acuity (BCVA) was determined.

RESULTS

BCVA differed significantly between patients and controls (P < 0.0001). Among patients, BCVA was negatively correlated with perifoveal capillary blood flow velocity by univariate analysis (r = -0.7916, P < 0.0001), and positively correlated with retinal thickness at the central fovea (r = 0.8970, P < 0.0001). Multivariate analysis showed that retinal thickness at the central fovea was the only independent determinant of BCVA (P < 0.0001).

CONCLUSIONS

In patients with BRVO, BCVA was more strongly influenced by retinal thickness at the central fovea than by perifoveal capillary blood flow velocity.

Visual acuity and foveal thickness after vitrectomy for macular edema associated with branch retinal vein occlusion: a case series

Background

The mechanism by which vitrectomy improves macular edema in patients with branch retinal vein occlusion remains unclear, although intraocular levels of vascular endothelial growth factor have been suggested to influence the visual prognosis and macular edema.

Methods

A series of 54 consecutive patients (54 eyes) with branch retinal vein occlusion was studied prospectively. All patients underwent pars plana vitrectomy for treatment of macular edema. Best corrected visual acuity and retinal thickness (examined by optical coherence tomography) were assessed before and after surgery. The level of vascular endothelial growth factor in vitreous fluid harvested at operation was determined. Patients were followed for at least 6 months postoperatively.

Results

Both the visual acuity and the retinal thickness showed significant improvement at 6 months postoperatively (P = 0.0002 and P < 0.0001, respectively). The vitreous level of vascular endothelial growth factor was significantly higher in patients who showed less improvement of visual acuity compared with those who had a better visual prognosis (p = 0.0135). In contrast, a high vitreous level of vascular endothelial growth factor was associated with greater improvement of macular edema (p = 0.0064).

Conclusions

These results suggest that the vitreous level of vascular endothelial growth factor might influence the visual prognosis and the response of macular edema to vitrectomy in patients with branch retinal vein occlusion.

Perimetric sensitivity with the micro perimeter 1 and retinal thickness in patients with branch retinal vein occlusion

PURPOSE

To evaluate the relationship between retinal sensitivity and thickness of the macular edema associated with branch retinal vein occlusion (BRVO).

DESIGN

Prospective case series.

METHODS

We prospectively examined 15 eyes of 15 patients with macular edema associated with BRVO. In each patient, retinal sensitivity in the macular area was examined with the Micro Perimeter 1 (MP-1); retinal thickness was measured by optical coherence tomography (OCT). Eyes with marked retinal hemorrhage or macular nonperfusion were excluded from the current study.

RESULTS

Retinal sensitivity measured with the MP-1 was significantly correlated with retinal thickness in the fovea (R(2) = 0.460) and in all extrafoveal regions (R(2) = 0.383 to 0.794). In four eyes treated with triamcinolone acetonide, retinal sensitivity showed marked improvement in parallel with the reduction of the macular edema.

CONCLUSIONS

Retinal sensitivity in the macular area correlates linearly and negatively with increased retinal thickness in eyes with BRVO.

Optical coherence tomography of branch retinal vein occlusion

PURPOSE

To evaluate the incidence of serous retinal detachment (SRD) secondary to a branch retinal vein occlusion (BRVO) by using optical coherence tomography (OCT).

METHODS

Fourteen eyes of 14 patients with a BRVO underwent a detailed history, ophthalmoscopic examination, and fluorescein angiographic evaluation. They were also studied with OCT.

RESULTS

The 14 patients included eight women and six men with a mean age of 73.6 +/- 10.5 years (range, 55-90 years). Four eyes were found to have cystoid macular edema by fluorescein angiography, whereas 10 cases were detected by OCT. SRD involving any portion of the macula was found in 10 (71.4%) of the 14 eyes, and SRD extending into the fovea was found in six (42.9%) eyes. Two (14.3%) of the 14 patients also showed a subfoveal hemorrhage that appeared to have gravitated inferiorly through the SRD to the dependent portion of the detachment.

CONCLUSIONS

That few patients with SRD secondary to a BRVO discovered by ophthalmoscopy have been reported in the literature would suggest that this is an uncommon complication. The authors found with OCT that SRD commonly occurs in BRVO. In addition, subretinal hemorrhage may occur in the context of BRVO, and the authors propose that blood gravitates through the subretinal fluid to settle behind the retina.