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Jee D, Park S, Kwon JW. Subretinal fluid in macular edema secondary to branch retinal vein occlusion. Sci Rep 2024; 14:13623. [PMID: 38871805 PMCID: PMC11176314 DOI: 10.1038/s41598-024-64047-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024] Open
Abstract
We identified characteristics of patients with subretinal fluid (SRF) in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and determined their clinical outcomes after anti-vascular endothelial growth factor (VEGF) treatment. Fifty-seven eyes of BRVO patients with ME were divided into two groups according to the presence or absence of SRF at diagnosis. We compared the aqueous profiles, ocular and systemic characteristics at baseline, and the clinical outcomes. The SRF group had significantly greater central subfield thickness (CST) values and poorer best-corrected visual acuity (BCVA) at baseline compared to the non-SRF group. The former group had significantly higher aqueous levels of interleukin-8, VEGF, and placental growth factor. CST reduction and BCVA improvement during treatment were significantly greater in the SRF group than in the non-SRF group. Consequently, CST values were significantly lower in the SRF group than in the non-SRF group at 12 months, when BCVA did not differ significantly between the two groups. The SRF group required more frequent anti-VEGF treatment over 12 months and exhibited a higher rate of macular atrophy. Based on the aqueous profiles and the number of treatments required, the presence of SRF in BRVO patients appears to be associated with higher disease activity.
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Affiliation(s)
- Donghyun Jee
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Soyoung Park
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jin-Woo Kwon
- Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Korea.
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Sun G, Wang X, Tian M, Yi Z, Xu A, He L, Zheng H, Chen C. Relationship between ischemic index, leakage index, and macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2024; 262:1499-1506. [PMID: 38147156 DOI: 10.1007/s00417-023-06343-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE To investigate the combined association of the ischemic index and leakage index with macular edema on ultra-widefield fluorescein angiography (UWFFA) in patients with branch retinal vein occlusion (BRVO). METHODS Retrospective image analysis study. The leakage index and ischemic index were calculated using Fiji after aligning early and late UWFFA images. Differences in the ischemic index, leakage index, and central macular thickness (CMT) between ischemic and non-ischemic BRVO were compared. Moreover, the association between the ischemic index, leakage index, and macular edema was analyzed. RESULTS Eighty-three patients with BRVO were enrolled, including 53 non-ischemic BRVO and 30 ischemic BRVO patients. No significant differences were observed in leakage index and CMT between ischemic BRVO and non-ischemic BRVO (all P > 0.05). In all included patients, CMT correlated with the panretina and all subregion leakage indexes (all P < 0.01), but not with the ischemic index (all P > 0.05). In the ischemic BRVO group, CMT showed a correlation with the leakage index in several regions, but not with the ischemic index. After adjusting for the ischemic index and other clinical features, CMT remained significantly correlated with the leakage index in all regions. CONCLUSION The leakage index may be a more effective biomarker for monitoring BRVO-associated macular edema compared to the ischemic index. Further follow-up studies are warranted to validate these findings.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Miao Tian
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Amin Xu
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Lu He
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, 430060, China.
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Sun G, Wang X, Yi Z, He L, Zheng H, Chen C. Distribution of leakage index using ultra-widefield fluorescein angiography in patients with non-ischemic branch retinal vein occlusion and its association with macular edema. Photodiagnosis Photodyn Ther 2023; 43:103731. [PMID: 37549817 DOI: 10.1016/j.pdpdt.2023.103731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/25/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND To investigate the distribution of leakage index in patients with non-ischemic branch retinal vein occlusion (BRVO) and its correlation with the severity of macular edema. METHODS Retrospective observational study. Forty-five eyes of 45 patients with BRVO were included. Late ultra-widefield fluorescein angiography images of the affected eyes were processed and analyzed for their leakage index using Fiji software. The visible panretinal area was further divided into the peri‑macular area (PMA), near-peripheral area (NPA), midperipheral area (MPA), and far-peripheral area (FPA). The relationship between the leakage index and central retinal thickness (CMT) was analyzed for the panretina and each subregion. RESULTS The median (interquartile range) leakage indexes of the panretina, PMA, NPA, MPA, and FPA were 5.532% (7.667%), 23.127% (26.073%), 8.303% (16.807%), 1.588% (6.204%), and 0.408% (2.215%), respectively, with a mean CMT of 552.800 ± 183.335 μm. The CMT was positively correlated with the leakage index in the panretina, PMA, NPA, MPA and FPA (r = 0.468, 0.426, 0.463, 0.447, 0.320, respectively; all p < 0.05). CONCLUSIONS The leakage index in non-ischemic BRVO patients is associated with macular edema severity. The leakage index has the potential to be a useful indicator for monitoring and guiding treatment of macular edema in BRVO patients.
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Affiliation(s)
- Gongpeng Sun
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiaoling Wang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lu He
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, China.
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Tan TE, Ibrahim F, Chandrasekaran PR, Teo KYC. Clinical utility of ultra-widefield fluorescein angiography and optical coherence tomography angiography for retinal vein occlusions. Front Med (Lausanne) 2023; 10:1110166. [PMID: 37359003 PMCID: PMC10285461 DOI: 10.3389/fmed.2023.1110166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Retinal vein occlusions (RVOs) are the second most common retinal vascular disease after diabetic retinopathy, and are a significant cause of visual impairment, especially in the elderly population. RVOs result in visual loss due to macular ischemia, cystoid macular edema (CME), and complications related to neovascularization. Vascular assessment in RVOs traditionally relies on standard fluorescein angiography (FA) for assessment of macular and retinal ischemia, which aids in prognostication and guides intervention. Standard FA has significant limitations-it is time-consuming, requires invasive dye administration, allows for limited assessment of the peripheral retina, and is usually evaluated semi-qualitatively, by ophthalmologists with tertiary expertise. More recently, the introduction of ultra-widefield FA (UWF FA) and optical coherence tomography angiography (OCTA) into clinical practice has changed the tools available for vascular evaluation in RVOs. UWF FA allows for evaluation of peripheral retinal perfusion, and OCTA is non-invasive, rapidly-acquired, and provides more information on capillary perfusion. Both modalities can be used to provide more quantitative parameters related to retinal perfusion. In this article, we review the clinical utility and impact of UWF FA and OCTA in the evaluation and management of patients with RVOs.
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Affiliation(s)
- Tien-En Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Farah Ibrahim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | | | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Deep Capillary Plexus as Biomarker of Peripheral Capillary Nonperfusion in Central Retinal Vein Occlusion. OPHTHALMOLOGY SCIENCE 2023; 3:100267. [PMID: 36824600 PMCID: PMC9941371 DOI: 10.1016/j.xops.2022.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
Purpose To identify the vascular biomarkers of peripheral capillary nonperfusion in patients affected by naive central retinal vein occlusion (CRVO), and to analyze their changes over the follow-up. Study Design Consecutive prospective case series with a planned follow-up of 2 years. Participants Thirty-five patients affected by CRVO and 35 healthy gender- and age-matched subjects were enrolled in the study. Methods Ophthalmic examination included best corrected visual acuity (BCVA), ultrawidefield fluorescein angiography (UWFFA), OCT, and OCT angiography (OCTA). Main Outcome Measures Vessel density (VD) at the superficial capillary plexus and deep capillary plexus (DCP) were calculated on OCTA images. The ischemic index (ISI) was calculated on UWFFA. Results The mean baseline ISI was 37%, increasing to 40% at the end of the follow-up, whereas it was 4.9% in the patients' fellow eyes and 4.5% in the control group with no change over the follow-up. OCT angiography revealed VD reduction in the DCP, considering both 3 × 3 mm and 12 × 12 mm scans. The correlation analyses revealed that DCP VD was the only parameter showing a statistically significant correlation with the foveal avascular zone (FAZ) area, BCVA, and ISI. Conclusions Deep capillary plexus VD impairment is detectable in all CRVO cases, variably involving both the central retina (with enlarged FAZ) and the periphery (with VD reduction in the peripheral retina). The severity of DCP VD reduction has correlates with various clinical markers. Deep capillary plexus VD may represent a crucial biomarker to characterize CRVO, and further studies are necessary to identify the cutoff thresholds for the different clinical manifestations.
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Key Words
- BCVA, best corrected visual acuity
- BRVO, branch retinal vein occlusion
- CMT, central macular thickness
- CNP, capillary non-perfusion
- CRVO, central retinal vein occlusion
- DCP, deep capillary plexus
- Deep capillary plexus
- FA, fluorescein angiography
- FAZ, foveal avascular zone
- ISI, ischemic index
- OCTA
- OCTA, OCT angiography
- RVO, retinal vein occlusion
- Retina
- Retinal vein occlusion
- SCP, superficial capillary plexus
- UWFFA, ultrawidefield fluorescein angiography
- Ultra wide field
- VD, vessel density
- cISI, complete ischemic index
- pISI, partial ischemic index
- tISI, total ischemic index
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Analysis of the Cytokine Expression in the Aqueous Humor of Individuals with BRVO-Associated Macular Edema. J Ophthalmol 2022; 2022:1514244. [PMID: 35967519 PMCID: PMC9371839 DOI: 10.1155/2022/1514244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aimed to determine the expression levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in the aqueous humor of patients with macular edema (ME) caused by branch retinal vein occlusion (BRVO), as well as to investigate the relationship between the cytokines as mentioned earlier and best-corrected visual acuity (BCVA), ME, and the degree of ME from the molecular level. Methods In a prospective observational study, fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were used to classify 58 patients with non-ischemic BRVO-ME into three groups according to the degree of ME: 14-mild, 17-moderate, and 27-severe. The specific concentration of IL-6, VEGF, ICAM-1, and VCAM-1 in the aqueous humor was detected using the BD CSCanto™ II Flow Cytometer (US). Spearman or Pearson correlation analysis was used to test the correlation between the levels of BCVA and severity of ME and the expression levels of IL-6, VEGF, ICAM-1, and VCAM-1 in the aqueous humor. Results According to the obtained data, BCVA did not correlate with the severity of ME, and these four cytokines expression levels in patients' aqueous humor (P > 0.05). Moreover, BCVA did not correlate with mild, moderate, or severe ME as well (P > 0.05). However, the levels of these four cytokines were correlated with the severity of the ME. These underlined cytokines were linked to the mild, moderate, and severe degrees of ME. VEGF was also significantly correlated (r > 0.8, P < 0.0001) with the severity of ME. Conclusions This study suggests that the severity of ME in BRVO-ME patients is significantly correlated with the expression levels of IL-6, VEGF, ICAM-1, and VCAM-1 in the aqueous humor. Lowering the level of disease-associated cytokines may potentially reduce the degree of ME. Therefore, an in-depth study of the levels and the relationship may provide some evidence for the pathogenesis, treatment, and prevention of BRVO-ME.
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Tang Y, Cheng Y, Wang S, Wang Y, Liu P, Wu H. Review: The Development of Risk Factors and Cytokines in Retinal Vein Occlusion. Front Med (Lausanne) 2022; 9:910600. [PMID: 35783660 PMCID: PMC9240302 DOI: 10.3389/fmed.2022.910600] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022] Open
Abstract
Retinal vein occlusion (RVO) is the second most prevalent retinal disease. Despite this, the pathogenic mechanisms and risk factors are not entirely clear. In this article, we review recent publications on the classification, pathogenesis, risk factors, ischemic changes, cytokines, and vital complications of RVO. Risk factors and cytokines are important for exploring the mechanisms and new treatment targets. Furthermore, risk factors are interrelated, making RVO mechanisms more complex. Cytokines act as powerful mediators of pathological conditions, such as inflammation, neovascularization, and macular edema. This review aims to summarize the updated knowledge on risk factors, cytokines of RVO and signaling in order to provide valuable insight on managing the disease.
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Affiliation(s)
- Yi Tang
- Eye Center of Second Hospital, Jilin University, Changchun, China
| | - Yan Cheng
- Eye Center of Second Hospital, Jilin University, Changchun, China
| | - Shuo Wang
- Eye Center of Second Hospital, Jilin University, Changchun, China
| | - Yongjie Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, China
| | - Pengjia Liu
- Australian Institute of Bioengineering and Nanotechnology, University of Queensland, St Lucia, QLD, Australia
| | - Hong Wu
- Eye Center of Second Hospital, Jilin University, Changchun, China
- *Correspondence: Hong Wu
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