Journal
RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES
Volume 34, Issue 9, Pages 1736-1742Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/IAE.0000000000000148
Keywords
retinal vein occlusion; peripheral retinal nonperfusion; ischemic index; visual acuity; macular edema
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Funding
- NIH [EY03040]
- NEI [R01 EY014375]
- National Healthcare Group Clinician Scientist Career Scheme Grant [CSCS/12005]
- Optos
- Carl Zeiss Meditec
- Optovue Inc
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Purpose: To evaluate the extent of peripheral retinal nonperfusion in retinal vein occlusion and to determine its effect on the severity of macular edema and response to treatment. Methods: This prospective clinic-based cohort study included 32 consecutive patients with retinal vein occlusion and refractory macular edema evaluated using spectral domain optical coherence tomography and wide-field fluorescein angiography. Areas of ischemia were calculated as a percentage of the total visible retina (ischemic index), which was evaluated when macular edema was present (foveal central subfield >300 mu m) and when edema had resolved (foveal central subfield <= 300 mu m). Ischemic index was the main outcome measure. Results: The mean ischemic index at study enrollment was 14.8% and was larger when macular edema was present compared with when edema had resolved (14.8 vs. 10.3%, P < 0.001). Compared with those with less nonperfusion, patients with ischemic index >10% had thicker mean foveal central subfield on optical coherence tomography (520.8 vs. 424.5 mu m, P = 0.029) and worse visual acuity (56.3 vs. 59 letters) with the presence of macular edema and experienced greater decrease in optical coherence tomography (296.1 vs. 165.3 mu m, P = 0.019) and gain in visual acuity (12.4 vs. 0.9 letters, P = 0.036) in response to treatment. Conclusion: The area of peripheral retinal nonperfusion is variable in patients with retinal vein occlusion and affects its clinical course and response to treatment.
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