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Quantitative measurement of vascular density and flow using optical coherence tomography angiography (OCTA) in patients with central retinal vein occlusion: Can OCTA help in distinguishing ischemic from non-ischemic type?
摘要： Background: To evaluate microvascular changes and quantitative parameters in patients with central retinal vein occlusion (CRVO) by using optical coherence tomography angiography (OCTA) and finding difference between presumably ischemic and non ischemic CRVO. Methods: Patients with CRVO (31) and healthy control (20) were enrolled in this observational case control study. The OCTA was done for each patient and control subject. In macular area 2 images were taken for each eye (3 × 3 mm and 8 × 8 mm). The images were analyzed at three capillary plexuses (superficial and deep retinal capillary layers and choriocapillaris layer). Results: Thirty-one patients with CRVO (mean age 60.00 ± 13.72 years) and 20 healthy age/gender matched subjects (mean age 54.10 ± 12.33 years) were enrolled in this study (p = 0.095). The mean visual acuity of patients was 0.47 ± 0.54 LogMAR. Eyes with CRVO as compared with fellow eyes and control group showed significant reduction of flow in superficial (1.171 ± 0.262 vs. 1.362 ± 0.285 vs. 1.453 ± 0.105) and deep capillary plexus (1.042 ± 0.402 vs. 1.331 ± 0.315 vs. 1.526 ± 0.123) and choriocapillaris (1.206 ± 0.543 vs. 1.841 ± 0.308 vs. 1.966 ± 0.05) and vascular density in superficial (45.92 ± 4.2 vs. 50.99 ± 4.35 vs. 52.85 ± 2.99) and deep (48.03 ± 4.71 vs. 55.86 ± 3.81 vs. 58.2 ± 2.65) capillary plexuses. Some parameters (flow of both retinal capillary plexuses and parafoveal vascular density in deep plexus) showed significantly reduction in fellow eyes than control group. The parameters including flow [superficial (1.014 ± 0.264 vs. 1.279 ± 0.19) and deep (0.873 ± 0.442 vs. 1.152 ± 0.32) capillary plexuses and choriocapillaris (0.79 ± 0.327 vs. 1.424 ± 0.51)] and vascular density [superficial (44.24 ± 2.13 vs. 46.58 ± 4.13) and deep (45.28 ± 3.5 vs. 49.32 ± 3.94) capillary plexuses] were lower significantly in ischemic type than non ischemic CRVO. The most damaged parameter was flow in deep capillary plexus. The model with smallest Akaike information criterion and Bayesian information criterion was chosen as the best model. For easier calculation, we also calculated the reduced model. By choosing the threshold of 12.6, the formula [3.9 × F1S + 0.8 × F3S] can diagnose the presumably ischemic CRVO from non ischemic type with AUC of 0.84, sensitivity of 100% and specificity of 69%. (F1S: flow in the central 1 mm-radius-circle of superficial plexus and F3S: flow in the central 3 mm-radius-circle of superficial plexus). Conclusion and relevance: In CRVO patients, the OCTA can accurately evaluate changes in microvascular structures. It may help in differentiation ischemic CRVO from non-ischemic CRVO.
关键词： Ischemic,Non-ischemic,Central retinal vein occlusion,Optical coherence tomography angiography
更新于2025-09-23 15:23:52
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Baseline characteristics associated with early visual acuity gains after ranibizumab treatment for retinal vein occlusion
摘要： Background: To identify baseline patient characteristics associated with early clinically significant visual acuity (VA) improvements within 3 months of treatment initiation in ranibizumab-treated patients with retinal vein occlusion (RVO) in the SHORE study. Methods: Post hoc analysis of baseline patient characteristics in the randomized, open-label, vision examiner–masked SHORE phase 4 study that compared monthly versus pro re nata dosing of ranibizumab in patients with branch and central RVO. Patients who enrolled in SHORE fulfilled eligibility criteria per protocol (N = 202). SHORE data were retrospectively analyzed to identify baseline patient characteristics associated with early clinically significant improvements in VA, defined as improvement to a Snellen equivalent of 20/40 or better vision (≥ 69 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) or an increase in best-corrected VA (BCVA) of 15 or more ETDRS letters from baseline within 3 months of treatment initiation. Main outcome measures were BCVA gain of 15 or more ETDRS letters from baseline, Snellen equivalent of 20/40 or better vision, and baseline factors associated with early clinically significant improvement in BCVA. Results: The median time for patients to achieve a BCVA of 20/40 or better was 59 days and the median time for patients to gain 15 or more ETDRS letters was 63 days. Better baseline BCVA (> 50 ETDRS letters/Snellen equivalent ≥ 20/100), greater baseline total macular volume (> 9.99 mm3), and presence of subretinal fluid at baseline were all associated with early improvement to 20/40 or better vision (ETDRS equivalent ≥ 69 letters; P < .0001, P = .02, and P = .03, respectively). Conclusions: This retrospective analysis found that better BCVA, greater total macular volume, and presence of subretinal fluid at baseline were associated with more rapid vision gains. Clinicians may find these helpful when considering the likelihood of achieving early clinically significant VA improvements with ranibizumab in patients with RVO.
关键词： Ranibizumab,Branch retinal vein occlusion,Central retinal vein occlusion,CRVO,BRVO,Retinal vein occlusion,Anti-VEGF,RVO
更新于2025-09-23 15:22:29
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Bevacizumab versus bevacizumab and macular grid photocoagulation for macular edema in eyes with non-ischemic branch retinal vein occlusion: results from a prospective randomized study
摘要： Background The objective of the study was the investigation of the effects of intravitreal bevacizumab (BEV) with or without additional macular grid laser photocoagulation (GRID) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods Prospective, randomized, monocentric study. Thirty-two patients were included. Initially, all eyes in both groups received three monthly injections of BEV, followed by additional injections if re-treatment criteria were met. In the BEV + GRID group, photocoagulation was performed 2 weeks after the first BEV injection and laser re-treatment was allowed. The follow-up was 38 weeks. Main outcome measures were best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Changes of foveal avascular zone (FAZ) and of retinal ischemia, as well as the number of injections were also evaluated. Results Sixteen eyes were randomized into each group. At baseline, BCVA was similar in both groups (BEV + GRID: 20/71; BEV: 20/60; P = 0.51). At 38 weeks, BCVA significantly improved in the two groups (BEV + GRID gain of 9 ± 11.2 letters and 16.25 ± 10.08 letters in the BEV) with no difference between them (P < 0.06). With regard to anatomical findings, initial CRT in BEV + GRID was 496.2 μm ± 138.4 μm and 538.9 μm ± 156.9 μm in BEV (P < 0.1697). At 38 weeks, CRT decreased in both groups significantly, 98.2 μm in the BEV + GRID (P = 0.02) and 141.7 μm in the BEV group (P = 0.01), with no significant difference between groups (P < 0.17). The area of FAZ a significantly increased in both groups (41% (P = 0.04) in BEV + GRID; 35% (P = 0.03) in BEV) during the study and the grade of peripheral ischemia remained unchanged. The mean number of injections was 3.8 (range 3–6) with no significant difference between groups. Conclusions Our data demonstrate a beneficial effect of bevacizumab in ME in eyes with BRVO. A loading phase of three injections led to a significant improvement in vision in both groups, which persisted at week 38. Additional grid laser photocoagulation exhibited no beneficial functional or anatomical effect during the study, nor did it reduce the number of injections. The FAZ area increased significantly in both groups, but overall retinal ischemia did not. Further studies investigating more numerous eyes and longer follow-up are needed to confirm these data.
关键词： Anti-VEGF,Grid laser photocoagulation,Macular edema,Branch retinal vein occlusion,Bevacizumab
更新于2025-09-23 15:22:29
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[IEEE 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) - Honolulu, HI (2018.7.18-2018.7.21)] 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) - Evaluation of a Force-Sensing Handheld Robot for Assisted Retinal Vein Cannulation*
摘要： Approximately 16.4 million people are affected by retinal vein occlusion (RVO) resulting from hyper-coagulability, low blood flow or thrombosis in the central or the branched retinal veins. Most common current treatments for RVO aim to limit the damage. In recent years, an experimental procedure, retinal vein cannulation (RVC) has been studied in animal models as well as human eye models. RVC is a procedure for targeted delivery of a therapeutic agent into the occluded retinal vein for dissolving the thrombi. Although effective treatment has been demonstrated via RVC, performing this procedure manually still remains at the limits of human skills. RVC requires to precisely insert a thin cannula into a delicate thin retinal vein, and to maintain it inside the vein throughout the infusion. The needle-vein interaction forces are too small to sense even by an expert surgeon. In this work, we present an evaluation study of a handheld robotic assistant with a force-sensing microneedle for RVC. The system actively cancels hand tremor, detects venous puncture based on detected tool-tissue forces, and stabilizes the needle after venous puncture for reduced trauma and prolonged infusion. Experiments are performed cannulating the vasculature in fertilized chicken eggs. Results show 100% success in venous puncture detection and significantly reduced cannula position drift via the stabilization aid of the robotic system.
关键词： handheld robotic assistant,retinal vein cannulation,force-sensing microneedle,cannula stabilization,Retinal vein occlusion,venous puncture detection
更新于2025-09-23 15:21:01
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Optical coherence tomography parameters predictive of visual outcome after anti-VEGF therapy for retinal vein occlusion
摘要： Purpose: To determine the optical coherence tomography (OCT) parameters that are predictive of visual outcome after anti-VEGF therapy for a retinal vein occlusion (RVO). Methods: Fifty-seven eyes with macular edema (ME) secondary to a central or branch RVO treated with bevacizumab or ranibizumab were studied. Spectral-domain OCT and microperimetry were performed before, 1, 3, and 6 months after the treatment and at the final visit. Central retinal thickness (CRT), macular volume (MV), integrity of the external limiting membrane (ELM), ellipsoid zone (EZ), and foveal bulge (FB), and photoreceptor outer segment (PROS) length were determined. Results: The mean follow-up period was 17.8±11.5 months. In 46 of the 57 eyes, a resolution of the ME was achieved. The pretreatment CRT and MV, presence of intact ELM, EZ, and FB, and PROS length at the time of ME resolution were significantly correlated with the best-corrected visual acuity and retinal sensitivity at the final visit (P0.050). Multiple regression analyses showed that the pretreatment MV had the highest correlation with the posttreatment best-corrected visual acuity and retinal sensitivity (P0.050). Conclusion: The CRT, MV, ELM, EZ, FB, and PROS length are predictive factors for the visual outcome after anti-VEGF therapy for RVO.
关键词： spectral-domain optical coherence tomography,visual acuity,retinal sensitivity,anti-VEGF therapy,retinal vein occlusion
更新于2025-09-23 15:21:01
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Disorganization of Retinal Inner Layers and Ellipsoid Zone Disruption Predict Visual Outcomes in Central Retinal Vein Occlusion
摘要： To assess the associations and predictive value of spectral-domain (SD) OCT inner and outer retinal structural parameters and visual acuity (VA) outcomes in macular edema (ME) secondary to central retinal vein occlusion (CRVO).
关键词： disorganization of retinal inner layers,visual acuity,ellipsoid zone disruption,macular edema,spectral-domain OCT,central retinal vein occlusion
更新于2025-09-23 15:21:01
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Direct photocoagulation to leakage points to treat chronic macular edema associated with branch retinal vein occlusion: a pilot study
摘要： Background: The aim was to investigate the effect of direct photocoagulation for treating chronic macular edema associated with BRVO. Methods: This study was a noncomparative, pilot interventional case series. We examined the CFT and best-corrected visual acuity over 6 months in patients with BRVO treated with direct photocoagulation. Results: Sixteen eyes of 16 patients had been treated with direct photocoagulation (mean follow-up period, 20.5 months). The mean CFT decreased significantly (P<0.001) between the baseline (465 μm) and the final visit (304 μm). The mean (logarithm of the minimum angle of resolution equivalent) best-corrected visual acuity at the baseline was 0.39 and improved significantly (P<0.001) to 0.20 at the final visit. Conclusion: Direct photocoagulation to leakage points is beneficial for treating chronic macular edema associated with chronic BRVO of longer than 12 months duration.
关键词： macular edema,optical coherence tomography,VEGF,photocoagulation,branch retinal vein occlusion
更新于2025-09-19 17:15:36
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Is there still a role of macular laser treatment in branch retinal vein occlusion in the era of intravitreal injections?
摘要： We aimed to evaluate whether macular laser still has a role in the treatment of macular oedema (MO) caused by branch retinal vein occlusion (BRVO) and provide an overview of recent studies on commonly available treatment options. A literature search was last conducted in PubMed on 26 February 2019, limited to human randomized controlled trials published in English since 2008. Seventeen articles addressing 13 trials were included in this assessment. In trials evaluating intravitreal corticosteroid and macular laser, triamcinolone was non-inferior to laser in regard to visual acuity (VA) and central retinal thickness (CRT) outcomes. Combination treatment of dexamethasone and laser resulted in better VA and lower CRT after 6 months. In trials evaluating vascular endothelial growth factor (VEGF) inhibitors versus macular laser treatment, or sham and rescue laser, better VA and CRT of VEGF inhibition treatment was consistently reported. Results of combination treatment versus VEGF inhibition monotherapy were inconsistent, with four of six studies reporting comparable outcomes and injection burden. Study comparison was affected by considerable differences in study design and inadequate reporting of laser protocol and rescue laser. Studies evaluating angiostatic treatment as monotherapy largely report the use of rescue laser, indicating that some patients would benefit from supplemental laser treatment even in the era of intravitreal therapy. Thus, we suggest further studies on optimal design of combination therapy prioritizing longer follow-up time to sufficiently evaluate the delayed effect of laser.
关键词： vascular endothelial growth factor,branch retinal vein occlusion,review,corticosteroid,macular oedema,randomized controlled trials,macular laser
更新于2025-09-19 17:13:59
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Subthreshold laser therapy for macular oedema from branch retinal vein occlusion: focused review
摘要： Retinal vein occlusion is the second- leading cause of vision loss by retinal vascular disease. Subthreshold micropulse laser therapy (SLT) is safer than conventional laser photocoagulation (CLP), yet existing reviews of its use for branch retinal vein occlusion (BRVO) are limited in scope. A literature search of PubMed, Google Scholar, Embase, Cochrane Library and ClinicalTrials.gov databases was conducted in August 2019 without restriction on language or publication date. Outcomes included changes in macular oedema (ME) and visual acuity (VA), and rates of complications or retreatments. Fourteen studies involving 315–405 eyes diagnosed with BRVO were evaluated. Treatment with SLT is associated with significant and durable reduction of ME and VA as early as 1 month. SLT performs comparably with conventional photocoagulation and intravitreal injections (IVIs) of ranibizumab. Subthreshold laser therapy is safer and as effective as CLP for the treatment of ME associated with BRVO. SLT may be used in combination with anti- VEGF IVIs to enhance improvement in VA and ME resolution.
关键词： macular oedema,visual acuity,intravitreal injections,Retinal vein occlusion,subthreshold micropulse laser therapy
更新于2025-09-19 17:13:59
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PDG31 COST-EFFECTIVENESS OF RANIBIZUMAB VERSUS LASER PHOTOCOAGULATION OR OBSERVATION FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION: FROM CHINESE SOCIETAL PERSPECTIVE
摘要： To evaluate the cost-effectiveness of ranibizumab compared with laser photocoagulation or no treatment (observation) in patients with macular edema secondary to branch retinal vein occlusion (BRVO-ME) and macular edema secondary to central retinal vein occlusion (CRVO-ME), respectively, from the Chinese societal perspective. Methods: A Markov model was constructed to simulate the long-term outcomes and costs of Chinese BRVO-ME and CRVO-ME patients. Model health states were de?ned by increments of 10 letters in best corrected visual acuity (BCVA) ranging from # 25 letters to 86-100 letters, with an extra absorbing state ’death’. Lifetime horizon was used, with a 1-month cycle length. Transition probabilities were calculated from the BLOSSOM clinical trial and CAMELLIA clinical trial. Health state utilities were estimated through literature, and costs were estimated from experts consultation of 6 hospitals in China and published literature. The primary outcomes of the model were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Uncertainty was addressed via univariate and probabilistic sensitivity analyses. Results: For BRVO-ME patients, lifetime costs of ranibizumab and laser photocoagulation were U80,834 and U44,799, respectively; lifetime QALYs gained were 8.95 and 8.31, respectively. Adopting a willingness to pay of U180,000/ QALY (3 times per-capita GDP, 2017 China) as the threshold, ranibizumab was found to be cost-effective compared with laser photocoagulation, with the ICER of U56,303/QALY. For CRVO-ME patients, lifetime costs of ranibizumab and observation were U120,246 and U117,757, respectively; lifetime QALYs gained were 9.48 and 8.93, respectively. Ranibizumab was found to be cost-effective compared with observation, with the ICER of U4,525/QALY. Univariate and probabilistic sensitivity analysis demonstrated the robustness of the results. Conclusions: From Chinese societal perspective, ranibizumab is the cost-effective therapy for both the treatment of BRVO-ME and CRVO-ME when compared to laser photocoagulation and observation, respectively.
关键词： ranibizumab,retinal vein occlusion,cost-effectiveness,macular edema,laser photocoagulation
更新于2025-09-16 10:30:52