Battaglia Parodi Maurizio, Iacono Pierluigi, Scaramuzzi Matteo, Bandello Francesco
*Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy; and †G.B. Bietti Foundation for Study and Research in Ophthalmology, IRCCS, Rome, Italy.
Retina. 2017 Oct;37(10):1888-1895. doi: 10.1097/IAE.0000000000001429.
To analyze the outer retinal layer changes on spectral-domain optical coherence tomography after dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusions (CRVO).
Thirty patients affected by macular edema related to CRVO (8 patients less than 50 years of age with nonischemic CRVO [<50-niCRVO], 12 patients more than 50 years with niCRVO [>50-niCRVO], and 10 patients with ischemic CRVO [iCRVO]) were included in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity, fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first implant. Further retreatments were performed on the basis of macular edema detection from the fourth month. Main outcome measure was the change in outer retinal layers at the 12-month examination.
The retinal layers of interest (external limiting membrane; ellipsoid zone; and retinal pigment epithelium) were classified as absent, disrupted, or present. The best baseline optical coherence tomography profile was found in <50-niCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium layers in no patients; present and disrupted external limiting membrane in 25% and 75% of cases, respectively; disrupted ellipsoid zone and retinal pigment epithelium in 100% of cases), whereas the worst was detected in the iCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium in 40%, 40%, and 10% of cases, respectively). A significant recovery of the retinal layers was observed in all CRVO subgroups; the greatest improvement was found in <50-niCRVO group. Median best-corrected visual acuity in the whole group improved from 0.85 to 0.45 (P = 0.0001). It is noteworthy that a significant best-corrected visual acuity gain was achieved only in eyes showing present or disrupted layers at baseline regardless of the CRVO subgroup examined, whereas eyes with absent layers at baseline were unable to attain any improvement.
Dexamethasone implant can promote the resolution of macular edema in patients affected by any CRVO subform, but a beneficial functional outcome could be achieved by eyes showing no absence of outer retinal layers on spectral-domain optical coherence tomography at baseline.
分析地塞米松植入治疗视网膜中央静脉阻塞（CRVO）继发黄斑水肿后，光谱域光学相干断层扫描（SD-OCT）下视网膜外层的变化。
30例CRVO相关黄斑水肿患者纳入前瞻性研究，其中8例年龄小于50岁的非缺血性CRVO患者（<50-niCRVO），12例年龄大于50岁的非缺血性CRVO患者（>50-niCRVO），10例缺血性CRVO患者（iCRVO）。经过包括最佳矫正视力、荧光素血管造影和SD-OCT在内的全面眼科检查后，每位患者接受首次植入。从第4个月开始，根据黄斑水肿检测情况进行进一步治疗。主要观察指标是12个月检查时视网膜外层的变化。
感兴趣的视网膜层（外界膜、椭圆体带和视网膜色素上皮）分为缺失、破坏或存在。<50-niCRVO组的基线光学相干断层扫描图像最佳（无患者外界膜、椭圆体带和视网膜色素上皮层缺失；25%和75%的病例外界膜存在和破坏；100%的病例椭圆体带和视网膜色素上皮破坏），而iCRVO组最差（40%、40%和10%的病例外界膜、椭圆体带和视网膜色素上皮缺失）。所有CRVO亚组均观察到视网膜层的显著恢复；<50-niCRVO组改善最大。全组最佳矫正视力中位数从0.85提高到0.45（P = 0.0001）。值得注意的是，无论所检查的CRVO亚组如何，仅基线时显示存在或破坏层的眼睛最佳矫正视力有显著提高，而基线时层缺失的眼睛无法获得任何改善。
地塞米松植入可促进任何CRVO亚型患者黄斑水肿的消退，但基线时SD-OCT显示视网膜外层无缺失的眼睛可获得有益的功能结果。
