Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
Japan Clinical Retina Study Group (J-CREST Group), Kagoshima, Japan.
Br J Ophthalmol. 2021 May;105(5):704-710. doi: 10.1136/bjophthalmol-2020-316214. Epub 2020 Jul 3.
To examine the choroidal change accompanying retinal vein occlusion (RVO) in detail, we measured changes in choroidal structure after intravitreal aflibercept (IVA) injections for RVO using binarisation of enhanced depth imaging optical coherence tomographic (EDI-OCT) images and assessed associations with clinical outcome.
Retrospective, observational case series. Forty treatment-naïve patients (10 central, 18 major branch and 12 macular branch RVO) were examined by EDI-OCT before and 1, 3 and 6 months after IVA injections. EDI-OCT images were binarised using ImageJ. Subfoveal cross-sectional areas of the luminal, stromal and total choroid over a 1500 µm span were measured and the stromal area to total choroidal area (S/C) ratio was calculated.
Compared to normal contralateral eyes, afflicted eyes at baseline exhibited significantly greater stromal area (p<0.001), total choroidal area (p=0.001) and S/C ratio (p<0.001), but no difference in luminal area (p=0.083). The stromal area, S/C ratio and total choroidal area were significantly reduced in afflicted eyes at 1, 3 and 6 months after IVA (all p<0.006). Baseline S/C ratio was significantly correlated with baseline visual acuity (VA), baseline central retinal thickness (CRT) and VA and CRT improvement at 1, 3 and 6 months post-treatment even after adjusting for the axial length, age and sex (all p<0.012).
RVO induces substantial oedema of the choroidal stromal area that is detectable by binarisation of EDI-OCT images. This stromal oedema likely stems from high intraocular vascular endothelial growth factor levels. Changes in choroidal structure may be used to assess severity and prognosis of RVO.
详细检查视网膜静脉阻塞（RVO）伴发的脉络膜变化，我们通过对增强深度成像光学相干断层扫描（EDI-OCT）图像进行二值化处理，测量 RVO 患者玻璃体内注射阿柏西普（IVA）后脉络膜结构的变化，并评估其与临床结果的相关性。
回顾性、观察性病例系列研究。40 例未经治疗的患者（10 例中央型、18 例大支型和 12 例黄斑支型 RVO）在接受 IVA 注射前和 1、3、6 个月后接受 EDI-OCT 检查。使用 ImageJ 对 EDI-OCT 图像进行二值化处理。测量 1500μm 跨度内脉络膜腔、基质和总脉络膜的横截面面积，并计算基质面积与总脉络膜面积（S/C）比值。
与正常对侧眼相比，患病眼在基线时表现出明显更大的基质面积（p<0.001）、总脉络膜面积（p=0.001）和 S/C 比值（p<0.001），但在腔面积上没有差异（p=0.083）。在接受 IVA 治疗后 1、3 和 6 个月，患病眼的基质面积、S/C 比值和总脉络膜面积均显著降低（均 p<0.006）。基线 S/C 比值与基线视力（VA）、基线中央视网膜厚度（CRT）以及治疗后 1、3 和 6 个月 VA 和 CRT 的改善显著相关，即使在校正眼轴长度、年龄和性别后也是如此（均 p<0.012）。
RVO 引起脉络膜基质区明显水肿，可通过 EDI-OCT 图像二值化检测到。这种基质水肿可能源于眼内高血管内皮生长因子水平。脉络膜结构的变化可用于评估 RVO 的严重程度和预后。
