National Institute for Health Research, Moorfields Biomedical Research Centre, London, UK.
The Royal Eye Unit, Kingston Hospital, Kingston, UK.
Eye (Lond). 2022 May;36(5):1086-1093. doi: 10.1038/s41433-021-01553-7. Epub 2021 May 25.
To report, using ultra-widefield angiography (UWFA) the area, distribution, and change in retinal capillary nonperfusion (RCNP) at baseline and 100 weeks in eyes with central retinal vein occlusion (CRVO) receiving anti-VEGF for macula oedema.
Prospective longitudinal multi-centre cohort study. Adults with CRVO treated with anti-VEGF therapy for macular oedema underwent UWFA at baseline and week-100. The area, distribution, and change in total, peripheral and posterior pole RCNP were determined.
Of 153 eyes at baseline, mean area of RCNP was 34.3DA and 12 (7.8%) had ≥75DA RCNP. More than 10DA RCNP was present in the temporal periphery in 75.8% of eyes vs. 10.5% in the nasal periphery. At week-100, mean RCNP was 42.1DA with a median change from baseline of 3.3DA 95% CI [0.4, 7.3]; p < 0.01. Of 146 eyes with ≤10DA of posterior pole RCNP at baseline, 16/146 (11.0%) progressed to >10DA at week-100. These eyes had a median increase in total RCNP of 69.7DA [95% CI 27.2-85.4] vs 0DA [0.0-1.4]; p < 0.001 for those who did not, and two developed neovascular glaucoma. Larger baseline area of RCNP and history of glaucoma were risk factors for posterior pole RCNP developing.
With UWFA, significant baseline RCNP was identified in the majority of CRVO patients, notably in the temporal periphery, but large increases over 100 weeks were uncommon. Development of >10DA posterior pole RCNP is a marker for widespread RCNP and in such cases the risk of anterior segment neovascularisation is not abolished by concomitant anti-VEGF therapy.
利用超广角血管造影（UWFA）报告基线和 100 周时接受抗血管内皮生长因子（VEGF）治疗黄斑水肿的视网膜中央静脉阻塞（CRVO）患者的视网膜毛细血管无灌注（RCNP）的面积、分布和变化。
前瞻性纵向多中心队列研究。接受抗 VEGF 治疗黄斑水肿的 CRVO 成人患者在基线和 100 周时接受 UWFA。确定总 RCNP、周边 RCNP 和后极 RCNP 的面积、分布和变化。
在 153 只基线眼目中，RCNP 的平均面积为 34.3DA，12 只（7.8%）眼有≥75DA 的 RCNP。75.8%的眼在颞侧周边有超过 10DA 的 RCNP，而在鼻侧周边有 10.5%的眼有超过 10DA 的 RCNP。在 100 周时，RCNP 的平均面积为 42.1DA，与基线相比中位数变化为 3.3DA（95%CI[0.4，7.3]）；p<0.01。在基线时后极 RCNP 为≤10DA 的 146 只眼中，有 16/146（11.0%）在 100 周时进展为>10DA。这些眼的总 RCNP 中位数增加了 69.7DA（95%CI[27.2-85.4]），而没有增加的眼为 0DA（0.0-1.4）；p<0.001，其中有 2 只眼发生新生血管性青光眼。较大的基线 RCNP 面积和青光眼病史是后极 RCNP 发展的危险因素。
通过 UWFA，在大多数 CRVO 患者中发现了显著的基线 RCNP，特别是在颞侧周边，但在 100 周内的大量增加并不常见。后极 RCNP 增加>10DA 是广泛 RCNP 的标志物，在这种情况下，前节新生血管化的风险并没有被同时的抗 VEGF 治疗所消除。
