Arrigo Alessandro, Aragona Emanuela, Antropoli Alessio, Bianco Lorenzo, Rosolia Andrea, Saladino Andrea, Bandello Francesco, Battaglia Parodi Maurizio
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
Ophthalmol Ther. 2023 Aug;12(4):2157-2169. doi: 10.1007/s40123-023-00734-9. Epub 2023 Jun 9.
Foveal eversion (FE) is a recently described optical coherence tomography (OCT) finding associated with negative outcome in diabetic macular edema. The main goal of the present study was to investigate the role of the FE metric in the diagnostic workup of retinal vein occlusion (RVO).
This study was a retrospective, observational case series. We included 168 eyes (168 patients) affected by central RVO (CRVO) and 116 eyes (116 patients) affected by branch (RVO). We collected clinical and imaging data from CRVO and BRVO eyes affected by macular edema with a minimum follow-up of 12 months. On structural OCT, we classified FE as pattern 1a, characterized by thick vertical intraretinal columns, pattern 1b, presenting thin vertical intraretinal lines, and pattern 2, showing no signs of vertical lines in the context of the cystoid macular edema. For statistical purposes, we considered data collected at baseline, after 1 year and at the last follow-up.
The mean follow-up was 40 ± 25 months for CRVO eyes and 36 ± 24 months for BRVO eyes. We found FE in 64 of 168 CRVO eyes (38%) and in 25 of 116 BRVO eyes (22%). Most of the eyes developed FE during the follow-up. For CRVO eyes, we found 6 eyes (9%) with pattern 1a, 17 eyes (26%) with pattern 1b and 41 eyes (65%) with pattern 2. Of those BRVO eyes with FE, we found 8 eyes (32%) with pattern 1a + 1b and 17 eyes (68%) with pattern 2. In both CRVO and BRVO the presence of FE was significantly associated with higher persistence of macular edema and worse outcome, with FE pattern 2 representing the most severe condition. Remarkably, FE patterns 1a and 1b were characterized by BCVA stability over the follow-up, whereas FE pattern 2 showed significant bestcorrected visual acuity (BCVA) worsening at the end of the follow-up.
FE can be considered a negative prognostic biomarker in RVO, associated with higher persistence of macular edema and worse visual outcome. Müller cell impairment might represent the pathogenic mechanism leading to the loss of macular structural support and impairment of fluid homeostasis.
黄斑反转（FE）是最近通过光学相干断层扫描（OCT）发现的一种与糖尿病性黄斑水肿不良预后相关的现象。本研究的主要目的是探讨FE指标在视网膜静脉阻塞（RVO）诊断检查中的作用。
本研究为回顾性观察病例系列。我们纳入了168例中心性视网膜静脉阻塞（CRVO）患者的168只眼和116例分支视网膜静脉阻塞（BRVO）患者的116只眼。我们收集了CRVO和BRVO合并黄斑水肿患者的临床和影像学数据，随访时间至少为12个月。在结构性OCT上，我们将FE分为1a型，其特征为视网膜内垂直柱状增厚；1b型，表现为视网膜内垂直细线；2型，在黄斑囊样水肿背景下无垂直线条迹象。为了进行统计学分析，我们考虑了基线、1年后和最后一次随访时收集的数据。
CRVO组患者的平均随访时间为40±25个月，BRVO组为36±24个月。我们在168只CRVO眼中的64只（38%）和116只BRVO眼中的25只（22%）发现了FE。大多数眼睛在随访期间出现了FE。在CRVO眼中，我们发现6只（9%）为1a型，17只（26%）为1b型，41只（65%）为2型。在有FE的BRVO眼中，我们发现8只（32%）为1a + 1b型，17只（68%）为2型。在CRVO和BRVO中，FE的存在均与黄斑水肿的持续时间延长和预后较差显著相关，其中2型FE代表最严重的情况。值得注意的是，1a型和1b型FE的特征是随访期间最佳矫正视力（BCVA）稳定，而2型FE在随访结束时显示BCVA显著恶化。
FE可被视为RVO的不良预后生物标志物，与黄斑水肿的持续时间延长和视力预后较差相关。Müller细胞损伤可能是导致黄斑结构支持丧失和液体稳态受损的致病机制。
