Department of Ophthalmology, "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania.
Oculens Clinic, Cluj Napoca, Romania.
Rom J Ophthalmol. 2023 Jul-Sep;67(3):312-324. doi: 10.22336/rjo.2023.51.
This study aimed to establish possible connections between macular dynamics, various macular features, and visual acuity prognosis among patients with retinal vein occlusions. This study included 85 patients with central retinal vein occlusions (CRVO) and 26 with branch retinal vein occlusions (BRVO). We assessed macular features such as central macular thickness (CMT), foveal intraretinal hemorrhage (IRH), the presence and distribution of hyperreflective foci (HF), ellipsoid zone (EZ) disruption, inner retinal layer disorganization (DRIL), and posterior vitreous detachment (PVD), as well as their dynamics over one year of observation and their impact on final visual acuity prognosis, depending on the type of occlusion. Best corrected visual acuity (BCVA) evolution is statistically significant regarding groups of age and type of occlusion and insignificant regarding gender. The best response to intravitreal treatment, quantified as a decrease in CMT, was registered after the first intravitreal injection. Connecting a decrease in CMT with BCVA improvement, we did not register a statistically significant correlation in the CRVO group, only in BRVO cases. The study results showed that complete PVD plays a significant positive role in decreasing CMT and BCVA improvement in cases of CRVO. Our study revealed that no matter the type of occlusion, the presence of foveal IRH will have a negative impact on the BCVA outcome. Statistically significant differences have been noted only for the evolution of visual acuity in non-ischemic CRVO cases, in correlation with the presence of EZ disruption. Outer retinal layer HF has proved to be a predictive factor for poor visual acuity outcomes. The most important non-imaging predicting factors regarding BCVA after retinal vein occlusions are age and baseline BCVA. CMT's dynamics still establish a weak connection with visual acuity fluctuations. The presence of foveal IRH, outer retinal layer HF, and foveal EZ disruption has a negative impact on visual acuity outcomes. CRVO = central retinal vein occlusions, BRVO = branch retinal vein occlusions, CMT = central macular thickness, IRH = foveal intraretinal hemorrhage, HF = hyperreflective foci, EZ = ellipsoid zone disruption, DRIL = inner retinal layer disorganization, PVD = posterior vitreous detachment, BCVA = best corrected visual acuity, OCT = optical coherence tomography, BCVA Ti = best corrected visual acuity at first, BCVA Tf = best corrected visual acuity after one year, NR of IVI = number of intravitreal injections, SD = standard deviation, M = male, F = female, CMT Ti = central macular thickness at first, CMT T1 = central macular thickness after first injection, CMT T3 = central macular thickness after 3 injections, CMT Tf = central macular thickness after one year.
本研究旨在确定视网膜静脉阻塞患者的黄斑动力学、各种黄斑特征与视力预后之间的可能联系。该研究纳入了 85 例中心性视网膜静脉阻塞（CRVO）患者和 26 例分支性视网膜静脉阻塞（BRVO）患者。我们评估了黄斑特征，如中央视网膜厚度（CMT）、黄斑区视网膜内出血（IRH）、高反射焦点（HF）的存在和分布、椭圆体带（EZ）中断、内视网膜层组织紊乱（DRIL）和玻璃体后脱离（PVD），以及它们在一年观察期内的动态变化及其对最终视力预后的影响，这取决于阻塞的类型。最佳矫正视力（BCVA）的演变在年龄和阻塞类型的分组上具有统计学意义，而在性别上无统计学意义。在第一次玻璃体腔内注射后，CMT 的下降与玻璃体腔内治疗的最佳反应相关，且具有统计学意义。我们没有在 CRVO 组中观察到 CMT 下降与 BCVA 改善之间的统计学显著相关性，而仅在 BRVO 病例中观察到。研究结果表明，完全性 PVD 在 CRVO 病例中对 CMT 降低和 BCVA 改善具有显著的积极作用。我们的研究表明，无论阻塞类型如何，黄斑区 IRH 的存在都会对 BCVA 结果产生负面影响。仅在非缺血性 CRVO 病例中观察到视力演变的统计学显著差异，与 EZ 中断的存在相关。外视网膜层 HF 已被证明是视力预后不良的预测因素。视网膜静脉阻塞后，与 BCVA 相关的最重要的非影像学预测因素是年龄和基线 BCVA。CMT 的动态变化仍然与视力波动有微弱的联系。黄斑区 IRH、外视网膜层 HF 和黄斑区 EZ 中断的存在对视力预后有负面影响。CRVO = 中心性视网膜静脉阻塞，BRVO = 分支性视网膜静脉阻塞，CMT = 中央视网膜厚度，IRH = 黄斑区视网膜内出血，HF = 高反射焦点，EZ = 椭圆体带中断，DRIL = 内视网膜层组织紊乱，PVD = 玻璃体后脱离，BCVA = 最佳矫正视力，OCT = 光学相干断层扫描，BCVA Ti = 首次最佳矫正视力，BCVA Tf = 一年后最佳矫正视力，IVI-NR = 玻璃体腔内注射次数，SD = 标准差，M = 男性，F = 女性，CMT Ti = 首次中央视网膜厚度，CMT T1 = 第一次注射后的中央视网膜厚度，CMT T3 = 第三次注射后的中央视网膜厚度，CMT Tf = 一年后的中央视网膜厚度。
