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1.
Invest Ophthalmol Vis Sci ; 59(7): 2708-2716, 2018 06 01.
Article in English | MEDLINE | ID: mdl-29860457

ABSTRACT

Purpose: To investigate the changes in the retinal microvasculature during the course of anti-VEGF therapy in eyes with macular edema due to retinal vein occlusion (RVO) and their association with visual outcomes. Methods: The vessel density (VD) and foveal avascular zone (FAZ) area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were quantitatively measured by optical coherence tomography angiography (OCTA) in 48 consecutive eyes with RVO before and 1, 3, 6, 9, and 12 months after anti-VEGF therapy. Anti-VEGF therapy was performed either with ranibizumab or aflibercept following a pro re nata (PRN) regimen. The correlation between post-treatment best-corrected visual acuity (BCVA) and changes in the retinal microvasculature evaluated by OCTA were assessed. Results: The BCVA improved significantly at 12 months (P < 0.001). Better BCVA at 12 months was significantly associated with a better VD in the SCP and DCP both at baseline (R2 = 0.524, P < 0.001 and R2 = 0.457, P < 0.001, respectively) and at 12 months (R2 = 0.521, P < 0.001 and R2 = 0.662, P < 0.001, respectively). Overall, both VD and FAZ did not change significantly during the 12 months. However, the progression of nonperfusion was observed in the SCP in 6 (13%) eyes and in the DCP in 10 (21%) eyes. The number of macular edema recurrence was significantly associated with a decrease in the VD (P = 0.006 [SCP] and P < 0.001 [DCP]) and less visual gain (P = 0.02) after treatment. Conclusions: Anti-VEGF therapy maintains retinal perfusion in most patients with RVO. Preserving retinal perfusion is crucial for better visual outcomes.


Subject(s)
Angiogenesis Inhibitors/therapeutic use , Macular Edema/drug therapy , Microvessels/physiology , Retinal Vein Occlusion/drug therapy , Retinal Vessels/physiology , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Visual Acuity/physiology , Aged , Aged, 80 and over , Female , Humans , Intravitreal Injections , Macular Edema/diagnostic imaging , Macular Edema/etiology , Macular Edema/physiopathology , Male , Microvessels/diagnostic imaging , Middle Aged , Ranibizumab/therapeutic use , Receptors, Vascular Endothelial Growth Factor/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Retinal Vein Occlusion/complications , Retinal Vein Occlusion/diagnostic imaging , Retinal Vein Occlusion/physiopathology , Retinal Vessels/diagnostic imaging , Retrospective Studies , Tomography, Optical Coherence/methods
2.
Retina ; 38(10): 2067-2072, 2018 Oct.
Article in English | MEDLINE | ID: mdl-28902097

ABSTRACT

PURPOSE: To investigate vascular perfusion and foveal avascular zone area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) after intravitreal aflibercept therapy in central retinal vein occlusion eyes and their association with best-corrected visual acuity. METHODS: Thirty-five subjects with central retinal vein occlusion and macular edema were evaluated. After macular edema resolution following intravitreal aflibercept, subjects underwent optical coherence tomography angiography to measure SCP and DCP perfusion and the foveal avascular zone within a 3 × 3-mm area. Correlations between best-corrected visual acuity and optical coherence tomography angiography measurements were examined. RESULTS: After intravitreal aflibercept therapy, mean retinal vascular area was 3.41 ± 0.74 mm in the SCP and 3.25 ± 0.91 mm in the DCP. Foveal avascular zone area was 1.03 ± 1.04 mm in the SCP and 1.78 ± 1.73 mm in the DCP. Improved best-corrected visual acuity was significantly associated with better SCP and DCP perfusion (both P < 0.001) and with smaller SCP and DCP foveal avascular zone areas (both P < 0.001). Additionally, SCP and DCP perfusion were negatively correlated with macular edema before treatment (P < 0.05) and ischemia (determined via pretreatment fluorescein angiography, P < 0.05), and positively correlated with photoreceptor integrity (P < 0.001). CONCLUSION: Patients with better retinal perfusion and less retinal ischemia are associated with better visual outcomes after aflibercept in eyes with central retinal vein occlusion.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Receptors, Vascular Endothelial Growth Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Retinal Vein Occlusion/drug therapy , Retinal Vessels/pathology , Adult , Aged , Aged, 80 and over , Female , Fluorescein Angiography/methods , Humans , Intravitreal Injections , Macular Edema/drug therapy , Male , Microvessels/pathology , Middle Aged , Retinal Vein Occlusion/pathology , Retinal Vein Occlusion/physiopathology , Tomography, Optical Coherence/methods , Visual Acuity/physiology
3.
Invest Ophthalmol Vis Sci ; 58(4): 2087-2094, 2017 04 01.
Article in English | MEDLINE | ID: mdl-28388705

ABSTRACT

Purpose: To investigate microvascular changes in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes with resolved branch retinal vein occlusion (BRVO) and their association with best-corrected visual acuity (BCVA). Methods: Eighty-five eyes (82 consecutive patients) with BRVO after resolution of the macular edema were retrospectively evaluated. All patients underwent optical coherence tomography angiography (OCTA) for assessment of microvascular changes, including capillary telangiectasia, microaneurysm, and disruption of the foveal avascular zone (FAZ). The areas of vascular perfusion and FAZ in the SCP and DCP were quantitatively evaluated. Best-corrected visual acuity was measured on the same day as OCTA examination. The correlation between BCVA and OCTA findings was assessed. Results: In eyes with resolved BRVO, the mean vascular perfusion areas in the SCP and DCP within a 3 × 3-mm area were 3.75 ± 0.49 and 3.80 ± 0.55 mm2, respectively. The mean FAZ areas of the SCP and DCP were 0.57 ± 0.36 and 0.76 ± 0.38 mm2, respectively. Better BCVA was significantly associated with a larger vascular perfusion area in the SCP (P < 0.001) and DCP (P < 0.001), and a smaller FAZ area in the SCP (P = 0.025) and DCP (P = 0.017). Stepwise multiple regression analysis revealed that the vascular perfusion area in the DCP was the most important parameter significantly correlated with BCVA (R2 = 0.33, P < 0.001). Conclusions: Preservation of the deep retinal vasculature is crucial for better visual function in BRVO.


Subject(s)
Fluorescein Angiography/methods , Macula Lutea/pathology , Microvessels/pathology , Retinal Vein Occlusion/diagnosis , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Visual Acuity , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fundus Oculi , Humans , Male , Middle Aged , Retrospective Studies
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