Deep learning segmentation of non-perfusion area from color fundus images and AI-generated fluorescein angiography.

The non-perfusion area (NPA) of the retina is an important indicator in the visual prognosis of patients with branch retinal vein occlusion (BRVO). However, the current evaluation method of NPA, fluorescein angiography (FA), is invasive and burdensome. In this study, we examined the use of deep learning models for detecting NPA in color fundus images, bypassing the need for FA, and we also investigated the utility of synthetic FA generated from color fundus images. The models were evaluated using the Dice score and Monte Carlo dropout uncertainty. We retrospectively collected 403 sets of color fundus and FA images from 319 BRVO patients. We trained three deep learning models on FA, color fundus images, and synthetic FA. As a result, though the FA model achieved the highest score, the other two models also performed comparably. We found no statistical significance in median Dice scores between the models. However, the color fundus model showed significantly higher uncertainty than the other models (p < 0.05). In conclusion, deep learning models can detect NPAs from color fundus images with reasonable accuracy, though with somewhat less prediction stability. Synthetic FA stabilizes the prediction and reduces misleading uncertainty estimates by enhancing image quality.

Simultaneous Branch Retinal Artery and Central Retinal Vein Occlusion Improved with No Ocular Therapy: A Case Report.

A rarely described condition known as branch retinal artery occlusion (BRAO) with concurrent obstruction of the central retinal vein (CRVO) is characterized by diffuse retinal hemorrhages, dilated and tortuous retinal veins, macular and disc edema, cotton wool spots, and a generalized delay in arteriovenous transit on fluorescein angiography, together with a retinal whitening in the area of the affected retinal arterial branch. Although BRAO and CRVO may share underlying systemic risk factors, the pathogenesis of combined BRAO + CRVO is still unknown. We present a BRAO + CRVO case report concerning a 63-year-old white male who came to our observation complaining of sudden vision loss in his right eye. An increased risk for thrombotic event was revealed in this case, and the patient improved only with systemic anticoagulant therapy and in the absence of ocular therapy. We also explain all the clinical findings that are detectable using different diagnostic devices and analyze the scientific literature for other, similar clinical cases.

Alteration of perivascular reflectivity on optical coherence tomography of branched retinal vein obstruction.

This study aimed to evaluate perivascular reflectivity in patients with branched retinal vascular obstruction (BRVO) using en-face optical coherence tomography (OCT). The study retrospectively analyzed 45 patients with recurrent BRVO, 30 with indolent BRVO, and 45 age- and sex-matched controls. Using a 3.0 × 3.0-mm deep capillary plexus slab on macular scans, OCT angiography (OCTA) and structural en-face OCT scans were divided into four quadrants. Obstructive quadrants of OCTA scans were binarized using a threshold value of mean + 2 standard deviation. The selected area of high signal strength (HSS) was applied to the structural en-face OCT scans, and the corrected mean perivascular reflectivity was calculated as the mean reflectivity on the HSS area/overall en-face OCT mean reflectivity. The same procedure was performed in the quadrants of the matched controls. Regression analysis was conducted on several factors possibly associated with corrected perivascular reflectivity. The perivascular reflectivity in the obstructive BRVO quadrant was significantly higher than in the indolent BRVO and control quadrants (P = 0.009, P = 0.003). Both univariate and multivariate regression analyses showed a significant correlation between the average number of intravitreal injections (anti-vascular endothelial growth factor or dexamethasone implant) per year and refractive errors and image binarization threshold and perivascular reflectivity (P = 0.011, 0.013, < 0.001/univariate; 0.007, 0.041, 0.005/multivariate, respectively). En-face OCT scans of the deep capillary plexus slab revealed higher perivascular reflectivity in recurrent BRVO eyes than in indolent BRVO and control eyes. The results also indicate a remarkable correlation between perivascular reflectivity and the average number of intravitreal injections, suggesting a link to recurrence rates.

High Variation in Inner Retinal Reflectivity Predicts Poor Visual Outcome in Patients With Central Retinal Vein Occlusion: SCORE2 Report 21.

Purpose: To assess the association of a novel spectral domain optical coherence tomography biomarker with 6-month visual acuity in in the Study of COmparative Treatments for REtinal Vein Occlusion 2. Methods: Spectral domain optical coherence tomography volume scans were evaluated for inner retinal hyperreflectivity, quantified by optical intensity ratio (OIR) and OIR variation. Baseline visual acuity letter score (VALS), baseline OCT biomarkers, and month 1 OIR were correlated with VALS at month 6. Regression trees, a machine learning technique yielding readily interpretable models, were used to assess for variable interaction. Results: Only baseline VALS correlated positively with month 6 VALS in multivariate regression. Regression trees detected a novel functional and anatomical interaction in a subgroup. Among patients with a baseline VALS worse than 43, those with an OIR variation at month 1 of more than 0.09 had a mean of 13 fewer letters of vision at 6 months compared with patients with an OIR variation of 0.09 or less. Conclusions: Baseline VALS was the strongest predictor of month 6 VALS. Regression tree analysis detected an interaction effect, in which higher OIR variation at month 1 predicted worse 6-month VALS in patients with low VALS at baseline. OIR variation may serve as a predictor for poor visual outcome despite treatment of macular edema secondary to retinal vein occlusion in patients with poor vision at baseline. Translational Relevance: Pixel heterogeneity in three-dimensional OCT data may serve as measure of disruption of the retinal laminations, and this factor may carry visually prognostic value.

Long-term changes in the choroidal thickness in patients with unilateral central retinal vein occlusion.

The purpose of this study was to investigate the long-term changes in the choroidal thickness in central retinal vein occlusion (CRVO) following anti-vascular endothelial growth factor (VEGF) treatment. This retrospective study included 41 eyes from 41 patients with treatment-naïve unilateral CRVO. We compared the best-corrected visual acuity (BCVA), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT) of CRVO eyes with those of fellow eyes at baseline, 12 months, and 24 months. Baseline SFCT was significantly higher in CRVO eyes than in fellow eyes (p < 0.001); however, there was no significant difference in the SFCT between CRVO eyes and fellow eyes at 12 months and 24 months. When compared with baseline SFCT, SFCT significantly decreased at 12 months and 24 months in CRVO eyes (all p < 0.001). In patients with unilateral CRVO, SFCT in the CRVO eye was significantly thicker than in the fellow eye at baseline, and after 12 months and 24 months, there was no difference from the fellow eye.

Quadrant Asymmetry in Optical Coherence Tomography Angiography Metrics in Ischemic Versus Non-Ischemic Central Retinal Vein Occlusion Eyes.

Purpose: To determine whether quadrant asymmetry (QA) of optical coherence tomography angiography (OCTA) metrics differs between non-ischemic versus ischemic central retinal vein occlusion (CRVO). Methods: Fifty-eight eyes (21 non-ischemic, 10 ischemic CRVO, and 27 contralateral control eyes) underwent 3 × 3 mm spectral-domain OCTA scans with quantification of the superficial retinal layer vessel length density (VLD) and perfusion density (PD). QA, defined as the maximum-minus-minimum value among four parafoveal Early Treatment Diabetic Retinopathy Study (ETDRS) quadrants, was compared by linear regression including fixed effects for each eye. Results: Mean age was 73.6 ± 11.4 (range 39-88), 73.8 ± 12.4 (range 39-91) and 77.2 ± 9.83, (range 60-88); and QA was 3.46 ± 1.76, 3.14 ± 1.57, and 4.88 ± 2.42 for VLD and 0.072 ± 0.038, 0.062 ± 0.036, and 0.11 ± 0.056 for PD for control, non-ischemic, and ischemic, respectively. QA was significantly higher in ischemic (0.109 ± 0.056) than non-ischemic CRVO eyes (0.062 ± 0.036; P = 0.02) and control eyes for PD (0.072 ± 0.038; P = 0.03). QA was also greater in ischemic (4.875 ± 2.418) than non-ischemic CRVO (3.141 ± 1.572) for VLD (P = 0.04). In terms of identifying which particular quadrant is most affected by ischemia, multivariate regression analysis comparing intra-quadrant effect on the presence of ischemia versus non-ischemia showed no quadrant was significantly affected (P > 0.05 for all quadrants). Conclusions: Ischemic CRVO increases intraeye QA of OCTA metrics when compared to non-ischemic CRVO and control eyes. No specific ETDRS quadrant appears to be more affected. Translational Relevance: This work uses an intraeye method to delineate between ischemic and non-ischemic CRVO by OCTA imaging, overcoming inter-eye variables encountered in clinical care.

Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion.

BACKGROUND: To evaluate microvascular morphological characteristics of the retina and optic disc (OD) in retinal vein occlusion (RVO) patients using optical coherence tomography angiography (OCTA), compare the results to age- and gender-matched healthy subjects, and determine correlations between OCTA parameters and best-corrected visual acuity (BCVA) and age. METHODS: In this retrospective study, right eyes of 53 RVO patients and 51 healthy subjects were compared regarding BCVA, as well as superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), foveal avascular zone (FAZ) parameters, outer retinal and choriocapillaris flow areas, OD whole and peripapillary VDs, and retinal nerve fiber layer thickness (RNFLT). Retinal vein occlusion patients were further divided into subgroups based on therapy and risk factors, and OCTA parameters were compared. RESULTS: Retinal vein occlusion rate or OCTA parameters did not differ significantly by gender (p > 0.05). Retinal vein occlusion patients had significantly decreased BCVA, whole, parafoveal and perifoveal SCP and DCP VDs, as well as VDs 300 µm area around FAZ (FD-300) than healthy subjects (p < 0.001). Their choriocapillaris flow area, RNFLT, whole and peripapillary VDs were also affected. However, FAZ area did not differ significantly between groups. Superior RNFLT (p = 0.016) and whole peripapillary VD (p < 0.001) differed significantly between laser photocoagulation-treated and non-treated patients. The remaining OCTA parameters revealed no significant differences CONCLUSIONS: The RVO and its therapeutic alternatives may affect both OD and retinal VDs. Given its numerous benefits, it seems that OCTA will be used more frequently in clinics for RVO diagnosis, monitoring, and therapeutic response evaluation.

Longitudinal analysis of aqueous humour cytokine expression and OCT-based imaging biomarkers in retinal vein occlusions treated with anti-vascular endothelial growth factor therapy in the IMAGINE study.

BACKGROUND/OBJECTIVES: Retinal vein occlusion (RVO) is the second most common retinal vascular disorder. Despite promising advances with anti-VEGF therapy, select patients are unresponsive to therapy. A precision medicine-based approach for therapeutic decision-making based on underlying biomarkers may facilitate treatment based on the underlying pathway. This study aims to identify the baseline and longitudinal cytokine profiles of RVO-related macular oedema and correlating these expression profiles with higher order OCT features using a novel retinal segmentation and feature extraction platform. SUBJECTS/METHODS: The IMAGINE study is a post-hoc assessment of aqueous humour cytokines with correlation to higher level analysis of imaging studies. OCT scans underwent machine learning enhanced segmentation of the internal limiting membrane (ILM), ellipsoid zone (EZ) and retinal pigment epithelium (RPE), as well as evaluating volumetric fluid metrics. Samples of aqueous humour were obtained at baseline, as well as months 4 and 9 prior to treatment. These samples were analysed for the expression of multiple cytokines. Patients were divided into Responders and Non-Responders based on OCT profiles. Additionally, patients were categorised as a Rebounder if their CST increased by 50% after initial improvement. RESULTS: Twenty-six eyes were included. The OCT-based response schema identified 21 Responders (81%) and 5 Non-Responders (19%). VEGF levels directly correlated with intraretinal fluid volume and angiogenin was inversely correlated with fluid indices. Multiple cytokines, including ANGPTL4, were directly correlated with ellipsoid zone disruption. The baseline VEGF levels were significantly higher in all responders compared to Non-Responders (p = 0.02). Rebounders tended to have significantly decreased levels of angiogenin and TIMP-1 (p = 0.019, p = 0.015). CONCLUSIONS: Cytokine expression was linked to specific OCT features and treatment response in RVO. Identification of an imaging phenotype that could serve as a surrogate for underlying active disease pathways could enhance treatment decision-making and precision medicine.

Assessing retinal vein occlusion based on color fundus photographs using neural understanding network (NUN).

OBJECTIVE: To develop and validate a novel deep learning architecture to classify retinal vein occlusion (RVO) on color fundus photographs (CFPs) and reveal the image features contributing to the classification. METHODS: The neural understanding network (NUN) is formed by two components: (1) convolutional neural network (CNN)-based feature extraction and (2) graph neural networks (GNN)-based feature understanding. The CNN-based image features were transformed into a graph representation to encode and visualize long-range feature interactions to identify the image regions that significantly contributed to the classification decision. A total of 7062 CFPs were classified into three categories: (1) no vein occlusion ("normal"), (2) central RVO, and (3) branch RVO. The area under the receiver operative characteristic (ROC) curve (AUC) was used as the metric to assess the performance of the trained classification models. RESULTS: The AUC, accuracy, sensitivity, and specificity for NUN to classify CFPs as normal, central occlusion, or branch occlusion were 0.975 (± 0.003), 0.911 (± 0.007), 0.983 (± 0.010), and 0.803 (± 0.005), respectively, which outperformed available classical CNN models. CONCLUSION: The NUN architecture can provide a better classification performance and a straightforward visualization of the results compared to CNNs.

Quantitative Assessment Parameters of Peripapillary Regions with Branch Retinal Vein Occlusion by Using Optical Coherence Tomography Angiography.

Purpose: To investigate the baseline parameters of peripapillary regions in both eyes of patients with unilateral branch retinal vein occlusion (BRVO) using optical coherence tomography angiography (OCTA) and their association with best-corrected visual acuity (BCVA). Methods: Forty-eight unilateral BRVO patients were enrolled. The 4.5 × 4.5 mm disc angiogram was acquired in the BRVO eyes and fellow eyes using the OCTA. Radial peripapillary capillary (RPC), whole vessel density, and retinal nerve fiber layer (RNFL) thickness in different regions and optic nerve head (ONH) analysis were automatically calculated. The partition includes the whole image, peripapillary, superior hemifield, inferior hemifield, eight equally divided sectors, and nine evenly divided square areas. Results: All vessel density and capillary vessel density in the whole and peripapillary regions of BRVO eyes were significantly lower than those in fellow eyes. The RNFL peripapillary thickness in BRVO eyes was significantly higher than those in fellow eyes. In eyes with supertemporal vein occlusion, all vessel density both in the superior hemifield and in the G12 region was significantly reduced compared with that in the fellow eyes. The capillary vessel density was significantly lower in the superior hemifield, superior temporal (ST), superior nasal (SN), and temporal superior (TS) areas than in the fellow eyes. The RNFL thickness in the NI, IN, TI, and TS sectors was significantly higher than in fellow eyes (all P < 0.05). Conclusions: OCTA provided quantitative information on peripapillary vascular density and RNFL thickness changes in BRVO. Branch retinal vein occlusion not only affects the blood vessel density in the macular area but also decreases the radial peripapillary capillaries. The capillary density is mainly affected in the affected hemifield but not in the unaffected hemifield.

Etiology of Macular Edema Defined by Deep Learning in Optical Coherence Tomography Scans.

Purpose: To develop an automated method based on deep learning (DL) to classify macular edema (ME) from the evaluation of optical coherence tomography (OCT) scans. Methods: A total of 4230 images were obtained from data repositories of patients attended in an ophthalmology clinic in Colombia and two free open-access databases. They were annotated with four biomarkers (BMs) as intraretinal fluid, subretinal fluid, hyperreflective foci/tissue, and drusen. Then the scans were labeled as control or ocular disease among diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), and retinal vein occlusion (RVO) by two expert ophthalmologists. Our method was developed by following four consecutive phases: segmentation of BMs, the combination of BMs, feature extraction with convolutional neural networks to achieve binary classification for each disease, and, finally, multiclass classification of diseases and control images. Results: The accuracy of our model for nAMD was 97%, and for DME, RVO, and control were 94%, 93%, and 93%, respectively. Area under curve values were 0.99, 0.98, 0.96, and 0.97, respectively. The mean Cohen's kappa coefficient for the multiclass classification task was 0.84. Conclusions: The proposed DL model may identify OCT scans as normal and ME. In addition, it may classify its cause among three major exudative retinal diseases with high accuracy and reliability. Translational Relevance: Our DL approach can optimize the efficiency and timeliness of appropriate etiological diagnosis of ME, thus improving patient access and clinical decision making. It could be useful in places with a shortage of specialists and for readers that evaluate OCT scans remotely.

Characterization of Macrophage-Like Cells in Retinal Vein Occlusion Using En Face Optical Coherence Tomography.

Purpose: To investigate the clinical features of a macrophage-like cell (MLC) obtained by en face optical coherence tomography (OCT) in retinal vein occlusion (RVO). Methods: The study involved 36 patients with treatment-naïve unilateral acute RVO, including 21 branch RVO (BRVO) and 15 central RVO. Vessel density and macular thickness were quantified using OCT angiography. A 3-µm en face OCT slab on the inner limiting membrane in the optic nerve head (ONH) region or macular region was used to visualize the MLCs. The MLCs were binarized and quantified using a semiautomated method. The unaffected fellow eyes served as the control group. Results: The morphology of MLCs appeared larger and plumper in RVO eyes. The mean MLC density in the ONH and macular regions was 2.46 times and 2.86 times higher than their fellow eyes, respectively (p < 0.001). The macular MLC density of the occlusive region was significantly lower than that of the unaffected region in BRVO (p = 0.01). The ONH and macular MLC densities in the non-perfused region were significantly lower than those in the perfused region in all RVO eyes (p < 0.001). The ONH MLC density in RVO eyes was negatively correlated with radial peripapillary capillary vessel density (r = -0.413, p = 0.012). Both ONH and macular MLC densities were positively correlated with macular thickness (r = 0.505, p = 0.002; r = 0.385, p = 0.02, respectively). Conclusion: The increased density and changes of morphology characterized by OCT may indicate generalized activation and aggregation of MLCs in RVO. More MLCs are recruited in the perfused region rather than the non-perfused region. RVO eyes with a higher density of MLCs tend to suffer from the thicker macula.

Arm-to-retina time predicts visual outcome of anti-vascular endothelial growth factor treatment for macular edema due to central retinal vein occlusion.

To explore the factors associated with best-corrected visual acuity (BCVA) after anti-vascular endothelial growth factor (anti-VEGF) treatment for macular edema secondary to central retinal vein occlusion (CRVO). We retrospectively reviewed the medical charts of 22 eyes of 22 treatment-naïve patients with CRVO diagnosed between September 2014 and December 2020. They received anti-VEGF treatment and follow-up for > 12 months. Mean patient age was 64.3 years; 13 (59.1%) were men. Eyes with baseline arm-to-retina (AR) time ≥ 16 s had better BCVA at 12 months (adjusted for baseline BCVA and age; B, - 0.658; 95% confidence interval - 1.058 to - 0.257; P = 0.003), greater mean BCVA change (P = 0.006), lower frequency of residual macular edema at 12 months (P = 0.026) and recurrent and/or unresolved macular edema during 12 months (P = 0.046), and higher frequency of reduction in central retinal thickness ≥ 150 µm at 1 and 12 months (both P = 0.046). Delayed AR time was associated with a better visual outcome and macular edema improvement in CRVO after anti-VEGF treatment regardless of initial BCVA and age. Our results may help understand the pathogenesis and predict the visual prognosis of patients before anti-VEGF therapy initiation.

Significant vision improvement and successful prevention of recurrence by electroacupuncture in hemiretinal vein occlusion combined with macular edema: A case report.

RATIONALE: Retinal vein occlusion (RVO) is the second commonest retinal vascular pathology, with macular edema (ME) as one of its major complications, which could finally cause vision loss. Anti-vascular endothelial growth factor (anti-VEGF therapy), as the standard therapy, has an unsustainable effect and needs repeated injections, which associates with frequent adverse events and significant economic burden. We reported a patient who had developed RVO and ME, and finally recovered after electroacupuncture treatment. PATIENT CONCERNS: A 56-year-old woman complained a decrease of visual acuity in the right eye for 1 year. She received injection of 0.5 mg Conbercept, one of the anti-VEGF therapies, in the vitreous cavity 6 times in 1 year, and finally turned to acupuncture for help out of short-term effectiveness after each injection and high expenditure (CNY 40,800). No other severe medical history was reported. DIAGNOSIS: Under comprehensive consideration of clinical manifestations and the results of fluorescein fundus angiography and optical coherence tomography, the patient was diagnosed with hemi-RVO and ME. INTERVENTIONS: The patient received electroacupuncture 3 sessions per week throughout 8 months (93 sessions in total). OUTCOMES: The visual acuity of the patient was improved from 0.6 to 0.9 after the 8-month electroacupuncture treatment and remained stable during the 24-month follow-up; the central retinal thickness remained stable between 350 and 414 throughout the treatment and follow-up periods. Patients regarded the vision-related quality of life as satisfactory. The total expenditure of electroacupuncture treatment was CNY 6045. The patient did not receive any Conbercept injection over the whole period of 32 months. No relevant adverse events occurred. LESSONS: Electroacupuncture might be effective in alleviating the symptoms of hemi-RVO-associated ME, with a potential of long-lasting effect. The frequency of anti-VEGF therapy could be reduced to the most extent, and the possibility of recurrence could be reduced as well, resulting good economic benefits.

Using ultra-widefield red channel images to improve the detection of ischemic central retinal vein occlusion.

PURPOSE: To examine the usefulness of red channel fundus imaging to detect the ischemic status in eyes with central retinal vein occlusion (CRVO). METHODS: Ultra-widefield (UWF) fundus images were obtained from 42 eyes with CRVO. Twenty-one eyes were ischemic, and 21 eyes were non-ischemic. Rubeosis was found in 11 ischemic eyes. UWF images were split into red and green channels using ImageJ software. Both the color and red channel images were used to predict the presence or absence of ischemia when examined by masked graders. The sensitivity and specificity of UWF imagings for the detection of ischemia were calculated in Group A (total 42 eyes), Group B (32 eyes excluding non-rubeotic ischemic CRVO) and Group C (31 eyes excluding rubeotic ischemic CRVO), respectively. Moreover, a linear mixed model was conducted to investigate the relationship between the type of images and the accuracy of prediction in each group. RESULTS: No significant difference in the sensitivity of color fundus imaging was seen between Group A and Group B. By contrast, a significant difference in the sensitivity of red channel imaging was seen between Group A and Group B (p = 0.031). The accuracies of the predictions were not associated with the type of image in Group A and Group B, but were significantly associated in Group C (p = 0.026). CONCLUSIONS: UWF red channel imaging enabled more accurate detection of the ischemic status, compared with color fundus images, especially in non-rubeotic CRVO eyes.

Association between capillary congestion and macular edema recurrence in chronic branch retinal vein occlusion through quantitative analysis of OCT angiography.

This study aims to quantitatively investigate the optical coherence tomographic angiography (OCTA) findings of capillary congestion and its association with macular edema (ME) recurrence in chronic branch retinal vein occlusion (BRVO). We retrospectively reviewed the medical records of 115 consecutive patients with major ischemic BRVO who reached stable macula (without ME for two consecutive visits) at baseline (the first visit within the stable period). All patients were classified into a recurrence or non-recurrence groups depending on ME recurrence. Capillary congestion of deep capillary plexuses (DCP-C) and other abnormal capillary lesions were segmented, and their areas, vascular densities, and mean retinal thicknesses (MRT) were calculated. The main outcomes were differences between the two groups and risk factors for recurrence among baseline and OCTA parameters. A total of 76 eyes were included, of which 22 (28.9%) recurred. DCP-C existed in all eyes at baseline. MRT of DCP-C (p = 0.006) was greater in the recurrence group. Greater MRT of DCP-C (OR: 1.044; p = 0.002) and more frequent intravitreal injections (OR: 1.803; p < 0.001) were associated with a higher risk of relapsing ME. DCP-C may contribute to the anatomical stability of chronic BRVO and simultaneously be the source of ME.

Optical Coherence Tomography Angiography Characteristics Serve as Retinal Vein Occlusion Therapeutic Biomarkers for Dexamethasone Intravitreal Implant.

BACKGROUND: Retinal vein occlusion (RVO) is the second most common vision-threatening retinal vascular disease. Intravitreal dexamethasone implant has been applied to treat macular edema secondary to RVO (RVO-ME). However, the alteration of morphologic features detected with optical coherence tomography angiography (OCTA) has not been fully studied in RVO-ME patients before and after the treatment. OBJECTIVE: This study is aimed at identifying potential therapeutic targets in RVO with integrative bioinformatic analysis and compares the OCTA characteristics alterations in patients with RVO-ME receiving injection of dexamethasone intravitreal implant. METHODS: Bioinformatic analysis was analyzed in GSE101398 dataset from the Gene Expression Omnibus database. Multiple functional enrichment analyses were performed, and protein-protein interaction network was constructed to visualize the key node genes. Eleven eyes with RVO-ME were examined with OCTA before and after intravitreal dexamethasone implant. The OCTA parameters, including macular thickness, vessel density, foveal avascular zone parameters, the number of hyperreflective foci (HRF), area of cystoid edema, and subretinal fluid (SRF), were compared. The correlation was analyzed between best-corrected visual acuity (BCVA) and OCTA parameters. RESULTS: A total of 79 differentially expressed genes were identified. Functional enrichment analyses revealed the enriched inflammatory events in RVO. In RVO-ME, Pearson correlation revealed that baseline BCVA was positively correlated with the area of SRF and central macular thickness, while no correlation was detected between baseline BCVA and HRF number or the area of cystoid edema. The visual acuity improved, and the central macular thickness was decreased after intravitreal dexamethasone implant injection. Besides, the number of HRF, the area of cystoid edema, and SRF were significantly alleviated after dexamethasone intravitreal injection. CONCLUSION: Retinal inflammation plays a crucial role in RVO pathogenesis. The imaging biomarkers of RVO including Müller glial intracellular edema, and retinal pigment epithelium dysfunction, could be assessed in OCTA and attenuated by intravitreal dexamethasone implant effectively.