Therapeutic benefit of lymphadenectomy for older patients with urothelial carcinoma of the upper urinary tract: a propensity score matching study.

OBJECTIVES: Regional lymphadenectomy for urothelial carcinoma of the upper urinary tract is sometimes avoided in older patients to reduce surgical burden. We aimed to evaluate the therapeutic impact of lymphadenectomy in older patients undergoing curative therapy for upper urinary tract urothelial carcinoma. METHODS: The patients with urothelial carcinoma of the upper urinary tract older than 75 years at the time of surgery and without lymph node or distant metastasis who underwent curative therapy at two tertiary hospitals between 1994 and 2019 were retrospectively analyzed. Complete-lymphadenectomy was performed as per our protocol. Cancer-specific survival, overall survival and metastasis-free survival after surgery were evaluated between complete-lymphadenectomy and no/incomplete-lymphadenectomy groups before and after 1:1 propensity score matching. RESULTS: The original cohort included 150 patients (median age, 80.71 years), and complete-lymphadenectomy was performed in 42 (28.00%) patients. Patients in complete-lymphadenectomy group were younger and less likely to be aged >80 years (both, P < 0.0001). After matching, 30 patients were allocated to each group and the ages were comparable (78.58 vs. 77.48 years, P = 0.1738). High-grade perioperative complication rates did not differ between groups both before and after matching. Cancer-specific survival, overall survival and metastasis-free survival were significantly longer in the complete-lymphadenectomy group both before and after matching (all, P < 0.05). CONCLUSIONS: This study suggests that complete-lymphadenectomy may provide therapeutic benefits for older patients. The decision to perform complete-lymphadenectomy must be based on the patient's physical condition, rather than his/her chronological age.

The target hemoglobin content values of reticulocytes for efficient anemia improvement are achieved by low ferritin levels and moderate transferrin saturation: a retrospective observational study.

Objectives: The optimal iron level in hemodialysis (HD) patients remains unclear. The hemoglobin content of reticulocytes (CHr) is a sensitive indicator of iron used for hematopoiesis. To identify the optimal iron content for HD patients, we investigated the relation between CHr levels and iron status, as well as the levels of hepcidin, a main regulator of iron metabolism.Methods: This study enrolled 181 HD outpatients treated with recombinant human erythropoietin (rHuEPO). A sensitivity analysis, using a generalized linear regression model that included the interaction term, was applied to determine the correlations between levels of CHr and those of serum ferritin (s-ft), transferrin saturation (TSAT), and hepcidin.Results: The greatest changes in correlation coefficients for levels of s-ft and TSAT with CHr levels indicated optimal cut-off points of 50 ng/mL (≤50 ng/mL, r = 0.47 vs >50 ng/mL, r = 0.22) and 24% (≤24%, r = 0.58 vs >24%, r = 0.08), respectively. The correlation coefficient for levels of CHr and hepcidin showed that the optimal lower and upper cut-off points were 20 ng/mL (≤20 ng/mL, r = 0.52 vs >20 ng/mL, r = -0.01) and 70 ng/mL (≤70 ng/mL, r = 0.36 vs >70 ng/mL, r = -0.45), respectively.Discussion: This study indicates that the amount of iron in HD patients is sufficient for hematopoiesis under conditions of low s-ft and moderate TSAT levels. High levels of hepcidin could induce negative iron metabolism in hematopoiesis.Conclusion: Therefore, controlling hepcidin levels to within approximately 20-70 ng/mL may prevent iron deficiency and reduced Hb synthesis, and may thus facilitate effective iron utilization in hematopoiesis.

Role of inflammation in previously untreated macular edema with branch retinal vein occlusion.

BACKGROUND: The association of inflammatory factors and the aqueous flare value with macular edema in branch retinal vein occlusion (BRVO) patients remains unclear. The relationship between the aqueous flare value and the vitreous fluid levels of vascular endothelial growth factor (VEGF), interleukin (IL)-6, monocyte chemotactic protein (MCP)-1, soluble intercellular adhesion molecule 1 (sICAM-1), and soluble VEGF receptor-2 (sVEGFR-2) was evaluated to investigate the role of inflammation in BRVO associated with macular edema. Aqueous flare values and the vitreous levels of VEGF, IL-6, MCP-1, sICAM-1, and sVEGFR-2 were compared between previously untreated patients with BRVO and patients with macular hole (MH). METHODS: Vitreous samples were obtained from 45 patients during vitreoretinal surgery (28 patients with BRVO and 17 with MH), and the levels of VEGF, IL-6, MCP-1, sICAM-1, and sVEGFR-2 were measured by enzyme-linked immunosorbent assay. Retinal ischemia was evaluated by measuring the area of capillary non-perfusion using fluorescein angiography and the Scion Image program. Aqueous flare values were measured with a laser flare meter and macular edema was examined by optical coherence tomography. RESULTS: The median aqueous flare value was significantly higher in the BRVO group (12.1 photon counts/ms) than in the MH group (4.5 photon counts/ms, P < 0.001). There were significant correlations between the aqueous flare value and the vitreous levels of VEGF, IL-6, MCP-1, and sICAM-1 in the BRVO group (ρ = 0.54, P = 0.005; ρ = 0.56, P = 0.004; ρ = 0.52, P = 0.006; and ρ = 0.47, P = 0.015, respectively). The aqueous flare value was also significantly correlated with the foveal thickness in the BRVO group (ρ = 0.40, P = 0.037). CONCLUSIONS: Inflammation may induce an increase of vascular permeability and disrupt the blood-aqueous barrier via release of inflammatory factors (VEGF, IL-6, MCP-1, and sICAM-1) in BRVO patients with macular edema.

Association of electroretinogram and morphological findings in central retinal vein occlusion with macular edema.

The objective of this study was to evaluate the relations among electroretinogram (ERG) parameters (cone a-wave, cone b-wave, and 30 Hz flicker), retinal thickness, and retinal volume in 16 patients with central retinal vein occlusion and macular edema. The amplitude and implicit time of the ERG parameters were extracted from the ERG traces. Retinal thickness and volume were measured by optical coherence tomography in nine macular subfields. Then the correlations among ERG parameters and morphological parameters were analyzed. The cone b-wave and 30 Hz flicker implicit time were correlated with retinal thickness and volume in seven out of nine subfields, excluding the temporal subfields. In addition, the amplitude of the cone b-wave was correlated with retinal thickness and volume in the nasal inner and nasal outer subfields. These findings suggest that retinal thickness and volume may be associated with outer and inner retinal function in central retinal vein occlusion patients.

Pentraxin 3 and other inflammatory factors in central retinal vein occlusion and macular edema.

PURPOSE: To evaluate the association between vitreous fluid levels of inflammatory factors and macular edema in patients with central retinal vein occlusion (CRVO). METHODS: In 30 CRVO patients with macular edema and 29 controls with idiopathic macular hole, vitreous fluid samples were obtained during vitreoretinal surgery. Retinal ischemia was evaluated from capillary nonperfusion on fluorescein angiography. Macular edema was examined by optical coherence tomography. RESULTS: Vitreous fluid levels of vascular endothelial growth factor (VEGF), soluble VEGF receptor 2 (sVEGFR-2), soluble intercellular adhesion molecule 1 (sICAM-1), interleukin 6 (IL-6), monocyte chemotactic protein 1 (MCP-1), and pentraxin 3 (PTX3) were significantly higher in CRVO patients than in macular hole patients. Vitreous fluid levels of VEGF, sICAM-1, IL-6, MCP-1, and PTX3 were significantly correlated with the retinal thickness at the central fovea. There were significant correlations between the vitreous fluid level of VEGF and the levels of sICAM-1, IL-6, and MCP-1 in the CRVO patients. There was also a significant correlation between sVEGFR-2 and PTX3 but not between VEGF and PTX3. CONCLUSION: These findings suggest the importance of VEGF, its signal transduction pathways, and the cytokine network and may be useful for understanding the mechanism of macular edema in CRVO and developing new treatments.

Aqueous flare and inflammatory factors in macular edema with central retinal vein occlusion: a case series.

BACKGROUND: The association of inflammatory factors and the aqueous flare value with macular edema in central retinal vein occlusion (CRVO) patients remains unclear. We investigated the relations between the aqueous flare value and vitreous levels of vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and interleukin-6 (IL-6) in patients with CRVO and macular edema or patients with idiopathic macular hole (MH). METHODS: In 38 patients who underwent unilateral vitrectomy (21 CRVO patients and 17 MH patients), vitreous samples were obtained during vitrectomy to measure VEGF, sICAM-1, and IL-6. Retinal ischemia was evaluated from capillary non-perfusion on fluorescein angiography, and the CRVO patients were classified into nonischemic or ischemic groups. Aqueous flare values were measured with a laser flare meter and macular edema was examined by optical coherence tomography. RESULTS: The median aqueous flare value increased significantly across the three groups (MH group < nonischemic CRVO group < ischemic CRVO group). There was a significant correlation between the flare value and vitreous levels of VEGF, sICAM-1, and IL-6 in the CRVO group. The flare value was also significantly correlated with the severity of macular edema in the CRVO group. CONCLUSIONS: Inflammation and/or ischemia may increase vascular permeability and disrupt the blood-aqueous barrier by increasing levels of inflammatory factors in patients with CRVO and macular edema.

Influence of pars plana vitrectomy on macular sensitivity and morphology in patients with branch retinal vein occlusion and serous retinal detachment.

BACKGROUND AND OBJECTIVE: To evaluate the influence of serous retinal detachment (SRD) on the outcome of pars plana vitrectomy (PPV) for macular edema in patients with branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: In an interventional case series, 20 patients (20 eyes) with BRVO and macular edema underwent PPV, including 12 patients with SRD and eight with cystoid macular edema (CME). Microperimetry of the macular region and optical coherence tomography were performed before and 6 months after PPV. RESULTS: In both the CME and SRD groups, the mean macular thickness and macular volume decreased significantly from baseline to 3 and 6 months after PPV (all P < .01), while visual acuity improved significantly in both groups (both P < .01). However, mean macular sensitivity only increased significantly in the SRD group (P < .05). CONCLUSION: PPV achieves greater improvement of macular sensitivity in BRVO patients with SRD than in those with CME.

Influence of retinal ischemia on macular function after pars plana vitrectomy for macular edema with branch retinal vein occlusion.

The influence of retinal ischemia on changes of visual acuity, macular sensitivity, macular thickness, and macular volume is unclear after pars plana vitrectomy (PPV) for macular edema with branch retinal vein occlusion (BRVO). Twenty-three patients (23 eyes) with BRVO and macular edema underwent PPV. Retinal ischemia was evaluated from capillary non-perfusion on fluorescein angiography, and patients were classified as ischemic or nonischemic. Microperimetry was performed with a Micro Perimeter 1. Macular thickness and volume were measured by optical coherence tomography. Mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly from before to 3 and 6 months after PPV (all P < 0.001). Likewise, total macular volume within the central 4°, 10°, and 20° fields decreased significantly from before to 3 and 6 months after PPV (all P < 0.001). Best-corrected visual acuity (BCVA) improved significantly from before to 3 and 6 months after PPV (P < 0.001). Furthermore, mean macular sensitivity within the central 4°, 10°, and 20° fields increased significantly from before to 3 and 6 months after PPV (P = 0.002, P = 0.001, and P = 0.001, respectively). There were no significant differences in the trend profiles of macular thickness, macular volume, and BCVA between the ischemic and nonischemic groups. However, there was a significant difference in the trend profile of macular sensitivity within the central 4°, 10°, and 20° fields between the ischemic and nonischemic groups (P = 0.017, P = 0.010 and P = 0.025, respectively). These findings suggest PPV may be more effective for improving macular sensitivity in ischemic than nonischemic BRVO.

Changes of macular sensitivity and morphology after pars plana vitrectomy for macular edema with central retinal vein occlusion: a case series.

BACKGROUND: It is unclear how retinal ischemia influences the changes of visual acuity, macular sensitivity, macular thickness, and macular volume after the performance of pars plana vitrectomy (PPV) for macular edema in patients with central retinal vein occlusion (CRVO). METHODS: Ten patients (10 eyes) with CRVO and macular edema underwent PPV. Retinal ischemia was evaluated from the area of capillary nonperfusion on fluorescein angiography, and the patients were classified into ischemic or nonischemic groups. Microperimetry was performed with a Micro Perimeter 1. Macular thickness and volume were measured by optical coherence tomography. RESULTS: In both groups, the mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly from baseline to 3 and 6 months after PPV (all P < 0.05). In the ischemic group, the mean macular sensitivity within the central 4°, 10°, and 20° fields increased from baseline to 3 and 6 months after PPV, but no significant difference was observed. CONCLUSIONS: These results suggest that PPV may be effective for improving macular thickness, volume, and sensitivity in patients with macular edema secondary to ischemic CRVO, although there was no significant difference.

Retinal function and morphology in central retinal vein occlusion with macular edema.

PURPOSE/AIM: To investigate the relations among best-corrected visual acuity (BCVA), macular sensitivity, macular thickness, and macular volume in patients with central retinal vein occlusion (CRVO) and macular edema. MATERIALS AND METHODS: In 16 consecutive patients with CRVO (mean age: 71.9 ± 6.9 years; 10 women and six men), macular function was documented by microperimetry and BCVA was determined on the logarithm of the minimum angle of resolution scale. Macular thickness and macular volume were measured by optical coherence tomography (OCT), and mean macular sensitivity was calculated for each of nine macular subfields on the retinal map obtained by OCT. RESULTS: BCVA was correlated with both macular thickness and macular volume in all nine subfields of the macular region. In contrast, macular sensitivity was correlated with both macular thickness and macular volume in six out of nine subfields (superior inner, superior outer, inferior inner, inferior outer, nasal inner, and nasal outer). The correlations were stronger in the nasal subfields than the other subfields. CONCLUSIONS: These findings suggest that evaluation of both visual acuity and macular sensitivity might be important when assessing visual function in CRVO patients with macular edema.

Visual function after pars plana vitrectomy in macular edema with branch retinal vein occlusion.

The objective of this study is to evaluate functional and morphological changes of the macula after pars plana vitrectomy (PPV) for macular edema with branch retinal vein occlusion (BRVO). Eighteen patients with BRVO (mean age: 71.3 ± 5.9 years; six women and 12 men) received PPV. Macular function was documented by microperimetry and best-corrected visual acuity (BCVA) was determined. Retinal thickness and retinal volume were measured by optical coherence tomography (OCT), and mean retinal sensitivity was calculated for each of nine macular subfields. Ischemia and serous retinal detachment (SRD) were evaluated by fluorescein angiography and OCT, respectively. Mean BCVA was significantly improved at 3 and 6 months after PPV. Mean retinal sensitivity, retinal thickness, and retinal volume were significantly improved after 3 and 6 months in five, eight, and eight subfields, respectively. Improvement of visual acuity and the percent change in retinal thickness or retinal volume were not correlated in any of the nine subfields, while improvement of retinal sensitivity was correlated with the percent change in both retinal thickness and retinal volume in the temporal outer subfield. There were significant differences with respect to the percent changes in retinal thickness and volume in the temporal outer field between the non-ischemic and ischemic groups, as well as between the patients with and without SRD. There was also a significant difference between the non-ischemic and ischemic groups with respect to the improvement of retinal sensitivity in three out of nine fields. These findings suggest that PPV can improve both functional and morphological changes due to macular edema in BRVO patients, and that morphological improvement in the temporal outer subfield after PPV might influence the functional prognosis of these patients.

Foveal sensitivity and morphology in major and macular branch retinal vein occlusion.

PURPOSE: To determine whether foveal thickness, foveal volume, visual acuity, and foveal sensitivity after intravitreal injection of triamcinolone acetonide (IVTA) are influenced by the extent of occlusion (major versus macular branch retinal vein occlusion (BRVO)). MATERIALS AND METHODOLOGY: In this interventional case series, 22 eyes of 22 BRVO patients with macular oedema were treated by IVTA. Patients were divided into 2 groups according to the site of occlusion, with the Major group having occlusion of a major retinal vein and the Macular group having occlusion of a macular venule. Foveal sensitivity was measured by microperimetry before IVTA and 3 and 6 months after IVTA. Visual acuity was converted to logarithm of the minimal angle of resolution (logMAR) values. Foveal thickness and macular volume were measured by optical coherence tomography before IVTA and 3 and 6 months after IVTA. RESULTS: Foveal thickness and foveal volume showed significant improvement from before to 3 and 6 months after IVTA in both groups (all P<0.001). Visual acuity also showed significant improvement from before to 3 and 6 months after IVTA in both groups (P=0.001 and P=0.022, respectively). Moreover, foveal sensitivity was significantly improved from before to 3 and 6 months after IVTA in the Major group (P<0.001). Foveal sensitivity also increased from before to 3 and 6 months after IVTA in the Macular group, but not significantly. There were no significant differences in the trend profiles of foveal thickness, foveal volume, visual acuity, and foveal sensitivity between the Major and Macular groups. CONCLUSIONS: These results suggest that IVTA may be effective for improving foveal morphology, visual acuity, and foveal sensitivity in BRVO patients regardless of the site of occlusion.

Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology.

BACKGROUND: The influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO). METHODS: Twenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (-) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded. RESULTS: In both the SRD (-) group and the SRD (+) group, the mean macular thickness within the central 4° field and the 10° and 20° fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P <0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P <0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4° field and the 10° and 20° fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P <0.05). The trend profiles of macular thickness within the 10° and 20° fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4° field and the 10° and 20° fields of the occluded region. CONCLUSIONS: These results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.

Macular sensitivity and morphology after intravitreal injection of triamcinolone acetonide for macular edema with branch retinal vein occlusion.

PURPOSE: To evaluate the changes of macular sensitivity, thickness, and total macular volume after intravitreal injection of triamcinolone acetonide to treat macular edema with branch retinal vein occlusion. METHODS: Seventeen eyes of 17 patients with branch retinal vein occlusion with macular edema received intravitreal triamcinolone acetonide. Using capillary nonperfusion on fluorescein angiography, patients were classified into nonischemic or ischemic groups. Microperimetry was used to measure macular sensitivity within the central 4°, 10°, and 20° fields. Macular thickness and macular volume within these fields were measured by optical coherence tomography. RESULTS: The mean macular thickness within the central 4°, 10°, and 20° fields decreased significantly after intravitreal therapy (all Ps < 0.001) as did total macular volume (all Ps < 0.001). Visual acuity was significantly better at 3 and 6 months (P = 0.002) as was the mean macular sensitivity within the three fields (all Ps < 0.05). There were no significant differences in the trend profile of macular thickness and volume within the three fields between the ischemic and nonischemic groups. There were also no significant differences in the trend profile of visual acuity and macular sensitivity. CONCLUSION: Intravitreal triamcinolone acetonide may improve macular sensitivity and morphology in patients with ischemic and nonischemic branch retinal vein occlusion.

Functional-morphological changes after intravitreal injection of triamcinolone acetonide for macular edema with branch retinal vein occlusion.

PURPOSE: To evaluate functional and morphological changes of the macula after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO). METHODS: Twenty patients with BRVO (mean age: 69.7 ± 9.8 years; 14 women and 6 men) received IVTA. Macular function was documented by microperimetry and best-corrected visual acuity (BCVA) was determined. Retinal thickness and retinal volume were measured by optical coherence tomography, and mean retinal sensitivity was calculated for each of 9 macular subfields. RESULTS: Mean BCVA significantly improved 6 months after IVTA. Mean retinal sensitivity, retinal thickness, and retinal volume significantly improved after 6 months in 4, 8, and 8 subfields, respectively. On multivariate analysis, improvement of retinal sensitivity was significantly correlated with the percent changes of both retinal thickness and retinal volume in 2 subfields [superior inner (the occlusion site) and temporal outer], although improvement of visual acuity was not significantly correlated with the percent change of macular edema in any of the 9 subfields. CONCLUSIONS: These findings suggest that IVTA can improve both functional and morphological changes due to macular edema in BRVO patients, and that morphological improvement after IVTA might be useful for assessing the functional prognosis of BRVO with macular edema.

Inflammatory factors in major and macular branch retinal vein occlusion.

Concentrations of inflammatory factors were measured in 40 patients with macular edema due to major branch retinal vein occlusion (BRVO) or macular BRVO who were treated by pars plana vitrectomy. Vitreous fluid levels of vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor (PEDF) were determined. Visual acuity and central macular thickness were significantly improved at 6 months in both groups. Vitreous fluid levels of VEGF and sICAM-1 were higher in the major BRVO group than the macular BRVO group, while the PEDF level was lower in the major group than the macular group. The mean visual acuity and central macular thickness at 6 months were not significantly different between the macular and major groups. In conclusion, patients with major BRVO had higher vitreous levels of inflammatory factors and lower vitreous levels of anti-inflammatory PEDF. Accordingly, regulating inflammatory factors might be more important in major BRVO than macular BRVO.

Coexistence of obstructive sleep apnoea and metabolic syndrome is independently associated with left ventricular hypertrophy and diastolic dysfunction.

PURPOSE: This study was conducted to investigate the impact of the severity of obstructive sleep apnoea (OSA) and metabolic syndrome (MS) on left ventricular (LV) hypertrophy and LV diastolic function. METHODS: Echocardiography for evaluation of LV hypertrophy (defined by relative wall thickness (RWT) and LV mass index (LVMI)) and for diastolic function (defined by the early rapid/atrial filling velocity (E/A ratio)) was performed on 660 OSA patients. RESULTS: In patients with both MS and severe OSA, LVMI and RWT were significantly higher and the E/A ratios were significantly lower compared to patients with neither MS nor severe OSA. Multivariate analysis after adjustment for other descriptive variables demonstrated that (1) coexistent MS and severe OSA was independently associated with increased LVMI and RWT and (2) severe OSA, MS and coexistence of both disorders were independently associated with a decreased E/A ratio. Significant interaction between MS and severe OSA was not observed with respect to LVMI and RWT, but was observed for the E/A ratio. CONCLUSIONS: Coexistent severe OSA and MS can exacerbate LV concentric hypertrophy. However, not only the coexistence of these two disorders, but also either severe OSA or MS can impair LV diastolic function.

Vitreous inflammatory factors and serous macular detachment in branch retinal vein occlusion.

PURPOSE: To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. METHODS: The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. RESULTS: The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). CONCLUSION: An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Influence of vitreous factors after vitrectomy for macular edema in patients with central retinal vein occlusion.

To investigate whether vitreous fluid levels of vascular endothelial growth factor (VEGF), pigment epithelium-derived factor (PEDF), and soluble intercellular adhesion molecule 1 (sICAM-1) influence visual prognosis and macular edema in patients with central retinal vein occlusion (CRVO). A prospective observational study was performed in 31 consecutive CRVO patients (31 eyes) with macular edema who underwent vitrectomy. Best-corrected visual acuity (BCVA), retinal thickness (examined by OCT), and vitreous fluid levels of VEGF, PEDF, and sICAM-1 were determined. Patients were followed for at least 6 months after surgery. Both visual acuity and retinal thickness showed significant improvement at 6 months postoperatively (P = 0.012 and P < 0.001, respectively). Vitreous fluid levels of VEGF were significantly higher (P = 0.027) in patients who showed less improvement of BCVA after vitrectomy than in those with a better outcome. Conversely, vitreous levels of PEDF were significantly lower (P = 0.047) in patients with less improvement of BCVA than in those with a better outcome. Vitreous levels of sICAM-1 were not significantly correlated with BCVA after vitrectomy (P = 0.731). Multiple regression analysis demonstrated that vitreous fluid levels of VEGF and PEDF were significant determinants of the improvement of BCVA (P = 0.013 and P = 0.007, respectively). These results suggest that vitreous fluid levels of VEGF and PEDF might influence visual prognosis after vitrectomy in CRVO patients with macular edema.