Association of Disorganization of Retinal Inner Layers with Ischemic Index and Visual Acuity in Central Retinal Vein Occlusion

Overview

Journal Ophthalmol Retina

Specialty Ophthalmology

Date 2018 Dec 5

PMID 30511035

Citations 19

Authors

Duncan Berry

Akshay S Thomas

Sharon Fekrat

Dilraj S Grewal

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine whether disorganization of retinal inner layers (DRIL) on optical coherence tomography (OCT) is associated with ischemia on ultra-widefield fluorescein angiography (UWFFA) and with visual outcomes in eyes with acute, treatment-naïve central retinal vein occlusion (CRVO).

Design: Retrospective, single-institution, longitudinal cohort study.

Participants: Twenty-five consecutive patients with treatment-naïve CRVO and ≥ 1 year follow-up.

Methods: Two independent masked graders evaluated the extent of DRIL, ellipsoid zone disruption, external limiting membrane disruption, and other OCT parameters at the baseline, 6- month, 12-month, and final visits. Baseline UWFFA images were assessed for ischemic index values and foveal avascular zone (FAZ) enlargement.

Main Outcome Measures: Associations of DRIL with UWFFA findings and clinical outcomes including corrected visual acuity (VA).

Results: The median time to final follow-up was 24 months (range 12.1 - 43.9 months). Median DRIL extent at baseline was 765 µm (range 0 - 1000 µm). Eighteen of 25 eyes (72%) had some degree of DRIL at baseline, and 20 of 25 eyes (80%) had cystoid macular edema (CME). Neither the presence nor extent of DRIL at baseline was associated with presenting VA. In a cross-sectional analysis of each visit, extent of DRIL correlated with worse VA at both the 6-month ( = 0.656; p = 0.001) and final ( = 0.509; p = 0.016) visits. At final follow-up, DRIL extent was the OCT parameter most strongly correlated with baseline ischemic index ( = 0.418; p = 0.047) and baseline enlarged FAZ (p = 0.057) on UWFFA. On multivariate regression analysis, DRIL extent at final follow-up was the only OCT parameter associated with worse VA (p = 0.013) and remained significant when accounting for CME as a potential confounder.

Conclusions: Extent of DRIL was not associated with presenting VA in treatment-naïve eyes with acute CRVO. Following six months of follow-up however, DRIL extent correlated with worse VA and was predictive of worse VA throughout more than 2 years of follow-up. Ischemic features on UWFFA at baseline are predictive of the extent of DRIL development at final follow-up.

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References

McIntosh R, Rogers S, Lim L, Cheung N, Wang J, Mitchell P . Natural history of central retinal vein occlusion: an evidence-based systematic review. Ophthalmology. 2010; 117(6):1113-1123.e15. DOI: 10.1016/j.ophtha.2010.01.060. View

Rahimy E, Sarraf D, Dollin M, Pitcher J, Ho A . Paracentral acute middle maculopathy in nonischemic central retinal vein occlusion. Am J Ophthalmol. 2014; 158(2):372-380.e1. DOI: 10.1016/j.ajo.2014.04.024. View

Schmid H, Renner M, Dick H, Joachim S . Loss of inner retinal neurons after retinal ischemia in rats. Invest Ophthalmol Vis Sci. 2014; 55(4):2777-87. DOI: 10.1167/iovs.13-13372. View

Ko J, Kwon O, Byeon S . Optical coherence tomography predicts visual outcome in acute central retinal vein occlusion. Retina. 2014; 34(6):1132-41. DOI: 10.1097/IAE.0000000000000054. View

Browning D, Punjabi O, Lee C . Assessment of ischemia in acute central retinal vein occlusion from inner retinal reflectivity on spectral domain optical coherence tomography. Clin Ophthalmol. 2017; 11:71-79. PMC: 5189968. DOI: 10.2147/OPTH.S122683. View

Ota M, Tsujikawa A, Murakami T, Yamaike N, Sakamoto A, Kotera Y . Foveal photoreceptor layer in eyes with persistent cystoid macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2007; 145(2):273-280. DOI: 10.1016/j.ajo.2007.09.019. View

Nicholson L, Ramu J, Triantafyllopoulou I, Patrao N, Comyn O, Hykin P . Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy. Clin Exp Ophthalmol. 2015; 43(8):735-41. DOI: 10.1111/ceo.12557. View

Sun J, Radwan S, Soliman A, Lammer J, Lin M, Prager S . Neural Retinal Disorganization as a Robust Marker of Visual Acuity in Current and Resolved Diabetic Macular Edema. Diabetes. 2015; 64(7):2560-70. PMC: 4477364. DOI: 10.2337/db14-0782. View

Tsui I, Kaines A, Havunjian M, Hubschman S, Heilweil G, Prasad P . Ischemic index and neovascularization in central retinal vein occlusion. Retina. 2010; 31(1):105-10. DOI: 10.1097/IAE.0b013e3181e36c6d. View

10.

Falavarjani K, Phasukkijwatana N, Freund K, Cunningham Jr E, Kalevar A, McDonald H . En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion. Am J Ophthalmol. 2017; 177:131-138. DOI: 10.1016/j.ajo.2017.02.015. View

11.

Sagong M, van Hemert J, Olmos de Koo L, Barnett C, Sadda S . Assessment of accuracy and precision of quantification of ultra-widefield images. Ophthalmology. 2015; 122(4):864-6. DOI: 10.1016/j.ophtha.2014.11.016. View

12.

Jaulim A, Ahmed B, Khanam T, Chatziralli I . Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature. Retina. 2013; 33(5):901-10. DOI: 10.1097/IAE.0b013e3182870c15. View

13.

Croft D, van Hemert J, Wykoff C, Clifton D, Verhoek M, Fleming A . Precise montaging and metric quantification of retinal surface area from ultra-widefield fundus photography and fluorescein angiography. Ophthalmic Surg Lasers Imaging Retina. 2014; 45(4):312-7. DOI: 10.3928/23258160-20140709-07. View

14.

Singer M, Sagong M, van Hemert J, Kuehlewein L, Bell D, Sadda S . Ultra-widefield Imaging of the Peripheral Retinal Vasculature in Normal Subjects. Ophthalmology. 2016; 123(5):1053-9. DOI: 10.1016/j.ophtha.2016.01.022. View

15.

Arend O, Wolf S, Harris A, Reim M . The relationship of macular microcirculation to visual acuity in diabetic patients. Arch Ophthalmol. 1995; 113(5):610-4. DOI: 10.1001/archopht.1995.01100050078034. View

16.

Simmons A, Merrill M, Reed J, Deans M, Edwards M, Fuerst P . Defective Angiogenesis and Intraretinal Bleeding in Mouse Models With Disrupted Inner Retinal Lamination. Invest Ophthalmol Vis Sci. 2016; 57(4):1563-77. PMC: 4824390. DOI: 10.1167/iovs.15-18395. View

17.

Klein R, Klein B, Moss S, Meuer S . The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2001; 98:133-41; discussion 141-3. PMC: 1298220. View

18.

. Natural history and clinical management of central retinal vein occlusion. The Central Vein Occlusion Study Group. Arch Ophthalmol. 1997; 115(4):486-91. DOI: 10.1001/archopht.1997.01100150488006. View

19.

Wang F, Xing S, He M, Hou Q, Chen S, Zou X . Nogo-A is associated with secondary degeneration of substantia nigra in hypertensive rats with focal cortical infarction. Brain Res. 2012; 1469:153-63. DOI: 10.1016/j.brainres.2012.06.040. View

20.

Radwan S, Soliman A, Tokarev J, Zhang L, van Kuijk F, Koozekanani D . Association of Disorganization of Retinal Inner Layers With Vision After Resolution of Center-Involved Diabetic Macular Edema. JAMA Ophthalmol. 2015; 133(7):820-5. DOI: 10.1001/jamaophthalmol.2015.0972. View