Patients with macular edema related to retinal vein occlusion had a higher likelihood of blindness and low vision if they had low best-corrected visual acuity after 1 month of intravitreal treatment.
According to a study, low vision and blindness in patients with retinal vein occlusion- related macular edema (RVO-ME) could be predicted by evaluating best-corrected visual acuity (BCVA) 1 month after being treated with injections intravitreal (IVI) published in the European Journal of Ophthalmology .
Retinal vein occlusion (RVO) has the highest correlation with hypertension, according to several previously published publications. Intravitreal injections (IVI) of antivascular endothelial growth factor (VEGF) or dexamethasone is the first-line treatment for RVO-ME. However, this treatment carries its own risks. Vision outcomes are predicted using optical coherence tomography (OCT). This study aimed to predict an unfavorable prognosis by paying attention to the appearance of non-invasive indicators.
Intravitreal injection procedure for macular degeneration | Image credit: AngeloSouza - stock.adobe.com
This study was conducted at Tsinghua Changgung Hospital, Beijing. Ophthalmic and systemic examinations were performed from April 2021 to September 2022. Past medical history was collected from the electronic medical record system. Patients were included if they had retinal vein occlusion (RVO) without recurrence of EM-RVO for more than 3 months and if they had RVO-related neovascular glaucoma.
Patients were excluded if they had an EM-RVO recurrence of less than 3 months or had an axial length of 26.5 mm or more. A central retinal thickness of 300 mm or more and visual acuity less than 20/30 were defined as EM-RVO recurrence.
Purposes
To detect key indicators leading to unfavorable outcomes of retinal vein occlusion -related macular edema (RVO-ME) within long-term follow-up and evaluate their predictive values.
Methods
A study was conducted on patients with RVO-ME between April 2021 and September 2022. All eligible patients were divided into two groups (favorable and unfavorable group) according to their final best-corrected visual acuity (BCVA) and whether neovascular glaucoma occurred. (NVG).
The unfavorable group was divided into subgroups 1 (with BCVA of ≥ 20/400 and < 20/60 and without NVG) and 2 (blindness group, with BCVA of < 20/400 or with NVG). Demographic data, medical history, ocular characteristics, and blood parameters were compared between groups.
Results
A total of 73 eyes of 73 Han Chinese patients (34 men vs. 39 women) with RVO-ME were enrolled. In multivariable regression analysis of continuous variables for unfavorable outcomes, BCVA 1 month after the first intravitreal injection (IVI) was an independent risk factor (odds ratios (OR) = 2.313, confidence interval (CI) 95 % 1.387–3.858, P = 0.001).
The area under the curve (AUC) of 1-month BCVA after first IVI for predicting low vision and blindness was 0.948 (95% CI: 0.859–1.000, p < 0.001) and 0.892 (95% CI) : 0.744–1.000, p < .001), with a cut-off value of 0.65 log of the minimum angle of resolution (log MAR) (Snellen 20/90) and 1.15 log MAR (Snellen 20/300), respectively .
Conclusion The most valuable indicator for predicting low vision and blindness was poor BCVA at 1 month after the first IVI compared with the favorable group. |
There were some limitations to this study. There may have been some selective bias due to the retrospective, nonrandomized design of the clinical trial. An in-depth analysis of OCT was not performed, although diabetic retinopathy, comorbid internal carotid artery disease, and poor ellipsoid zone were associated with poor visual prognosis. These results may not be generalizable to all populations.
The investigators of this study concluded that the “non-invasive dynamic assessment criteria of poor response to first IVI for unfavorable RVO-ME outcomes had good theoretical and practical value.” This could provide more options for ophthalmologists in the treatment of patients with RVO-ME.
