Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion

Abstract

inner layers (DRIL) has demonstrated significant correlations with visual acuity (VA) in center-involved diabetic macular edema. In patients with retinal vein occlusion (RVO) and secondary macular edema, DRIL may be a useful biomarker in determining VA outcomes. OBJECTIVE To examine whether DRIL at baseline and after treatment is associated with VA in RVO. DESIGN, SETTING, AND PARTICIPANTSA retrospective review of records of 147 patients 18 years or older with treatment-naive branch RVO (BRVO), central RVO (CRVO), or hemispheric RVO (HRVO), with a minimum of 12 months of follow-up, who presented to a tertiary ophthalmic center from December 1, 2010, to January 1, 2016, was conducted. Data collection continued through January 2017. Exclusion criteria included active confounding retinal or ocular disease, history of pars plana vitrectomy, or prior intravitreal injections. Two masked graders calculated a DRIL score based on DRIL presence in 3 predefined regions on spectral-domain optical coherence tomography at baseline, 6 months, and 12 months. A third masked grader was used for discrepancies.EXPOSURES Anti-vascular endothelial growth factor (AVF) therapy (ranibizumab, aflibercept, or bevacizumab) determined by the treating physician. MAIN OUTCOMES AND MEASURESThe DRIL score at baseline for determining VA outcomes and correlation of VA with changes in DRIL burden in response to AVF therapy. RESULTSIn the 147 patients (mean [SD] age, 68.9 [13.1] years; 75 [51.0%] female), baseline DRIL was seen in 91 eyes (61.9%). In the BRVO group but not the CRVO group, baseline DRIL was associated with lower baseline Early Treatment Diabetic Retinopathy Study (ETDRS) score (score of 66.7 for no DRIL vs 54.6 for DRIL, P = .002). Absence of DRIL at baseline in the CRVO/HRVO group correlated with greater VA gains at 6 months, adjusting for baseline VA (score change of 19.50 for no DRIL vs 12.72 for DRIL; P = .04). During 12 months, continued DRIL presence in BRVO was associated with less VA gain up to 6 months (score change of 6.2 for the DRIL increase group vs 18.6 for the DRIL decrease group vs 2.9 for the DRIL stable group; P = .02). Increasing DRIL scores in CRVO/HRVO were associated with reduced VA improvement at 6 months (score change of -0.12 for the DRIL increase group vs 16.90 for the DRIL decrease group vs 8.45 for the DRIL stable group; P = .002) and 12 months (score change of -1.91 for the DRIL increase group vs 17.83 for the DRIL decrease group vs 6.97 for the DRIL stable group; P < .001). CONCLUSIONS AND RELEVANCEBaseline DRIL presence and DRIL burden changes with AVF therapy for macular edema secondary to RVO may be useful biomarkers of ETDRS score improvements.

Evaluation of vessel density in disorganization of retinal inner layers after resolved diabetic macular edema using optical coherence tomography angiography

“…Previous studies reported the close correlation in diabetic retinopathy between DRILs and macular capillary non-perfusion, detected by Fluorescein Angiography (FA). Furthermore, the presence of DRILs was associated with reduction of visual acuity in patients with DME or with resolved macular edema [7][8][9][10][11].…”

Longitudinal Assessment of Ellipsoid Zone Mapping Parameters in Retinal Venous Occlusive Disease With Associated Macular Edema

“…7 OCT has been used extensively in the investigation of RVO, including evaluating changes in central subfield thickness (CST), intraretinal and subretinal fluid (SRF), photoreceptor damage, ellipsoid zone (EZ) integrity, and disorganization of inner retinal layers (DRIL). [8][9][10][11] The EZ is 1 of 4 outer retinal hyperreflective bands. It is the second-most inner band just posterior to the external limiting membrane.…”

The Role of Serum Inflammation-Based Factors in Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion and Its Subtypes

“…Risk factors of RVO are known to include hypertension, systemic vascular disease, hyperlipidemia, pregnancy, oral contraceptive use, and hypercoagulability; however, the underlying pathogenesis of RVO remains unclear [3]. Interestingly, some studies have shown that local and systemic inflammation can induce both atherosclerosis and systemic hypercoagulability, which influence the development of ME secondary to RVO (RVO-ME) [4]. Several studies have shown that the levels of inflammatory factors (e.g., vascular endothelial growth factor [VEGF], interleukin-1β, and interleukin-6) are associated with the severity of ME [5].…”