Retinal Nonperfusion in the Posterior Pole Is Associated With Increased Risk of Neovascularization in Central Retinal Vein Occlusion

Nicholson, Luke; Vázquez-Alfageme, Clara; Patrao, Namritha; Triantafyllopolou, Ioanna; Bainbridge, James; Hykin, Philip; Sivaprasad, Sobha

doi:10.1016/j.ajo.2017.07.015

Cited by 36 publications

(53 citation statements)

References 17 publications

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“…The clinical manifestations of posterior pole nonperfusion also have been reviewed in its significance in neovascularization in central retinal vein occlusion. 28 The significant association with nonperfusion in the posterior pole and poorer correlation with the periphery also interestingly mirrors the photoreceptor density map. 22,35 The concentric rings template, when superimposed onto a rod photoreceptor density map, reveals that rings M and 1 also correspond to the zones of the retina with the highest rod photoreceptor density.…”

Section: Discussionmentioning

confidence: 61%

“…This negative correlation between AV difference and posterior nonperfusion corroborates previous findings of the significance of posterior nonperfusion in retinal diseases, such as central retinal vein occlusion. 28 The importance of posterior ischemia and the metabolic demands of the retina has not been described as the noninvasive assessment of metabolic demands of the retina was not easily tested previously. With retinal oximetry, we have now identified a relationship between these variables.…”

Section: Discussionmentioning

confidence: 99%

“…This may be a contributory factor for the development of neovascularization which has been shown to be related to posterior pole nonperfusion and oximetry measurements of new vessels that have near arterial oxygen saturation levels. 28,30,31 In a clinical setting, using the AV difference measured with a noninvasive tool can aid the clinician in identifying an ischemic or nonischemic retina should angiography not be possible or available.…”

Section: Discussionmentioning

confidence: 99%

“…The modified area of each segment based on the corresponding enlargement factor in each ring was used. 27,28 The montaged image, using a steering protocol to obtain three images (superior, central, inferior), introduced projection distortions that as yet had not been studied or validated as the location of the same area of the retina is distorted differently in different images given the different angular location. Therefore, only the central image was used in this study as the projection distortion in this has been studied previously and we have made the appropriate corrections.…”

Section: Image Processingmentioning

confidence: 99%

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The Relationship Between Retinal Vessel Oxygenation and Spatial Distribution of Retinal Nonperfusion in Retinal Vascular Diseases

Nicholson

Vázquez-Alfageme

Hykin

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We study the relationship between retinal vessel oxygenation and the spatial distribution of retinal nonperfusion using ultrawide field angiography in eyes with retinal vascular diseases. METHODS. This prospective single center study recruited 57 eligible eyes from 44 patients with retinal vascular diseases. Retinal oximetry measurements were obtained using the Oxymap T1 device to determine the arteriovenous (AV) difference. Retinal nonperfusion was measured from ultrawide field angiography images taken with the Optos 200TX system and superimposing the images with the concentric rings template to determine the area and distribution of retinal nonperfusion. RESULTS. Seven (12.3%) eyes had a diagnosis of a branch or hemiretinal vein occlusion, 24 (42.1%) with central retinal vein occlusion and 26 (45.6%) with diabetic retinopathy (11 [19.3%] nonproliferative and 15 [26.3%] proliferative diabetic retinopathy). The correlation between the total area of retinal nonperfusion with the AV difference controlling for age was not statistically significant (R ¼ À0.103, P ¼ 0.449). However, when analyzing the correlation of AV difference with the area of retinal nonperfusion in the posterior pole controlling for age and peripheral nonperfusion, this was significant (R ¼ À0.295, P ¼ 0.029). This was not significant for the area of retinal nonperfusion in the periphery while controlling for posterior pole nonperfusion and age (R ¼ 0.124, P ¼ 0.368). CONCLUSIONS. Retinal nonperfusion has a negative correlation with AV difference measured on retinal oximetry. This correlation is significant in the posterior pole, but not in the peripheral retina.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Image Processingmentioning

confidence: 99%

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The Relationship Between Retinal Vessel Oxygenation and Spatial Distribution of Retinal Nonperfusion in Retinal Vascular Diseases

Nicholson

Vázquez-Alfageme

Hykin

et al. 2019

Invest. Ophthalmol. Vis. Sci.

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“…The degree of retinal non-perfusion may be prognostic for the chance of developing new vessels. The odds of developing neovascularization go from 0% with less than one disc area (DA) of non-perfusion to an 80% risk with 75 to 150 DA of non-perfusion 57 . The use of wide-field fluorescein angiography has allowed us to better determine capillary non-perfusion and the risk of developing neovascular complications.…”

Section: New Advances In the Treatment Of Rvomentioning

confidence: 99%

Recent advances in understanding and managing retinal vein occlusions

Esmaili

Boyer

2018

F1000Res

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Retinal vein occlusions are the second most common form of retinal vascular disease. Previously, laser treatment for branch retinal vein occlusion and intravitreal triamcinolone acetonide for central retinal vein occlusion were the standard of care. Recent studies have demonstrated that anti-vascular endothelial growth factor (anti-VEGF) agents have a superior safety and efficacy profile for the treatment of both branch and central retinal vein occlusions. The use of wide-field fluorescein angiography has also allowed better visualization of the retinal periphery. Despite the better documentation of retinal non-perfusion, laser photocoagulation to the areas of non-perfusion does not seem to result in a reduction of macular edema or reduction in treatment burden and has been relegated to patients who develop rubeosis or neovascularization of the retina. More recently, several studies have demonstrated the use of a long-acting dexamethasone implant administered intravitreally or triamcinolone administered in the suprachoroidal space as a viable approach to treat retinal vein occlusion.

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Retinal Nonperfusion Characteristics on Ultra-Widefield Angiography in Eyes With Severe Nonproliferative Diabetic Retinopathy and Proliferative Diabetic Retinopathy

et al. 2019

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IMPORTANCE Threshold of retinal nonperfusion for the development of proliferative diabetic retinopathy (PDR) is unclear.OBJECTIVES To identify a threshold of retinal nonperfusion for the presence of retinal neovascularization and the distribution and area of retinal nonperfusion in eyes with severe nonproliferative diabetic retinopathy (NPDR), PDR, neovascularization of the optic disc (NVD), and retinal neovascularization elsewhere (NVE). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional image analysis study was performed between September 24, 2018, and October 24, 2018, at a multicenter national study in the United Kingdom. Baseline images were obtained from 2 completed randomized clinical trials (Ranibizumab for Diabetic Macular Edema Panretinal Photocoagulation [RDP] study and Clinical Efficacy of Intravitreal Aflibercept vs Panretinal Photocoagulation for Best Corrected Visual Acuity in Patients With Proliferative Diabetic Retinopathy at 52 Weeks [CLARITY] study). The RDP study recruited eyes with severe NPDR between April 1, 2014, and December 31, 2015, and the CLARITY study recruited eyes with PDR between August 22, 2014, and November 20, 2015. Ultra-widefield angiography images of eyes with no prior panretinal photocoagulation treatment were included. MAIN OUTCOMES AND MEASURES The total area of retinal nonperfusion, the area of posterior pole retinal nonperfusion, and the area of peripheral retinal nonperfusion were measured. RESULTS A total of 92 patients (92 eyes) were included in the study: 59 in the PDR group (mean [SD] age, 42 [15] years; 20 female [33.9%]) and 33 in the NPDR group (mean [SD] age, 63 [10] years; 3 female [9.1%]). Forty eyes had NVE and 19 had NVD with or without NVE.We identified a retinal nonperfusion threshold of 118.3 disc areas (DA) with a specificity of 84.9% (95% CI, 68.1% to 94.9%) for PDR. The median area of retinal nonperfusion was 67.8 DA (95% CI, 44.2 to 107.3 DA) in the NPDR eyes and 147.9 DA (95% CI, 127.4 to 173.5 DA) for eyes with proliferative changes, with a difference of 69.0 DA (95% CI, 42.2 to 97.7 DA; P < .001). No difference was found in the median area of posterior nonperfusion between NPDR and PDR, with a difference of 0 DA (95% CI, −6.7 to 5.2 DA; P = .56). As for peripheral nonperfusion, NPDR eyes measured 64.1 DA and PDR eyes measured 130.6 DA, with a difference of 70.8 DA (95% CI, 48.4 to 94.9 DA; P < .001). Eyes with NVD had the largest total area of retinal nonperfusion, with a difference of 65.1 DA (95% CI, 28.6 to 95.8 DA; P < .001) compared with eyes with only NVE.CONCLUSIONS AND RELEVANCE These findings suggest eyes with at least 107.3 DA of nonperfusion are at risk of proliferative disease, and eyes with NVD have the largest area of retinal nonperfusion.

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Retinal Nonperfusion in the Posterior Pole Is Associated With Increased Risk of Neovascularization in Central Retinal Vein Occlusion

Abstract: With ultra-widefield angiography, we have ascertained that posterior pole nonperfusion of more than 10 DA remains the key risk factor for new vessel development compared to areas of nonperfusion confined to the periphery.

Cited by 36 publications

References 17 publications

The Relationship Between Retinal Vessel Oxygenation and Spatial Distribution of Retinal Nonperfusion in Retinal Vascular Diseases

The Relationship Between Retinal Vessel Oxygenation and Spatial Distribution of Retinal Nonperfusion in Retinal Vascular Diseases

Recent advances in understanding and managing retinal vein occlusions

Retinal Nonperfusion Characteristics on Ultra-Widefield Angiography in Eyes With Severe Nonproliferative Diabetic Retinopathy and Proliferative Diabetic Retinopathy

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