Spectral-Domain OCT Predictors of Visual Outcomes after Ranibizumab Treatment for Macular Edema Resulting from Retinal Vein Occlusion

Abstract

Objective/Purpose: To evaluate spectral domain optical coherence tomography (SD-OCT) features associated with baseline vision and visual outcomes after 7 monthly ranibizumab doses in the prospective, multicenter Study Evaluating Dosing Regimens for Treatment with Intravitreal Ranibizumab Injections in Subjects with macular Edema following Retinal Vein Occlusion (SHORE). Design: Post-hoc analysis of prospective clinical trial dataSubjects/Participants/Controls: 202 participants in the 15-month, phase IV, SHORE study comparing monthly versus PRN (pro re nata, as-needed) ranibizumab after 7 monthly doses in eyes with retinal vein occlusions (RVO) with macular edema.Methods/Intervention/Testing: The baseline SD-OCT images were assessed for 1) central subfield thickness (CST), 2) presence of vitreomacular adhesion, vitreomacular traction, or epiretinal membrane, 3) presence, location, and amount of intraretinal or subretinal fluid (IRF or SRF), 4) presence, location, and amount of hyperreflective foci (HF), 5) disorganization of retinal inner layers (DRIL), and 6) disruption of external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ). Univariate and multivariable regression analyses were performed to evaluate the association of these features with baseline BCVA and change in BCVA after 7 initial monthly ranibizumab injections.Main Outcome Measure: Association of SD-OCT features with baseline BCVA and change in BCVA after 7 monthly ranibizumab injections.Results: Prior to therapy, worse baseline BCVA was associated with ERM presence (P=0.0045), thicker SRF (P=0.0006), larger size of intraretinal cysts (P=0.0015), as well as higher % of DRIL (P<0.0001), % ELM disruption (P<0.0001), % EZ disruption (P=0.0003), and % IZ disruption (P=0.0018). In multivariate models, only % ELM disruption independently impacted baseline

Ellipsoid Zone Defects in Retinal Vein Occlusion Correlates With Visual Acuity Prognosis: SCORE2 Report 14

“…At month 7, none of the OCT surrogate parameters were independently associated with improvement in VALS. 30 The trial had a relatively short duration compared to SCORE2 and also used a single high-resolution scan through the foveal center. The data from SCORE2 trial represent one of the largest long-term prospective clinical trial results studying the association of EZ and visual acuity and therefore provides conclusive evidence that EZ defect in retinal vein occlusion correlates with worse visual acuity.…”

Smooth Border Between Inner Nuclear/Outer Plexiform Layers: Branch Retinal Vein Occlusion Biomarker of Fewer Macular Edema Recurrences

“…16 The locations of abnormal uid accumulation in the retina also have been investigated in eyes with ME in BRVO; Shroff et al reported three distinct anatomic patterns of structural changes on OCT, i.e., a serous retinal detachment in only 15%, cystoid ME in 40%, and a combination of the two in 45% 17 ; Yamaike et al reported that cystoid spaces were often seen in the inner nuclear layer (INL) (76%) and outer plexiform layer (OPL) (84%) on OCT images in eyes with BRVO 18 ; Yiu et al reported intraretinal uid in the INL, OPL, and outer nuclear layer in 78.1%, in the OPL and outer nuclear layer (19.3%), and in the INL (2.6%). 19 When reviewing OCT images of eyes with BRVO and ME in our clinic, we observed that all eyes had cystoid spaces in the OPL, some had them only in the OPL, and others had them in the INL and OPL; but no eyes had them only in the INL. Interestingly, we noticed that the eyes with a smooth border between the INL and the OPL seemed to have fewer recurrences of ME, while the eyes with a jagged border received more injections.…”

Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics

“…Благодаря внедрению в кли- Ряд авторов на основании данных ОКТ указывают на наличие признаков дезорганизации внутренних слоев сетчатки и нарушения целостности эллипсоидной зоны, которые находятся в прямой корреляционной зависимости с остротой зрения. Эти специфические структурные изменения могут стать важнейшим предиктором для оценки проводимого лечения МО и долгосрочного прогноза в отношении зрительных функций [27,28].…”