June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Peripheral Retinal Perfusion and Functional Analysis of Patients with Ischemic Central Retinal Vein Occlusion
Author Affiliations & Notes
  • Charles Wykoff
    Retina Consultants of Houston, Houston, TX
    Weill Cornell Medical College, Methodist Hospital, Houston, TX
  • David Brown
    Retina Consultants of Houston, Houston, TX
    Weill Cornell Medical College, Methodist Hospital, Houston, TX
  • Daniel Croft
    Retina Consultants of Houston, Houston, TX
  • Footnotes
    Commercial Relationships Charles Wykoff, Genentech (R), Regeneron (R), Bayer (C); David Brown, Regeneron Pharmaceuticals, Inc. (F), Regeneron Pharmaceuticals, Inc. (C), Regeneron Pharmaceuticals, Inc. (R), Bayer HealthCare (F), Bayer HealthCare (C), Bayer HealthCare (R), Genentech (C), Roche (C), Alimera (C), Alcon (C), Novartis (C), Thrombogenics (C), Genentech (F), Roche (F), Thrombogenics (F), GSK (F), Alimera (F), Alcon (F), Allergan (F), Eli Lilly (F); Daniel Croft, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1156. doi:
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    • Get Citation

      Charles Wykoff, David Brown, Daniel Croft, RAVE Study Group; Peripheral Retinal Perfusion and Functional Analysis of Patients with Ischemic Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1156.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Progressive retinal perfusion and peripheral visual field (VF) changes in eyes with central retinal vein occlusions (CRVO) are incompletely understood. Our purpose was to quantify long-term trends in capillary non-perfusion and VF patterns in patients with ischemic CRVO treated with ranibizumab over 36 months.

 
Methods
 

Wide-field fluorescein angiography (FA) and Goldmann VF (GVF) were performed serially in patients with ischemic CRVO who were treated in the 36-month prospective Rubeosis Anti-VEGF (RAVE) trial evaluating intravitreal ranibizumab. All patients received ranibizumab injections for 9 months followed by pro re nata ranibizumab in months 12-36. Serial wide-field FA was performed with a Heidelberg Spectralis HRA utilizing the Staurenghi contact lens. Areas of perfusion/non-perfusion were graded by masked graders and pixels quantified. GVF were assessed every 6 months and changes in the I-4e isopter were analyzed.

 
Results
 

Twelve patients had sequential wide-field FA for 36 months. At baseline, mean perfusion was 36.7% (106.4 disc areas) of the gradable field (mean: 290 disc areas, range 178-452). The area of non-perfusion increased in all patients with a mean loss of approximately 5% of retina area (loss of 14.5 mean disc areas of perfusion) per 6 month period. In comparison to progressive loss of perfusion, 3 patterns of GVF progression were identified: early loss (n=6), early gain with late loss (n=3), and stability (n=3). Progressive non-perfusion and changes in GVF were most pronounced in the first year of the trial. Despite capillary and GVF losses, vision improved in these eyes from a baseline of 23.1 best corrected Early Treatment Diabetic Retinopathy Study (ETDRS) letters to 30.5 ETDRS letters (mean gain: +7.4 letters) at month 36.

 
Conclusions
 

In this prospective CRVO trial, progressive capillary loss was quantified. Similarly, peripheral visual field loss as measured by GVF progressed in most eyes (n=9). Changes in perfusion and GVF were particularly evident in the first year of treatment. Despite perfusion and GVF losses in many patients, vision improved, as the majority of these anatomic and functional changes were peripheral.

 
 
Wide field fluorescein angiogram of ischemic CRVO at baseline
 
Wide field fluorescein angiogram of ischemic CRVO at baseline
 
 
Wide field fluorescein angiogram of the same ischemic CRVO after 2 years of intravitreal ranibizumab treatment showing extensive loss of retinal perfusion
 
Wide field fluorescein angiogram of the same ischemic CRVO after 2 years of intravitreal ranibizumab treatment showing extensive loss of retinal perfusion
 
Keywords: 572 ischemia • 749 vascular occlusion/vascular occlusive disease • 550 imaging/image analysis: clinical  
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