Clinical Correlation Of Wide-angle Fluorescein Angiography And Retinal Oxymetry Findings In The Treatment Response Of Retinal Vein Occlusions

Abstract

 

Purpose:

 

To study the association of angiographic non-perfusion and retinal oxygenation status with the treatment response in retinal vein occlusions.

 

Methods:

 

Prospective case series. Patients with a diagnosis of central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) were recruited. Evaluations were performed every 4 weeks +/- 7 days for 3 months. All subjects underwent a complete ophthalmologic evaluation, retinal oximetry (RO) and spectral domain optical coherence tomography (SD-OCT) at every visit. Ultra wide-field fluorescein angiography (UWFA) was performed at baseline and after 3 months of follow-up. Based on clinical findings, patients received laser and/or anti-VEGF treatments. The RO images were graded by hemoglobin oxygen saturation using the Oxymap software. The UWFA images were graded with the ischemic index (II) using Adobe Photoshop CS3.

 

Results:

 

Twenty eyes of 20 patients were studied. Three patients were excluded due to poor quality of the images. Seventeen patients were included with a mean age of 72.5 years (range 55-86). Mean follow-up of the vein occlusions was 23.4 months. Ten eyes had residual cystoid macular edema (CME) after failed treatments. UWFA showed peripheral areas of non-perfusion with an ischemic index (II) that ranged from 16-33%. RO images demonstrated a low hemoglobin oxygen saturation in 100% of cases. CRVO patients showed a lower saturation than BRVO cases and these indices improved after receiving treatment. Persistence of CME was associated with a higher ischemic index and lower oxygen saturation levels, and some of these cases seemed to benefit from laser treatment in addition to intravitreal injections of anti-VEGF.

 

Conclusions:

 

Hemoglobin oxygen saturation may fluctuate after treatment but its correlation with CME is weak. Areas of non-perfusion shown in UWFA were correlated with persistence of CME. Patients with higher II might need a combination of laser+intravitreal injections of anti-VEGF to improve the clinical outcome in cases of retinal vein occlusions.

 

Keywords: vascular occlusion/vascular occlusive disease • imaging/image analysis: clinical • laser