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P. Prasad, I. Tsui, G. Heilweil, J.-P. Hubschman, S. D. Schwartz; Ischemic Index for the Quantification of Retinal Non-Perfusion in Branch Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2010;51(13):285.
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To quantify retinal non-perfusion as an index for ischemia in patients with branch retinal vein occlusion (BRVO). To correlate ischemic index values with the presence of neovascularization and macular edema in BRVO.
An imaging database of ultra wide-field angiograms performed at a single academic institution was searched for patients with a diagnosis of BRVO. Images from 25 patients with BRVO not previously treated with focal macular laser, scatter photocoagulation or intravitreal pharmacotherapy were graded for the presence of non-perfusion, neovascularization and macular edema. Image analysis software was used to quantitatively measure areas of non-perfusion and to calculate a retinal ischemic index defined as total area of non-perfusion divided by total area of retina visualized. Statistical analysis was performed to determine the sensitivity and specificity of various degrees of non-perfusion for the presence of neovascularization and macular edema. A chart review (average follow-up time 16 months) was performed for all patients for the development of macular edema or neovascularization.
Ultra wide-field angiograms from 25 eyes of 25 patients were analyzed with a diagnosis of BRVO. Non-perfusion was visualized and quantified in all patients and an ischemic index was generated for each patient. Neovascularization and macular edema were seen in 28% and 80% of patients, respectively. Ischemic index values ranged from 0.1% to 30%. An ischemic index of 7% was 100% sensitive and 83% specific for the presence of neovascularization and 50% sensitive and 100% specific for macular edema. Increasing ischemic index for all patients was significantly associated with neovascularization (p < 0.01). Increasing inschemic index for patients with major BRVO was significantly associated with macular edema (p =0.028)
Retinal ischemia following branch retinal vein occlusion can be quantified utilizing ultra wide-field fluorescein angiography. A retinal ischemic index may help risk stratify patients with BRVO for the development of neovascularization and macular edema.
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