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Mark Goerlitz-Jessen, Tahreem Aman Mir, Akshay S Thomas, Stephen Paul Yoon, Sharon Fekrat; The Impact and Implication of a Fovea-Involving Intraretinal Hemorrhage in Patients with Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5459.
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© ARVO (1962-2015); The Authors (2016-present)
To understand the impact and implication of a fovea-involving intraretinal hemorrhage in central retinal vein occlusion (CRVO).
A retrospective review of medical records was performed for all patients diagnosed with CRVO, seen in the Retina Division at the Duke Eye Center, from January 1, 2009 – June 30, 2016 with a follow-up duration of ≥6 months. The presence or absence and size of fovea-involving hemorrhage were determined on presenting fundus photographs. The main outcome measure was mean change in visual acuity (VA) at the final follow-up visit. Secondary outcomes included percentage of patients with gain of > 3 lines, mean change in central subfield thickness (CST) from baseline, and mean number of intravitreal anti-VEGF injections received during the first year of follow-up and by the final follow-up visit.
One hundred and fifteen (39.8%) of the total 289 CRVO patients identified had fovea-involving hemorrhage. At baseline, patients with fovea-involving hemorrhage (Group 1) had significantly poorer mean logMAR VA (1.2±0.1 vs 0.9±0.06, p=0.001) and a higher CST (610.4±35.9 vs 435.0±21.6 µm, p<0.001) compared to patients without fovea-involving hemorrhage (Group 2). The mean fovea-involving hemorrhage size was 8.68±1.01 disc areas (DAs), with 39% of patients >5 DAs. The mean duration of follow-up was similar for both groups (46.1 vs 34.9 months, p=0.38).Improvement from baseline VA at final follow-up was similar for both groups (0.11±0.05 vs 0.08±0.08, p=0.74). However, a significantly higher percentage of eyes in Group 1 had improvement in vision of ≥3 lines (31.3% vs. 10.3%, p<0.001). At the final follow-up, there was a trend to poorer vision in Group 1 (1.24±0.09 vs 1.02±0.08, p=0.08). The mean decrease in CST was greater for Group 1 compared to Group 2 (325.5±42.6 vs. 136.9±27.8 µm, p<0.001) at final follow-up. On average patients in Group 1 received a significantly greater number of intravitreal anti-VEGF injections at year 1 (4.2±0.4 vs 2.6±0.3, p=0.001) and also by the final follow-up visit (7.02±0.91 vs 4.27±0.56, p=0.01).
Fovea-involving hemorrhage was associated with poorer baseline VA, greater CST, and greater treatment burden. There was also a trend towards poorer visual outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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