Neuroretinal atrophy following resolution of macular oedema in retinal vein occlusion

Br J Ophthalmol. 2019 Jan;103(1):36-42. doi: 10.1136/bjophthalmol-2017-311614. Epub 2018 Mar 6.

Abstract

Background/aims: To characterise neuroretinal atrophy in retinal vein occlusion (RVO).

Methods: We included patients with central/branch RVO (CRVO=196, BRVO=107) who received ranibizumab according to a standardised protocol for 6 months. Retinal atrophy was defined as the presence of an area of retinal thickness (RT) <260 µm outside the foveal centre. Moreover, the thickness of three distinct retinal layer compartments was computed as follows: (1) retinal nerve fibre layer to ganglion cell layer, (2) inner plexiform layer (IPL) to outer nuclear layer (ONL) and (3) inner segment/outer segment junction to retinal pigment epithelium. To characterise atrophy further, we assessed perfusion status on fluorescein angiography and best-corrected visual acuity (BCVA), and compared these between eyes with/without atrophy.

Results: 23 patients with CRVO and 11 patients with BRVO demonstrated retinal atrophy, presenting as sharply demarcated retinal thinning confined to a macular quadrant. The mean RT in the atrophic quadrant at month 6 was 249±26 µm (CRVO) and 244±29 µm (BRVO). Individual layer analysis revealed pronounced thinning in the IPL to ONL compartment. Change in BCVA at 6 months was similar between the groups (BRVO, +15 vs +18 letters; CRVO, +14 vs +18 letters).

Conclusions: In this exploratory analysis, we describe the characteristics of neuroretinal atrophy in RVO eyes with resolved macular oedema after ranibizumab therapy. Our analysis shows significant, predominantly retinal thinning in the IPL to ONL compartment in focal macular areas in 11% of patients with RVO. Eyes with retinal atrophy did not show poorer BCVA outcomes.

Keywords: imaging; retina.

Publication types

  • Clinical Trial, Phase III
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / therapeutic use*
  • Atrophy
  • Female
  • Fluorescein Angiography
  • Humans
  • Intravitreal Injections
  • Light Coagulation* / methods
  • Macular Edema / drug therapy*
  • Macular Edema / etiology
  • Macular Edema / pathology*
  • Male
  • Middle Aged
  • Optic Atrophy
  • Prospective Studies
  • Ranibizumab / therapeutic use*
  • Regression Analysis
  • Retina / pathology*
  • Retinal Neurons / pathology*
  • Retinal Vein Occlusion / complications*
  • Tomography, Optical Coherence
  • Visual Acuity / physiology

Substances

  • Angiogenesis Inhibitors
  • Ranibizumab