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.
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Contributors DP designed the study, analysed the data, and drafted and revised the paper. She is the guarantor. A-MP analysed the data and revised the manuscript draft. W-DV implemented the algorithm necessary for data analysis and revised the paper draft. JG planned and performed the statistical analysis of the paper and revised the paper draft. HB analysed the data, provided the visualisation of the data and revised the paper draft. BSG designed the study protocol and revised the paper draft. BHN analysed the data and revised the paper draft. SMW designed the study and coordinated the analysis, including the statistical analysis of the data, and drafted and revised the paper. UMS-E initiated the project, designed the study and revised the manuscript.
Funding Austrian Federal Ministry of Economy, Family and Youth, National Foundation for Research, Technology and Development.
Disclaimer The funding organisation had no role in the design or conduct of this research.
Competing interests UMS-E reports consultancy for Bayer, Boehringer and Novartis. BSG reports consultancy for Roche. SMW reports consultancy for Bayer and Novartis, as well as research support by Bayer and Genentech. All other authors have no financial interest to disclose.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval Ethics Committee of the Medical University of Vienna.
Provenance and peer review Not commissioned; externally peer reviewed.
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