Author: Andrea Attilio Rosolia (Italy)
Co-authors: Andrea Attilio Rosolia, Alessandro Arrigo, Alessio Antropoli, Lorenzo Bianco, Maurizio Battaglia Parodi, Francesco Maria Bandello
Purpose
To investigate the influence of the OCT biomarker foveal eversion (FE) on treatment response and persistence of macular edema (ME) due to retinal vein occlusion.
Setting/Venue
Department of Ophthalmology, Scientific Institute San Raffaele Hospital, University Vita-Salute, Milan, Italy.
Methods
We retrospectively studied 168 eyes with Central Retinal Vein Occlusion (CRVO) and 116 eyes with Branch Retinal Vein Occlusion (BRVO). The inclusion criterion was the presence of a clinically relevant macular edema. All patients received treatment with intravitreal anti-VEGF, dexamethasone, or both. From structural Optical Coherence Tomography images (Spectralis HRA, Heidelberg Engineering; Heidelberg, Germany), we extracted the presence of foveal eversion, defined as a complete convex profile of the central fovea, the behavior of macular edema and central macular thickness (CMT) during 24 ± 30 months of follow-up.
Results
64 out of 168 CRVO eyes (38%) and 25 out of 116 BRVO eyes (22%) showed foveal eversion. Eyes with and without foveal eversion resulted in age- and sex-matched (p˃0.05), the percentage of iRVO and laser treatment was similar between the two groups (p˃0.05), as the percentage of eyes underwent cataract surgery (p˃0.05). In CRVO eyes, the mean number of injections required from the FE eyes was higher (12 ± 8 vs. 6 ± 7) (p˂0.001). The mean baseline LogMAR BCVA was similar with 12-month follow-up (p˃0.05), while the last LogMAR BCVA showed a significant worsening in eyes with FE (p˂0.001). The mean CMT was significantly higher in eyes with FE at baseline, after 12 months, and at last follow-up (p˂0.001). Comparably, in BRVO eyes, the mean number of injections required from the FE eyes was higher (10 ± 9 vs 5 ± 5), the mean LogMAR BCVA was higher in eyes with FE at baseline and after 12-months follow-up (p˂0.01), as the mean CMT was significantly higher in eyes with FE at baseline, after 12 months and at last control (p˂0.001).
Conlusions
The eversion of the foveal profile is a poorly investigated structural OCT biomarker. We showed a clinical relevance of FE, associated with higher percentage of ME persistence in retinal vein occlusion. In the perspective of even more optimized and personalized therapeutic strategies, foveal eversion might represent an easily evaluable biomarker for the management of CRVO and BRVO eyes. The anatomical explanation of a chronic complete eversion of the foveal profile is not completely clear; it could be the final effect of a combination of significant retinal structural loss. Considering the role of intraretinal glial cells, in particular Müller cells, in the metabolic functions of the retina, including regulation of permeability, release of growth factors and other inflammatory mediators, this process might be related to a strong involvement of these cells. This specific cytotype is densely present in the fovea, and it might be responsible for a remarkable loss of foveal structural and functional integrity, leading to the onset of foveal eversion.
Financial Disclosure
None
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