Association of Disorganization of Retinal Inner Layers with Ischemic Index and Visual Acuity in Central Retinal Vein Occlusion
Association of Disorganization of Retinal Inner Layers with Ischemic Index and Visual Acuity in Central Retinal Vein Occlusion
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DOI：
10.1016/j.oret.2018.04.019
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发表时间：
2018-11-01
影响因子：
4.5
通讯作者：
Grewal, Dilraj S.
中科院分区：
文献类型：
--
作者：
Berry, Duncan;Thomas, Akshay S.;Grewal, Dilraj S.
目的：为了确定OCT显示的视网膜内层（DRIL）紊乱是否与超宽视野荧光素血管造影（UWFFA）显示的缺血以及急性、未经治疗的视网膜中央静脉阻塞（CRVO）患者的视力结果相关。设计：回顾性、单机构、纵向队列研究。参与者：25名连续的未经治疗的CRVO患者，随访时间> 1年。在基线、6个月、12个月和最终访视时，由两名独立的设盲分级员评价DRIL、椭圆区（EZ）破坏、外界膜（ELM）破坏和其他OCT参数的程度。基线UWFFA图像评估缺血指数值和中心凹无血管区（FAZ）expansion.Main Outcome Measures：DRIL与UWFFA结果和临床结局（包括矫正视力（VA））的相关性。结果：最终随访的中位时间为24个月（范围：12.1e43.9个月）。基线时的中位DRIL范围为765 μ m（范围，0-1000 mm）。基线时25只眼中有18只（72%）有一定程度的DRIL，25只眼中有20只（80%）有囊样黄斑水肿（CME）。基线时DRIL的存在或程度与VA的出现无关。在每次访视的横断面分析中，DRIL程度与6个月（r = 0.656; P = 0.001）和最终（r = 0.509; P = 0.016）访视时的VA恶化相关。在最终随访时，DRIL范围是与基线缺血指数（r = 0.418; P = 0.047）和基线UWFFA上FAZ扩大（P = 0.057）最强相关的OCT参数。在多变量回归分析，DRIL程度在最终随访是唯一的OCT参数与较差的VA（P = 0.013），并仍然显着时，占CME作为一个潜在的confronter.Conclusions：DRIL的程度是不相关的治疗初治的眼睛与急性CRVO提出VA。然而，在6个月的随访后，DRIL程度与VA恶化相关，并且在超过2年的随访中预测VA恶化。基线时UWFFA的缺血特征可预测最终随访时DRIL发展的程度。(C)2018年美国眼科学会。
Purpose: To determine whether disorganization of retinal inner layers (DRIL) on OCT is associated with ischemia on ultra-widefield fluorescein angiography (UWFFA) and with visual outcomes in eyes with acute, treatment-naive central retinal vein occlusion (CRVO).Design: Retrospective, single-institution, longitudinal cohort study.Participants: Twenty-five consecutive patients with treatment-naive CRVO and > 1-year follow-up.Methods: Two independent masked graders evaluated the extent of DRIL, ellipsoid zone (EZ) disruption, external limiting membrane (ELM) disruption, and other OCT parameters at the baseline, 6-month, 12-month, and final visits. Baseline UWFFA images were assessed for ischemic index values and foveal avascular zone (FAZ) enlargement.Main Outcome Measures: Associations of DRIL with UWFFA findings and clinical outcomes including corrected visual acuity (VA).Results: The median time to final follow-up was 24 months (range, 12.1e43.9 months). Median DRIL extent at baseline was 765 mu m (range, 0-1000 mm). Eighteen of 25 eyes (72%) had some degree of DRIL at baseline, and 20 of 25 eyes (80%) had cystoidmacular edema (CME). Neither the presence nor extent of DRIL at baselinewas associated with presenting VA. In a cross-sectional analysis of each visit, extent of DRIL correlated with worse VA at both the 6-month (r = 0.656; P = 0.001) and final (r = 0.509; P = 0.016) visits. At final follow-up, DRIL extent was the OCT parameter most strongly correlated with baseline ischemic index (r = 0.418; P = 0.047) and baseline enlarged FAZ (P = 0.057) onUWFFA. On multivariate regression analysis, DRIL extent at final follow-up was the only OCT parameter associated with worse VA (P = 0.013) and remained significant when accounting for CME as a potential confounder.Conclusions: Extent of DRIL was not associated with presenting VA in treatment-naive eyes with acute CRVO. After 6 months of follow-up, however, DRIL extent correlated with worse VA and was predictive of worse VA throughout more than 2 years of follow-up. Ischemic features on UWFFA at baseline are predictive of the extent of DRIL development at final follow-up. (C) 2018 by the American Academy of Ophthalmology.