Macular Ischemia Correlated with Final Visual Outcome in Retinal Vein Occlusion Patients

Gwang Myung Noh; Ji Eun Lee; Ki Yup Nam; Seung Uk Lee; Sang Joon Lee

doi:10.3341/jkos.2014.55.10.1493

Journal List > J Korean Ophthalmol Soc > v.55(10) > 1009810

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Noh, Lee, Nam, Lee, and Lee: Macular Ischemia Correlated with Final Visual Outcome in Retinal Vein Occlusion Patients

Original Article

J Korean Ophthalmol Soc 2014;55(10):1493-1498.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.10.1493

Macular Ischemia Correlated with Final Visual Outcome in Retinal Vein Occlusion Patients

Gwang Myung Noh, MD, Ji Eun Lee, MD, Ki Yup Nam, MD, PhD, Seung Uk Lee, MD, PhD, Sang Joon Lee, MD, PhD

Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea

Address reprint requests to Sang Joon Lee, MD, PhD, Department of Ophthalmology, Kosin University Gospel Hospital, #262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea, Tel: 82-51-990-6140, Fax: 82-51-990-3026 E-mail: hhiatus@gmail.com

Received 25 January 2014 Revised 23 May 2014 Accepted 29 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To identify the correlation between final visual outcome after at least 6 months of follow-up and the extent of macular ischemia on the first visit.

Methods

We performed a retrospective clinical analysis of macular ischemia using clinical records, fundus examinations, and fluorescein angiographies in 83 patients (86 eyes) diagnosed with retinal vein occlusion from January 1998 to July 2012 and followed up for over 6 months. We evaluated the extent and the location of macular ischemia, macular edema, initial and final visual acuities and systemic disease based on fluorescein angiography and optical coherence tomography performed within 2 weeks of the first visit. The patients were divided into the following 4 groups based on the extent and location of macular ischemia and edema: superotemporal, superonasal, inferotemporal, and inferonasal.

Results

Retinal vein occlusions (RVOs) consisted of 24 central RVOs (CRVOs) and 62 branch RVOs (BRVOs). Mean initial acuity (log MAR) was 0.35 ± 0.31 (36 eyes) in the no macular ischemia group, 0.40 ± 0.21 (11 eyes) in the 1-quadrant macular ischemia group, 0.71 ± 0.32 (26 eyes) in the 2-quadrant macular ischemia group and 0.73 ± 0.36 (13 eyes) in the over 3 quadrants macular ischemia group. Mean final acuity (log MAR) was 0.23 ± 0.23 in the no macular ischemia group, 0.40 ± 0.30 in the 1-quadrant macular ischemia group, 0.51 ± 0.32 in the 2-quadrant macular ischemic group and 0.73 ± 0.31 in the over 3 quadrants macular ischemia group.

Conclusions

The initial and final visual outcomes were worse when more quadrants were affected by macular ischemia. The extent of macular ischemia was correlated with initial visual acuity and final visual outcome but not with macular edema.

Keywords: Capillary nonperfusion, Macular ischemia, Retinal vein occlusion, Visual prognosis

References

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Figure 1.

(A) Fluorescein angiography shows broken perifoveal capillary network with capillary nonperfusion area which involves 2 quadrants within 1 disc diameter of the center of fovea. (B) Fluorescein angiography (early phase) shows intact perifoveal capillary network without capillary nonperfusion area. (C) Fluorescein angiography shows intact perifoveal capillary network with capillary nonperfusion area at superior m acule.

Figure 2.

Correlation between the extent of macular ischemia and the visual acuity (VA). (A) As the extent of macular ischemia occupies more area, it shows low initial visual acuity. (B) As the extent of macular ischemia occupies more area, there is a tendency to show low final visual acuity. It means that the larger ischemic area is, the worse visual outcome is to come. Q = quadrant of macular ischemic area. ^*p-value: statistical significances were tested by one-way ANOVA.

Table 1.

Characteristics of retinal vein occlusion patients

Characteristics	Subjects (n = 83)
Mean age (years) (range)	59.1 ± 11.5 (33-84)
Sex (M:F) (n) (%)	33 (39.76):50 (60.24)
Diagnosis (eyes)
Central retinal vein occlusion	24
Branch retinal vein occlusion	62
Duration of follow-up (months)	15.3 ± 6.5
Management (eyes)	65
Observation (eyes)	21
Initial visual acuity (log MAR)
Total	0.52 ± 0.35
Central retinal vein occlusion	0.51 ± 0.37
Branch retinal vein occlusion	0.53 ± 0.34
Final visual acuity (log MAR)
Total	0.41 ± 0.33
Central retinal vein occlusion	0.41 ± 0.39
Branch retinal vein occlusion	0.41 ± 0.31

Values are presented as mean ± SD unless otherwise indicated. log MAR = logarithm of the minimal angle of resolution.

Table 2.

Correlation between the extent of macular ischemia and systemic diseases associated with retinal vein occlusion

Systemic diseases	No. of cases (%)	p-value^*
Hypertension	29 (34.52)	0.866
Diabetes	11 (13.10)	0.146
Cardiovascular	9 (10.71)	0.510
Glaucoma	5 (5.95)	0.520
Hyperlipidemia	20 (23.81)	0.285
Total	74

^* p-value: statistical significances were tested by Pearson correlation test.

Table 3.

Visual outcome of the retinal vein occlusion (RVO)

Visual outcome	No. of cases (%)	Non-ischemia (%)	Ischemia (%)
Improvement	39 (45.35)	24 (66.67)	15 (30)
Stationary	32 (37.21)	7 (19.44)	25 (50)
Worseness	15 (17.44)	5 (13.89)	10 (20)
Total	86 (100)	36 (100)	50 (100)

Table 4.

Comparison of visual acuity between treated group and untreated group

Visual acuity	Treatment group (n = 65)	Observation group (n = 21)	p-value^*
Initial BCVA (log MAR)	0.61 ± 0.34	0.26 ± 0.25	<0.001
Final BCVA (log MAR)	0.45 ± 0.34	0.30 ± 0.27	0.073
Final-initial (log MAR)	−0.16 ± 0.35	0.04 ± 0.13	0.014

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; log MAR = logarithm of the minimal angle of resolution.

^* p-value: statistical significances were tested by independent t-test.

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