Prognosis and Disorganization of Retinal Inner Layers in Central Retinal Vein Occlusion with Dexamethasone Implantation

Hyun-Ji Kang; Yong-Wun Cho; Byeong-Sun Kim; Ji-Sung Jeong; Jong-Moon Park; In Young Chung; Woong-Sun Yoo

doi:10.3341/jkos.2019.60.11.1058

Journal List > J Korean Ophthalmol Soc > v.60(11) > 1137321

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kang, Cho, Kim, Jeong, Park, Chung, and Yoo: Prognosis and Disorganization of Retinal Inner Layers in Central Retinal Vein Occlusion with Dexamethasone Implantation

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(11): 1058-1063.

Published online: 19 November 2019

DOI: https://doi.org/10.3341/jkos.2019.60.11.1058

Prognosis and Disorganization of Retinal Inner Layers in Central Retinal Vein Occlusion with Dexamethasone Implantation

Hyun-Ji Kang, MD¹, Yong-Wun Cho, MD^1,², Byeong-Sun Kim, MD^1,², Ji-Sung Jeong, MD^1,², Jong-Moon Park, MD, PhD^1,^2,³, In Young Chung, MD, PhD^1,^2,³, Woong-Sun Yoo, MD^1,^2,³

¹Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea.

²Department of Ophthalmology, Gyeongsang National University Hospital, Jinju, Korea.

³Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.

Address reprint requests to Woong-Sun Yoo, MD. Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea. Tel: 82-55-750-8171, Fax: 82-55-758-4158, oocee@hanmail.net

Received 22 May 2019 Revised 3 June 2019 Accepted 24 October 2019

The Korean Ophthalmological Society

(open-access):

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 examine whether disorganization of retinal inner layers (DRILs) at baseline and after treatment was associated with visual acuity in patients with macular edema secondary to central retinal vein occlusion (CRVO) who were treated with intravitreal dexamethasone implants.

Methods

A retrospective review of records of 22 patients with treatment-naive CRVO with centrally involved macular edema treated with intravitreal dexamethasone implants. Spectral domain-optical coherence tomography images were obtained during each visit. The DRIL extent and additional parameters were evaluated in a 2,000 µm-wide foveal centered area.

Results

In the 22 patients (74.5 ± 8.92 years), baseline DRIL was observed in 21 eyes (94.5%). Using univariate analysis, baseline best corrected visual acuity (BCVA) was significantly associated with the extent of baseline DRIL (p = 0.005, r = −0.58), and the extent of external limiting membrane disruption and ellipsoid zone (p = 0.015, r = −0.51; p = 0.011, r = −0.533, respectively). The final BCVA was significantly correlated with the baseline BCVA (p < 0.001, r = 0.74) and extent of DRIL (p = 0.04, r = −0.35). Changes in the BCVA were correlated with changes of DRIL between baseline and the final visit (p = 0.041, r = 0.439).

Conclusions

The extents of baseline DRIL and DRIL changes after treatment with intravitreal dexamethasone implants for macular edema secondary to CRVO may be useful parameter for visual acuity improvement.

Keywords: Dexamethasone, Disorganization of retinal inner layers, Macular edema, Retinal vein occlusion

Figures and Tables

Figure 1

Spectral domain-optical coherence tomography of disorganization of retinal inner layers (DRIL) in a representative case. The yellow lines highlight the inner retinal layer interfaces, which disappear in the areas of DRIL.

Figure 2

Mean best corrected visual acuity (BCVA) at baseline, 4 months, and 8 months after treatment. BCVA showed increase in 4 months and 8 months after treatment. M = months.

Figure 3

Mean central retinal thickness (CRT) at baseline, 4 months, and 8 months after treatment. CRT was decreased in 4 months and 8 months after treatment. M = months.

Figure 4

Mean extent of disorganization of inner retinal layers (DRIL) at baseline, 4 months, and 8 months after treatment. DRIL was decreased in 4 months and 8 months after intravitreal dexamethasone implant injection. M = months.

Figure 5

Scatter plot graph between the change of best-corrected visual acuity (BCVA) and the decrease of disorganization of retinal inner layers (DRIL) extent. It shows that more DRIL extent decrease associated with more improvement of BCVA with statistically significant.

Table 1

Baseline characteristics and initial SD-OCT parameters of patients

Values are presented as mean ± standard deviation or number unless otherwise indicated.

SD-OCT = spectral domain optical coherence tomography; M:F = male:female; R:L = right:left; FA = fluorescein angiography; DM = diabetes mellitus; RVO = retinal vein occlusion; BCVA = best corrected visual acuity; CRT = central retinal thickness; DRIL = dIsorganization of retinal inner layers; IRC = intra retinal cyst; SRF = sub retinal fluid; ELM = external limiting membrane; EZ = ellipsoid zone.

Table 2

Association of baseline SD-OCT parameters with baseline BCVA

SD-OCT = spectral domain optical coherence tomography; BCVA = best corrected visual acuity; CRT = central retinal thickness; DRIL = disorganization of retinal inner layers; IRC = intra retinal cyst; SRF = sub retinal fluid; ELM = external limiting membrane; EZ = ellipsoid zone.

^*Pearson correlation.

Table 3

Association of baseline SD-OCT parameters with final BCVA

SD-OCT = spectral domain-optical coherence tomography; BCVA = best corrected visual acuity; CRT = central retinal thickness; DRIL = disorganization of retinal inner layers; IRC = intra retinal cyst; SRF = sub retinal fluid; ELM = external limiting membrane; EZ = ellipsoid zone.

^*Pearson correlation coefficient.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

References

1. Cugati S, Wang JJ, Rochtchina E, Mitchell P. Ten-year incidence of retinal vein occlusion in an older population: the Blue Mountains Eye Study. Arch Ophthalmol. 2006; 124:726–732.

2. McIntosh RL, Mohamed Q, Saw SM, Wong TY. Interventions for branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology. 2007; 114:835–854.

3. Pielen A, Feltgen N, Isserstedt C, et al. Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review. PLoS One. 2013; 8:e78538.

4. Ota M, Tsujikawa A, Kita M, et al. Integrity of foveal photoreceptor layer in central retinal vein occlusion. Retina. 2008; 28:1502–1508.

5. Sun JK, Radwan SH, Soliman AZ, et al. Neural retinal disorganization as a robust marker of visual acuity in current and resolved diabetic macular edema. Diabetes. 2015; 64:2560–2570.

6. Santos AR, Costa MÂ, Schwartz C, et al. Optical coherence tomography baseline predictors for initial best-corrected visual acuity response to intravitreal anti-vascular endothelial growth factor treatment in eyes with diabetic macular edema: the CHARTRES study. Retina. 2018; 38:1110–1119.

7. Nicholson L, Ramu J, Triantafyllopoulou I, et al. Diagnostic accuracy of disorganization of the retinal inner layers in detecting macular capillary non-perfusion in diabetic retinopathy. Clin Exp Ophthalmol. 2015; 43:735–741.

8. Babiuch AS, Han M, Conti FF, et al. Association of disorganization of retinal inner layers with visual acuity response to anti-vascular endothelial growth factor therapy for macular edema secondary to retinal vein occlusion. JAMA Ophthalmol. 2019; 137:38–46.

9. Mimouni M, Segev O, Dori D, et al. Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with macular edema secondary to vein occlusion. Am J Ophthalmol. 2017; 182:160–167.

10. Kim TH, Yoon CK, Lee JE, et al. One-year outcome of intravitreal dexamethasone implant for macular edema secondary to central retinal vein occlusion. J Korean Ophthalmol Soc. 2016; 57:1918–1925.

TOOLS

Similar articles