EVALUATION BIOMARKERS ON OPTICAL COHERENCE TOMOGRAPHY IN PATIENTS WITH MACULAR EDEMA DUE TO CENTRAL RETINAL VEIN OCCLUSION WITH ANTIANGIOGENE TREATMENT
Abstract
Retinal vein occlusions (RVO) are the second leading cause of vision loss from retinal vascular diseases in the adult population. Vascular endothelial growth factor (VEGF) plays a major role in the pathophysiology of RVO. The aim of the study is to evaluate structural biomarkers and their impact on acuity, as well as to determine the correlation between visual acuity and the number of applications. The study includes 24 patients with macular edema as a result of central retinal vein occlusion, who are treated with an antiangiogenic drug - Aflibercept. Analysis of SD-OCT/OCTA tomograms was performed at 3 time points (before treatment, at 3 and 6 months) from the start of treatment. Biomarkers were analyzed: Central subfield thickness (CST), presence of epiretinal membrane, change in vascular density in the foveal zone before treatment and at the 6th month of treatment, evaluation of the effect on visual acuity and correlation with intravitreal applications. In the 24 patients (24 eyes) included, a decrease in CST was observed in all. In relation to visual acuity, there was an increase of 2 Snellen lines. Change in the vitreomacular interface was present in 42% of patients. Vascular density was evaluated with OCTA, the change of which was on average from 36.73% ± 11.13 to 23.58% ± 7.26. Antiangiogenic treatment is the first line of treatment for retinal vein occlusions. Timely use of these agents is crucial for better visual acuity, and analysis of biomarkers on optical coherence tomography has prognostic significance.
Keywords: vein occlusion, optical coherence tomography, angiography, anti VEGF, biomarkers.
References
2. Ponto KA, Elbaz H, Peto T, Laubert-Reh D, Binder H, Wild PS, et al. Prevalence and risk factors of retinal vein occlusion: the Gutenberg health study. J Thromb Haemost. 2015;13(7):1254–1263.
3. Hahn P, Fekrat S. Best practices for treatment of retinal vein occlusion. Curr Opin Ophthalmol . 2012;23:175–181.
4. Song P, Xu Y, Zha M, Zhang Y, Rudan I. Global epidemiology of retinal vein occlusion: a systematic review and meta-analysis of prevalence, incidence, and risk factors. J Glob Health. 2019 Jun;9(1):010427.
5. Shimura M, Utsumi T, Imazeki M, Yasuda K, Noma H. Efficacy-Based Aflibercept Treatment Regimen for Central Retinal Vein Occlusion. Ophthalmol Retina. 2021 Nov;5(11):1177-1179.
6. Maggio E, Mete M, Maraone G, Attanasio M, Guerriero M, Pertile G. Intravitreal injections for macular edema secondary to retinal vein occlusion: long-term functional and anatomical outcomes. J Ophthalmol. 2020; 2020:7817542.
7. Brown DM, Heier JS, Clark WL, et al. Intravitreal aflibercept injection for macular edema secondary to central retinal vein occlusion: 1-year results from the phase 3 COPERNICUS study. Am J Ophthalmol. 2013 Mar;155(3):429-437.
8. Ding X, Hu Y, Yu H, Li Q. Changes of Optical Coherence Tomography Biomarkers in Macular Edema Secondary to Retinal Vein Occlusion After Anti-VEGF and Anti-Inflammatory Therapies. Drug Des Devel Ther. 2022 Mar 15;16:717-725.
9. Campa C, Alivernini G, Bolletta E, Parodi MB, Perri P. Anti-VEGF Therapy for Retinal Vein Occlusions. Curr Drug Targets. 2016;17(3):328-36.
10. Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, et al. Guidelines for the management of retinal vein occlusion by the European Society of Retina Specialists (EURETINA) . Ophthalmologica . 2019; 242 ( 3 ):123–162.
11. Yiu G, et al. Spectral-domain OCT predictors of visual outcomes after ranibizumab treatment for macular edema resulting from retinal vein occlusion. Ophthalmol. Retina. 2020;4:67–76. doi: 10.1016/j.oret.2019.08.009 [ PubMed ]
12. Mimouni M, 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. doi: 10.1016/j.ajo.2017.08.005. [ PubMed ]
13. Chan EW, et al. Disorganization of retinal inner layers and ellipsoid zone disruption predict visual outcomes in central retinal vein occlusion. Ophthalmol Retina. 2019; 3 :83–92. doi: 10.1016/j.oret.2018.07.008. [ PubMed ]
14. Uji A, et al. Association between hyperreflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular edema. Am. J. Ophthalmol. 2012;153:710–717.e711. doi: 10.1016/j.ajo.2011.08.041. [ PubMed ]
15. Marmor MF. Mechanisms of fluid accumulation in retinal edema. Doc. Ophthalmol. 1999;97:239–249. doi: 10.1023/A:1002192829817. [ PubMed ]
16. Park DG, et al. Prospective trial of treat-and-extend regimen with aflibercept for branch retinal vein occlusion: 1-year results of the PLATON trial. Graefes. Arch. Clin. Exp. Ophthalmol. 2021; 259 :2879–2886. doi: 10.1007/s00417-021-05150-y. [ PubMed ]
17. Sirakaya E, Kucuk B, Agadayi A. Aflibercept treatment for macular edema following branch retinal vein occlusion: Age-based responses. Ophthalmologica. 2020; 243 :94–101. doi: 10.1159/000502042. [ PubMed ]
18. Korobelnik JF, Holz FG, Roider J, et al. GALILEO Study Group. Intravitreal Aflibercept Injection for Macular Edema Resulting from Central Retinal Vein Occlusion: One-Year Results of the Phase 3 GALILEO Study. Ophthalmology. 2014 Jan;121(1):202-208.
19. Korobelnik JF, Larsen M, Etter N, Bailey C, et al. Efficacy and Safety of Intravitreal Aflibercept Treat-and-Extend for Macular Edema in Central Retinal Vein Occlusion: the CENTERA Study. Am J Ophthalmol. 2021 Jul;227:106-115.
20. Campochiaro PA, Clark WL, Boyer DS, et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion: the 24-week results of the VIBRANT study. Ophthalmology. 2015 Mar;122(3):538-44.
21. Suzuki N, Hirano Y, Tomiyasu T, et al. Retinal hemodynamics seen on optical coherence tomography angiography before and after treatment of retinal vein occlusion. Invest Ophthalmol Vis Sci. 2016;57:5681–5687.
22. Ghasemi Falavarjani K, Iafe NA, Hubschman JP, et al. Optical coherence tomography angiography analysis of the foveal avascular zone and macular vessel density after anti-VEGF therapy in eyes with diabetic macular edema and retinal vein occlusion. Invest Ophthalmol Vis Sci. 2017;58:30–34.
23. Sellam A, Glacet-Bernard A, Coscas F, et al. Qualitative and quantitative follow-up using optical coherence tomography angiography of retinal vein occlusion treated with anti-VEGF: optical coherence tomography angiography follow-up of retinal vein occlusion. Retina. 2017;37:1176–1184.
24. Wakabayashi T, Sato T, Hara-Ueno CH, Fukushima Y, Sayanagi K, Shiraki N, Sawa M, Ikuno Y, Sakaguchi H, Nishida K. Retinal microvasculature and visual acuity in eyes with branch retinal vein occlusion: imaging analysis by optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2017; 58:2087–94.
25. Mastropasqua R, Toto L, Antonio LD, Borrelli E, Senatore A, Nicola MD, Martino GD, Ciancaglini D, Carpineto P. Optical coherence tomography angiography microvascular findings in macular edema due to central and branch retinal vein occlusions. Sci Rep. 2017; 7:40763.
26. Martinet V, Guigui B, Glacet-Bernard A, et al. Macular edema in central retinal vein occlusion: correlation between optical coherence tomography, angiography and visual acuity. Int Ophthalmol. 2012;32(4):369–77.
27. Coscas F, Glacet-Bernard A, Miere A, Caillaux V, Uzzan J, Lupidi M, Coscas G, Souied EH. Optical coherence tomography angiography in retinal vein occlusion: evaluation of superficial and deep capillary plexa. Am J Ophthalmol. 2016;161:160–71.