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EVALUATION OF MACULAR ISCHEMIA IN EYES WITH CENTRAL RETINAL VEIN OCCLUSION: An Optical Coherence Tomography Angiography Study

Ghashut, Rima, MD*; Muraoka, Yuki, MD, PhD*; Ooto, Sotaro, MD, PhD*; Iida, Yuto, MD*; Miwa, Yuko, MD*; Suzuma, Kiyoshi, MD, PhD*; Murakami, Tomoaki, MD, PhD*; Kadomoto, Shin, MD*,†; Tsujikawa, Akitaka, MD, PhD*,‡; Yoshimura, Nagahisa, MD, PhD*,†

doi: 10.1097/IAE.0000000000001749
Original Study: PDF Only

Purpose: To quantitatively assess macular perfusion status using optical coherence tomography angiography in eyes with aflibercept-treated central retinal vein occlusion and resolved macular edema and to investigate the impact of macular morphology and perfusion status on visual function.

Methods: This prospective consecutive case series included 23 patients with central retinal vein occlusion. All patients received intravitreal aflibercept injections before analysis. Visual acuity, macular sensitivity, and the macular nonperfusion area (NPA) were evaluated in eyes without macular edema. The macular NPA was evaluated by optical coherence tomography angiography using 3 mm × 3 mm images of the macula. Foveal ellipsoid zone disruption was also analyzed.

Results: The superficial macular NPA measured 4.15 mm2 ± 0.71 mm2 (95% confidence interval 3.85–4.46), and the deep macular NPA measured 4.23 mm2 ± 0.97 mm2 (95% confidence interval 3.82–4.56). The logarithm of the minimum angle of resolution visual acuity was significantly associated with foveal ellipsoid zone disruption (P = 0.001), the superficial macular NPA (P = 0.015), and the deep macular NPA (P = 0.018). Macular sensitivity correlated negatively with logarithm of the minimum angle of resolution visual acuity (P = 0.007), the superficial macular NPA (P = 0.029), and the deep macular NPA (P = 0.040), but not with the foveal ellipsoid zone disruption (P = 0.435).

Conclusion: Optical coherence tomography angiography is a novel technique that enables segmented evaluation of the macular perfusion status in eyes with central retinal vein occlusion and provides visual prognostic information. Enlargement of the macular NPA in the superficial and deep layers was significantly correlated with impaired visual acuity and with decreased macular sensitivity in patients with aflibercept-treated central retinal vein occlusion and resolved macular edema.

Enlargement of the macular nonperfusion area was significantly correlated with impaired visual acuity and decreased macular sensitivity in patients with central retinal vein occlusion without macular edema.

*Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan;

Department of Ophthalmology, Kitano Hospital, Osaka, Japan; and

Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Kagawa, Japan.

Reprint requests: Yuki Muraoka, MD, PhD, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: muraoka@kuhp.kyoto-u.ac.jp

Supported in part by the Japan Society for the Promotion of Science (JSPS), Tokyo, Japan (Grant-in-Aid for Scientific Research, number 21592256); the Japan National Society for the Prevention of Blindness, Tokyo, Japan; Novartis Pharma K.K., Tokyo, Japan; and the Innovative Techno-Hub for Integrated Medical Bio-Imaging of the Project for Developing Innovation Systems from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan. The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript.

Y. Muraoka has received grant support from Bayer, Novartis Pharma K.K., Senju, and Nidek; S. Ooto has received grant support from Novartis Pharma K.K., Bayer, Santen, and Senju; K. Suzuma has received grant support from Novartis Pharma K.K. and Bayer; T. Murakami has received grant support from Bayer, Novartis Pharma K.K., Santen, and Senju; A. Tsujikawa has received grant support from Pfizer, Novartis Pharma K.K., Bayer, Alcon, Santen, Senju, Nidek, and AMO Japan; and N. Yoshimura has received grant support from Topcon Corporation, Nidek, and Canon. N. Yoshimura has also served as a consultant for Nidek. None of the remaining authors has any conflicting interests to disclose.

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© 2018 by Ophthalmic Communications Society, Inc.