Search Results (41)

Background: Branch retinal vein occlusion (BRVO) represents a segmental retinal ischemic disorder characterized by localized oxidative–inflammatory activation. While redox-driven cytokine responses have been described in central retinal vein occlusion, their role in BRVO-specific macular edema and treatment responsiveness remains unclear. This study investigated whether novel redox-related inflammatory mediators in the aqueous humor are associated with disease severity and structural response to anti-vascular endothelial growth factor (VEGF) therapy in BRVO. Methods: Aqueous humor samples were collected from 30 treatment-naïve patients with BRVO and 19 control patients. Levels of VEGF and the novel redox-related inflammatory factors FMS-related tyrosine kinase 3 ligand (Flt-3L), fractalkine, CXCL-16, and endocan-1 were measured by suspension array, and the severity of macular edema was evaluated by measuring central macular thickness and neurosensory retinal thickness (TNeuro) by spectral-domain optical coherence tomography. Therapeutic response was assessed one month after intravitreal ranibizumab injection (IRI). Results: Aqueous levels of VEGF, Flt-3L, and endocan-1 were significantly higher in the BRVO group, and levels of Flt-3L, CXCL-16, and endocan-1—markers associated with oxidative endothelial damage and leukocyte recruitment—correlated significantly with each other and with aqueous flare values. Notably, baseline Flt-3L levels significantly correlated with the reduction in TNeuro, suggesting that this redox-sensitive signaling molecule is a potential biomarker for treatment sensitivity. Conclusions: These findings suggest that novel inflammatory factors, potentially driven by oxidative-nitrosative stress, play a pivotal role in the pathophysiology of BRVO. Baseline Flt-3L may serve as a predictive biomarker for structural responsiveness to anti-VEGF therapy in BRVO, suggesting that oxidative–inflammatory signaling contributes not only to disease severity but also to therapeutic heterogeneity. Full article

Background: Retinal vascular diseases, including neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusion (RVO), and myopic choroidal neovascularization (mCNV), often require repeated intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Although ranibizumab is well established, long-term affordability remains challenging. Objective: To compare the functional, anatomical, treatment-burden, and safety outcomes of biosimilar ranibizumab (Ranieyes) and innovator ranibizumab (Lucentis/Accentrix) in routine clinical practice. Methods: This multicenter retrospective comparative study included 4997 eyes from 3577 patients treated across five tertiary eye-care centers in India. The biosimilar group comprised 2543 eyes from 1812 patients (10,893 injections), and the innovator group comprised 2454 eyes from 1765 patients (10,136 injections). Eligible indications were nAMD, DME, BRVO, CRVO, mCNV, and an exploratory miscellaneous preoperative adjunct subgroup. BCVA (logMAR), central subfield thickness (CST; µm), injection burden, and ocular/systemic adverse events were assessed over 24 months. Results: Both groups showed early improvement in BCVA and CST across the major disease categories, followed by long-term stabilization. Between-group differences were generally small, not sustained over follow-up, and of limited clinical magnitude. Serious ocular and systemic adverse events were rare in both groups, and no new safety signal emerged. Conclusions: In this large real-world cohort, the biosimilar ranibizumab Ranieyes showed outcomes broadly comparable to innovator ranibizumab across the major retinal disease subgroups, although these findings should be interpreted as observational comparative evidence rather than formal proof of equivalence. Full article

This pilot study assessed the effectiveness of the intravitreal dexamethasone implant (Ozurdex) in retinal vein occlusion (RVO) patients and explored potential pre-treatment biomarkers to improve management and prognosis. Eighteen patients with branch RVO (BRVO) and twenty-four with central RVO (CRVO) receiving two intravitreal injections of Ozurdex (at baseline and between 4 and 6 months) were included. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded at baseline and after 3, 6, and 12 months. Retinal morphology was assessed using optical coherence tomography (OCT), and serum biomarkers were analyzed by ELISAs. No significant BCVA improvement was observed in RVO patients, while CRT significantly decreased from 3 to 12 months. Patients without defects of the retinal inner layers, ellipsoid zone, and external limiting membrane showed significantly higher BCVA at 6 and 12 months. Both BRVO and CRVO groups demonstrated significant BCVA improvement and CRT reduction at 6 and 12 months, with better outcomes in BRVO patients. These patients exhibited lower baseline serum levels of xanthine oxidase (XO) and thrombospondin-1 (TSP-1), which inversely correlated with BCVA at 12 months. Ozurdex was effective in real-life RVO treatment, particularly in BRVO. Serum XO and TSP-1 may serve as prognostic biomarkers for RVO. Full article

Background/Objectives: This study evaluates whether ultrawide-field optical coherence tomography angiography (UWF-OCTA) can guide navigated laser therapy for non-perfused areas (NPAs) in branch retinal vein occlusion (BRVO). It further explores whether the laser spots can be accurately placed according to plan, considering that the retina is three-dimensional (3D), while UWF-OCTA provides two-dimensional (2D) images. Methods: UWF-OCTA images from three devices—VG200, Xephilio OCT-S1, and Bmizar—guided the treatments. These images were superimposed onto NAVILAS^® system images to guide NPA treatments. Pre-treatment planning was strategically designed to avoid normal and collateral vessels, with immediate post-laser OCTA and en face images assessing the efficacy of the laser spots in avoiding these vessels as planned. The accuracy of navigated laser therapy was further analyzed by comparing the intended laser locations with the actual spots. Results: All montaged OCTA images from the three devices were seamlessly integrated into the navigated laser system without registration errors. All patients received treatments targeting the NPAs as planned. However, not all collateral or normal vessels were successfully avoided by the laser spots. A further analysis revealed that the actual locations of the laser spots deviated slightly from the planned locations, particularly in the mid-periphery areas. Conclusions: UWF-OCTA-guided navigated laser photocoagulation is feasible and precise for treating NPAs in BRVO. Nonetheless, minor deviations between planned and actual locations were observed. This discrepancy, particularly important when treating diseases of the macular area, should be carefully considered when employing OCTA-guided navigated laser photocoagulation. Full article

Purpose: This study aims to evaluate the clinical utility of a prototype ultra-widefield (UWF) single-capture optical coherence tomography (OCT) lens developed to image large areas of the retina. Material and Methods: This study included OCT and angio-OCT measurements performed with a REVO FC 130 (Optopol Technology, Poland) with an add-on widefield lens in a case series of 215 patients with retinal pathologies and 39 healthy subjects. The imaging width provided by the lens was 22 mm (covering a 110-degree field of view), while the scanning window height ranged from 2.8 to 6 mm. Results: The quality of the peripheral UWF OCT and angio-OCT images obtained by REVO FC 130 with the attachable lens is very good and sufficient for patient diagnosis, follow-up, and treatment planning. Both the boundaries of the non-perfusion zones and the location and extent of vascular proliferations can be accurately traced. Furthermore, the vitreoretinal interface can also be accurately assessed over a large area. The imaging quality of the macula with UWF OCT angiography is also good. The mean thickness measurement difference between a UWF and a standard 10 mm 3D retinal scan in a healthy individuals for the Central ETDRS sector was −1.37 ± 2.96 µm (the 95% limits of agreement (LoA) on Bland–Altman plots ranged from −6.82 to 2.43); for the Inferior Inner sector, it was −2.81 ± 1.09 µm (95% LoA, −4.94 to −0.68); for the Inferior Outer sector, it was −1.31 ± 2.58 µm (95% LoA, −6.38 to 3.75); for the Nasal Inner sector: −1.46 ± 1.19 µm (95% LoA, −3.79 to 0.88); for the Nasal Outer sector, it was −0.56 ± 2.61 µm (95% LoA, −5.67 to 4.55); for the Superior Inner sector, it was −2.71 ± 3.16 µm (95% LoA, −8.91 to 3.48); for the Superior Outer sector, it was −1.82 ± 1.39 µm (95% LoA, −4.55 to 0.91); for the Temporal Inner sector, it was −1.77 ± 2.24 µm (95% LoA, −6.16 to 2.62); for the Temporal Outer sector, it was −3.61 ± 1.43 µm (95% LoA, −6.41 to −0.81). Discussion: The proposed method of obtaining UWF OCT and UWF angio-OCT images using an add-on lens with the REVO FC 130 gives high-quality scans over the entire 110-degree field of view. This study also shows a high agreement of the ETDRS sector’s thickness measurements between UWF and standard retinal scans, which allows UWF to be used for quantitative macular thickness analysis. Considering its image quality, simplicity, and reliability, an add-on lens can be successfully used for the UWF OCT and OCT angiography evaluation of the retina on a daily basis. Full article

Background/Objectives: We sought to assess the relationship between contrast sensitivity (CS) and optical coherence tomography (OCT) findings, including ganglion cell–inner plexiform layer (GCIPL) thickness, in eyes with cystoid macular edema, secondary to branch retinal vein occlusion (BRVO-CME), treated with intravitreal ranibizumab (IVR). Methods: This prospective study included 44 patients with BRVO-CME who underwent treatment with IVR (three monthly injections and pro re nata) and were followed up for 12 months. We collected data on CS, best-corrected visual acuity (BCVA), and OCT findings (ellipsoid zone [EZ] and external limiting membrane status [ELM], central foveal thickness [CFT], and average GCIPL thickness) at the time of the final visit when macular edema was resolved. Multiple regression analysis was used to evaluate the relationship between visual functions and OCT findings, age, and lens status. Results: Multiple regression analysis revealed that lower GCIPL thickness was significantly associated with worse CS (β = 0.008; 95% CI, 0.002–0.014; p = 0.011), whereas this was not the case with BCVA. Lower CFT and mild cataracts were also associated with worse CS (CFT: β = 0.003; 95% CI, 0.001–0.004; p = 0.001; mild cataract: β = −0.182; 95% CI, −0.286–−0.078; p = 0.001) and worse BCVA (CFT: β = −0.002; 95% CI, −0.003–−0.001; p < 0.001; mild cataract: β = 0.079; 95% CI, 0.008–0.150; p = 0.029). Conclusions: GCIPL thickness may serve as a valuable biomarker for CS in eyes with BRVO-CME following IVR treatment. Full article

Hypoxic damage to retinal pigment epithelial (RPE) cells and subsequent neovascularization are key factors in the pathogenesis of branch retinal vein occlusion (BRVO). Naringin (NG), a naturally occurring flavanone glycoside, has demonstrated significant antioxidant and anti-neovascular activities. However, the regulatory effects and mechanisms of NG on ferroptosis in BRVO are yet to be explored. Our study aimed to investigate the protective effects of NG on RPE cells under hypoxic stress and to elucidate the underlying molecular mechanisms. Our findings revealed that NG significantly reduced cytotoxicity induced by cobaltous chloride (CoCl₂) and also inhibited vascular proliferation in the retina, thereby attenuating choroidal neovascularization. NG pretreatment largely countered the overproduction of reactive oxygen species (ROS) and malondialdehyde (MDA) triggered by hypoxic damage, while also restoring levels of the antioxidants glutathione (GSH) and superoxide dismutase (SOD). Furthermore, NG pretreatment significantly activated the expression of hypoxia-inducible factor-1 alpha (HIF-1α) and its downstream heme oxygenase-1 (HO-1) and NADPH dehydrogenase (NQO1). In conclusion, NG not only inhibits neovascularization but also alleviates inflammation in RPE cells by modulating the HO-1/GPX4 pathway to inhibit ferroptosis. These findings highlight the potential of NG as a promising therapeutic agent for the treatment of BRVO. Full article

Branch retinal vein occlusion (BRVO) is a common retinal vascular condition and a significant contributor to vision loss worldwide, particularly in middle-aged and elderly populations. This review synthesizes current knowledge on the epidemiology, pathogenesis, and clinical features of BRVO, alongside recent advancements in diagnostic and therapeutic strategies. BRVO is approximately four times more prevalent than central retinal vein occlusion (CRVO) and often leads to significant vision impairment. By focusing on BRVO, this review aims to address the specific challenges and advancements in its diagnosis and management. The pathophysiology of BRVO is complex, involving factors such as venous compression, inflammation, and increased levels of vascular endothelial growth factor (VEGF). Diagnostic approaches such as optical coherence tomography (OCT) and fluorescein angiography are highlighted for their roles in assessing disease severity and guiding treatment decisions. Therapeutic interventions, including laser photocoagulation, anti-VEGF therapy, and intravitreal corticosteroids, are critically evaluated, emphasizing emerging treatments such as gene therapy, peptide-based agents, and small-molecule inhibitors. Despite advancements in management strategies, the recurrence of macular edema and treatment resistance remain significant challenges. Continued research is essential to refine therapeutic protocols and improve long-term visual outcomes for patients with BRVO. Full article

Background: Retinal vein occlusion (RVO) is a relatively uncommon condition with a complex pathophysiology. However, its association with traditional cardiovascular risk factors is well established. In this study, we compared arterial stiffness and endothelial function between patients with RVO and healthy controls. Methods: We enrolled 28 consecutive patients with RVO, either central (CRVO) or branch (BRVO), and 30 healthy controls. We measured: (i) perfused boundary region of the sublingual arterial microvessels (a marker of endothelial glycocalyx thickness), (ii) pulse wave velocity (PWV), augmentation index (AIx), and central systolic blood pressure (cSBP). Results: No statistically significant differences regarding age, gender, and major cardiovascular risk factors were noted between patients and controls. Compared to controls, patients with RVO had higher PBR, PWV, AIx, and cSBP values (p < 0.05). For each of these indices, no statistically significant differences were noted between patients with CRVO and BRVO (p > 0.05). Conclusions: Patients with RVO demonstrated reduced endothelial glycocalyx thickness and increased arterial stiffness compared to healthy controls. These findings further elucidate the role of atherosclerosis and endothelial dysfunction in the pathophysiology of the disease and indicate the need for the evaluation of subclinical cardiovascular disease in such patients. Full article

Background/Objectives: We intended to investigate choroidal blood flow (CBF) and choroidal thickness (CT) alternations in treatment-naive eyes with non-ischemic branch retinal vein occlusion (BRVO) following intravitreal aflibercept injection (IVA). Methods: Twenty eyes of 20 patients with treatment-naive non-ischemic BRVO, treated with IVA 1+ pro re nata, were included in this study. In the BRVO eyes, CBF and CT were measured in the occlusive region, subfovea, as well as the non-occlusive region, via laser speckle flowgraphy (LSFG) and enhanced depth-imaging optical coherence tomography over a 6-month follow-up period. CBF was analyzed via the mean blur rate using LSFG analysis software (version 3.10.0). Results: CT showed significant reductions in both the occlusive and subfoveal region at 1 week and 1 month after treatment (both p < 0.05). CBF was significantly decreased in the subfovea and the non-occlusive region at 1 week and 1 month from baseline, respectively (both p < 0.05). The mean number of IVA injections during the 6-month period was 1.95 ± 0.6. Conclusions: Aflibercept treatment reduced CBF and CT in addition to a decrease in retinal thickness. These changes at each region might be associated with the improvement of macular edema in BRVO eyes. Full article

Background/Objectives: To evaluate the roles of choroidal blood flow (CBF) and choroidal thickness (CT) as predictors of macular edema recurrence in patients with treatment-naive non-ischemic branch retinal vein occlusion (BRVO) after intravitreal ranibizumab (IVR) injection. Methods: Sixteen eyes from sixteen patients with treatment-naive non-ischemic BRVO treated with IVR, once initially and then as needed, were included in the study. CBF and CT in the subfovea, occlusive, and non-occlusive regions were measured via laser speckle flowgraphy and enhanced depth imaging optical coherence tomography over 12 months. Results: Baseline CT was significantly greater in the occlusive region (335 ± 72.1 µm) than in the non-occlusive region (274 ± 36.7 µm, p = 0.028). CT in the occlusive region was reduced significantly after 1 week (p = 0.008), but CBF did not change significantly after IVR throughout the follow-up period (p > 0.05). The occlusive/non-occlusive region CBF ratio at baseline was significantly associated with the number of IVR injections over 12 months (mean 2.63) in patients with BRVO (p = 0.048). Conclusions: Baseline CBF imbalance in eyes with treatment-naive BRVO may indicate the recurrence of macular edema after ranibizumab therapy. Full article

Subthreshold lasers operate below the threshold of visible tissue damage, thereby preventing ophthalmoscopically visible thermal damage to the chorio-retinal layers. They could represent a safe and effective alternative and/or adjunctive procedure to conventional lasers in treating diabetic macula edema (DME), central serous chorioretinopathy (CSCR), and branch retina vein occlusion (BRVO). This review focuses on the use of subthreshold micropulse laser (SMPL), its settings, and clinical applications. Despite their widespread use, a standardized protocol for sub-threshold laser settings has not been established yet, and thus, there is uncertainty in selecting effective and safe parameters for any specific situation. We conducted a comprehensive overview of the existing indications for subthreshold laser therapy and their settings for different retinal diseases. The debate revolves around which parameters could guarantee the safety of the procedure for each case, depending on the duty cycle, the laser wavelength, the spot duration, and the power, with laser power titration on one side or choosing a fixed lowered power value on the other side. SMPL therapy for DME, CSCR, and BRVO-associated macular edema has shown significant effectiveness in reducing the macular thickness, facilitating subretinal fluid absorptions, increasing the best corrected visual acuity (BCVA) and reducing the number of intravitreal injections (IVI) required annually. We presented a broad list of the laser parameters reported in the literature, organized into different tables divided based on the specific pathology, with the aim of providing a useful tool for future studies. Full article

Retinal vein occlusion (RVO) is a significant cause of vision loss, characterized by the occlusion of retinal veins, leading to conditions such as central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Macular edema (ME), a prevalent consequence of RVO, is the primary cause of vision impairment in affected patients. Anti-VEGF agents have become the standard treatment, showing efficacy in improving visual acuity (VA) and reducing ME. However, a subset of patients exhibit a suboptimal response to anti-VEGF therapy, necessitating alternative treatments. Corticosteroids, which address inflammatory pathways implicated in ME, have shown promise, particularly in cases resistant to anti-VEGF. This review aims to identify biomarkers that predict treatment response to corticosteroids in RVO-associated ME, utilizing multimodal imaging and cytokine assessments. Baseline imaging, including SD-OCT and OCT-A, is essential for evaluating biomarkers like hyperreflective foci (HRF), serous retinal detachment (SRF), and central retinal thickness (CRT). Elevated cytokine levels, such as IL-6 and MCP-1, correlate with ME severity and poor anti-VEGF response. Early identification of these biomarkers can guide timely transitions to corticosteroid therapy, potentially enhancing treatment outcomes. The practical conclusion of this review is that integrating biomarker assessment into clinical practice enables personalized treatment decisions, allowing for earlier and more effective management of RVO-associated ME by transitioning patients to corticosteroid therapy when anti-VEGF agents are insufficient. Advanced diagnostics and machine learning may further refine personalized treatment strategies, improving the management of RVO-associated ME. Full article

Background/Objectives: The purpose of this study was to analyze relevant areas in acute-stage fluorescein angiography (FA) images, predicting the long-term visual prognosis of branch retinal vein occlusion (BRVO) based on gradient-weighted class activation mapping (Grad-CAM). Methods: This retrospective observational study included 136 eyes with BRVO that were followed up for more than a year post-FA. Cropped grayscale images centered on the fovea (200 × 200 pixels) were manually pre-processed from early-phase FA at the acute phase. Pairs of the cropped FA images and the best-corrected visual acuity (BCVA) in remission at least one year post-FA were used to train a 38-layer ResNet with five-fold cross-validation. Correlations between the ResNet-predicted and true (actually measured) logMAR BCVAs in remission, and between the foveal avascular zone (FAZ) area measured by ImageJ (version 1.52r) from FA images and true logMAR BCVA in remission were evaluated. The heat maps generated by Grad-CAM were evaluated to determine which areas were consumed as computational resources for BCVA prediction. Results: The correlation coefficient between the predicted and true logMAR BCVAs in remission was 0.47, and that between the acute-stage FAZ area and true logMAR BCVA in remission was 0.42 (p < 0.0001 for both). The Grad-CAM-generated heat maps showed that retinal vessels adjacent to the FAZ and the FAZ per se had high selectivity (95.7% and 62.2%, respectively). Conclusions: The Grad-CAM-based analysis demonstrated FAZ-neighboring vessels as the most relevant predictor for the long-term visual prognosis of BRVO. Full article

Background: This prospective study evaluated the impact of anatomical and tomographic biomarkers on clinical outcomes of intravitreal dexamethasone implants in patients with macular edema secondary to retinal vein occlusion (RVO). Methods: The study included 46 patients (28 with branch RVO (BRVO) and 18 with central RVO (CRVO)). Best corrected visual acuity (BCVA) significantly improved from a mean baseline of 0.817 ± 0.220 logMAR to 0.663 ± 0.267 logMAR at six months and 0.639 ± 0.321 logMAR at twelve months (p < 0.05). Central retinal thickness (CRT) showed a significant reduction from 666.2 ± 212.2 µm to 471.1 ± 215.6 µm at six months and 467 ± 175.7 µm at twelve months (p < 0.05). No significant differences were found in OCT biomarkers between baseline and follow-ups. Results: The study analysed improvements in visual acuity relative to baseline biomarkers. At six months, ellipsoid zone disruption (EZD) was significant for all subgroups. Disorganization of retinal inner layers (DRIL), external limiting membrane (ELM) disruption, macular ischemia (MI), CRT, and BRVO showed significance for any improvement, while DRIL and ELM were significant for changes greater than 0.3 logMAR (p < 0.05). At twelve months, EZD remained significant for all subgroups. ELM, MI, CRT, and BRVO were significant for any improvement, while MI and BRVO were significant for changes greater than 0.3 logMAR (p < 0.05). Hyperreflective foci were not statistically significant at either time point (p > 0.05). Conclusions: The regression model suggested that MI and CRVO could be negative predictive factors for visual outcomes, while ELM and EZD were associated with BCVA improvement one-year post-treatment. Full article