Application Of Fundus Imaging In Prognostic Evaluation Of Macular Edema Secondary To Branch Retinal Vein Occlusion Treated With Ranibizumab

Purpose:In this study,firstly,we used optical coherence tomography angiography(OCTA)parameters to quantitatively evaluate the short-term efficacy of ranibizumab in patients with macular edema secondary to branch retinal vein occlusion(BRVO-ME).Secondly,we aimed to explore the role of OCTA and optical coherence tomography(OCT)parameters in predicting the efficacy of ranibizumab in the treatment of BRVO-ME.Methods:Part Ⅰ:A retrospective analysis was conducted on all BRVO-ME patients who received 3+PRN ranibizumab intravitreal injection in the First Affiliated Hospital of Anhui University of Science and Technology from March 2020 to June 2021.The visual acuity(log MAR BCVA),central retinal thickness(CRT),OCTA parameters of36 patients and adverse events at baseline and 6 months after treatment were recorded.The changes of parameters such as vessel density in superficial retinal capillary plexus(SCP),vessel density in deep retinal capillary plexus(DCP),foveal avascular zone(FAZ)area,perimeter of FAZ(PERIM),acircularity index(AI)and vessel density within a 300μm wide ring surrounding the FAZ(FD-300)before and after treatment were investigated to evaluate the curative effect of ranibizumab and vascular morphological changes in BRVO-ME.Part Ⅱ:A retrospective analysis was conducted on all BRVO-ME patients who received 3+PRN ranibizumab intravitreal injection in the First Affiliated Hospital of Anhui University of Science and Technology from March 2020 to June 2021.53patients were divided into the good prognosis group and the poor prognosis group according to the visual acuity changes before and 6 months after the treatment.Baseline OCT and OCTA parameters,including the presence of disorganization of the retinal inner layers(DRIL),intraretinal fluid(IRF)and subretinal fluid(SRF);the absence of external membrane(ELM),ellipsoid zone(EZ)and interdigitation zone(IZ);vessel density in superficial retinal capillary plexus(SCP),vessel density in deep retinal capillary plexus(DCP),foveal avascular zone(FAZ)area,perimeter of FAZ(PERIM),acircularity index(AI)and vessel density within a 300μm wide ring surrounding the FAZ(FD-300)were compared between two groups,and the binary logistic regression analysis was used to identify prognostic factor.Results:Part Ⅰ:A total of 36 patients with 36 single eyes were included in this part.(1)The visual acuity after ranibizumab treatment was significantly improved(preoperative log MAR BCVA 0.75±0.33 vs postoperative log MAR BCVA 0.53±0.37,P=0.009);CRT was significantly decreased(preoperative 496.47±107.58μm vs postoperative263.83±73.14μm,P<0.001);(2)Changes of OCTA parameters before and after treatment:FAZ area(preoperative 0.33±0.05 mm~2vs postoperative 0.43±0.05 mm~2,P<0.001)and PERIM(preoperative 2.33±0.42 mm vs postoperative 2.66±0.54 mm,P=0.005)were significantly increased with statistical difference,while AI(preoperative 1.23±0.07 vs postoperative 1.13±0.06,P<0.001)was significantly decreased with statistical difference.Other OCTA parameters including vessel density in SCP,vessel density in DCP and FD-300 showed no statistical difference before and after treatment;(3)One patient developed subconjunctival hemorrhage after injection and recovered spontaneously without any treatment.No serious adverse events such as retinal detachment,endophthalmitis,vitreous hemorrhage and neovascular glaucoma occurred.Part Ⅱ:A total of 53 patients with 53 single eyes were recruited in this part,including 35 in the good prognosis group and 18 in the poor prognosis group.(1)Comparison of baseline OCT parameters between the two groups showed that there were statistically significant differences in the number of patients with incomplete ELM structure and DRIL:there were 9 patients with incomplete ELM structure at baseline in the good prognosis group,and 10 patients in the poor prognosis group(P=0.032);there were 8 patients with DRIL at baseline in the good prognosis group and 12 patients in the poor prognosis group(P=0.002).And there were no statistical differences of the baseline OCT parameters in the number of patients with the IRF,SRF,incomplete EZ structure and incomplete IZ structure between the two groups.(2)Comparison of baseline OCTA parameters between the two groups showed that there were statistical differences on baseline vessel density in SCP(42.76±2.57%in good prognosis group vs 40.15±2.50%in poor prognosis group,P=0.001)and baseline vessel density in DCP(44.58±2.54%in good prognosis group vs 42.09±2.46%in poor prognosis group,P=0.001).And there were no statistical differences on baseline FAZ area,PERIM,AI and FD-300 between the two groups.(3)The baseline parameters including the presence of incomplete ELM structure,the presence of DRIL,vessel density in SCP and vessel density in DCP were substituted into the binary logistic regression analysis,and the results showed that the presence of baseline DRIL(P=0.005)had a significant impact on the visual prognosis.Conclusion:Intravitreal injection of ranibizumab can effectively improve the visual acuity of BRVO-ME patients,reduce macular edema and make the shape of FAZ tend to be regular.In addition,the presence of baseline DRIL in the affected eye has a predictive effect on the prognosis of BRVO-ME patients with ranibizumab therapy.Figure[10]table[6]reference[80]...