OSLI Retina

December 2019

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752 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Eyes With Acute, Treatment-Naïve CRVO and Foveal Intraretinal Hemorrhage: Characteristics and Outcomes Tahreem A. Mir, MD; Akshay S. Thomas, MD, MS; Stephen P. Yoon, MD; Faith Birnbaum, MD; Mark Goerlitz-Jessen, MD; Sharon Fekrat, MD BACKGROUND AND OBJECTIVE: To compare out- comes in eyes with central retinal vein occlusion (CRVO) presenting with (group 1) or without (group 2) fovea-involving intraretinal hemorrhage (IRH). PATIENTS AND METHODS: Retrospective review of patients diagnosed with acute, treatment-naïve CRVO between January 2009 and July 2016. RESULTS: One hundred fifteen (39.8%) of 289 CRVO eyes had fovea-involving IRH. At baseline, eyes in group 1 had significantly worse visual acu- ity (VA) (1.2 ± 0.10 logMAR vs. 0.9 ± 0.06 logMAR; P = .001) and greater central subfield thickness (CST) (610.4 µm ± 35.9 µm vs. 435.0 µm + 21.6 µm; P < .001) than eyes in group 2. Final visual outcomes were comparable between groups (1.24 ± 0.09 logMAR vs. 1.02 ± 0.08 logMAR; P = .08). Group 1 received a significantly greater number of intravitreal anti-vascular endothelial growth fac- tor injections during the first year (7.80 ± 0.40 vs. 5.20 ± 0.40; P = .001). CONCLUSIONS: Although treatment-naïve eyes with acute CRVO and fovea-involving IRH had worse VA and greater CST at presentation, the final VA was comparable to eyes without such a hemor- rhage. Eyes with foveal IRH had a greater treatment burden in the first 12 months. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:752-759.] INTRODUCTION In the Central Vein Occlusion Study (CVOS), the majority of eyes with central retinal vein occlusion (CRVO) and extensive intraretinal hemorrhages (IRH) at baseline were later classified as ischemic. 1 A recent study showed an association between the pattern of IRH in the periphery and retinal capillary nonperfu- sion in eyes with CRVO. 2 It is plausible that eyes with CRVO presenting with a fovea-involving IRH may be at an increased risk for macular ischemia and associ- ated vision loss. Vascular endothelial growth factor (VEGF) is an important contributor to the development of macu- lar edema in CRVO, 3, 4 and treatment with anti-VEGF agents have become the standard of care in these eyes. Intraretinal hemorrhage clears more rapidly following suppression of VEGF; however, the exact mechanism by which anti-VEGF agents facilitate IRH resolution has not been well described. 5 Visual and anatomical outcomes in CRVO eyes with fovea-involving IRH treated with anti-VEGF therapy, however, have not been previously report- ed. These eyes have been excluded from several lead clinical studies of agents targeting VEGF. 4-10 These exclusions make it difficult to extrapolate results from these studies to CRVO eyes with fovea-involving IRH. The purpose of our study is to better understand the impact and implication of fovea-involving IRH in eyes with acute, treatment-naïve CRVO. From the Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, Connecticut (TAM); Duke Eye Center, Duke University School of Medicine, Durham, North Carolina (AST, SPY, FB, MGJ, SF); and Tennessee Retina, Nashville (AST). Originally submitted January 1, 2019. Revision received April 19, 2019. Accepted for publication June 10, 2019. Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology on May 7, 2018, and at the annual meeting for American Society of Retina Specialists on July 22, 2018. Dr. Fekrat receives patent royalties from Alcon. Dr. Thomas is supported by the Ronald G. Michels Fellowship Foundation. The remaining authors report no relevant financial disclosures. Address correspondence to Sharon Fekrat, MD, Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Road, Durham, NC 27705; email: sharon.fekrat@duke.edu. doi: 10.3928/23258160-20191119-02

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