OSLI Retina

June 2020

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320 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Prognostic Value of Hyperreflective Material on Visual Acuity in Treatment-Naïve BRVO Ramesh Venkatesh, MS; Arpitha Pereira, DNB MRCSEd; Sajjan Sangai, MS; Sherina Thomas, MS; Naresh Kumar Yadav, DO, FRCS BACKGROUND AND OBJECTIVE: To correlate between hyperreflective material (HRM) seen on optical co- herence tomography (OCT) and visual outcomes in treatment-naïve acute branch retinal vein occlu- sion (BRVO). PATIENTS AND METHODS: Demographic and OCT features of patients with acute BRVO were ana- lyzed retrospectively. OCT parameters noted were macular edema type, HRM presence and location, and outer retinal layer integrity. Eyes were separat- ed into two groups: Group 1 (BRVO without HRM) and Group 2 (BRVO with HRM). RESULTS: Forty-seven eyes (67%) were included in Group 1 and 23 eyes (33%) were included in Group 2. Mean presenting logMAR visual acuity in Groups 1 and 2 was 0.521 ± 0.428 (mean Snel- len equivalent = 20/66) and 0.627 ± 0.427 (mean Snellen equivalent = 20/85), respectively. Poor vi- sion at final visit was noted in the BRVO with HRM group (P = .027). More intravitreal injections were required for macular edema resolution in the HRM group (4.83 vs. 2.67). CONCLUSIONS: Presence of HRM in BRVO is associ- ated with poorer vision. It can be a useful prognos- tic biomarker. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:320-327.] INTRODUCTION One of the commonest causes of retinal vascular disorder after diabetic retinopathy is retinal vein occlusion (RVO). There are two types of RVO, cen- tral retinal vein occlusion and branch retinal vein occlusion (BRVO), of which BRVO is more com- monly seen. 1 Risk factors associated with BRVO include arterial hypertension, glaucoma, diabetes mellitus, hyper viscosity, and old age. 2,3 Macular edema and retinal neovascularization are common sequelae of BRVO and can lead to visual impair- ment. 4,5 Visual acuity (VA) is a very sensitive indi- cator of the oxygen saturation levels at the macula. Better initial VA (≥ 20/50) suggests better macular oxygen saturation levels. 6 Generally, BRVO has a good prognosis: 50% to 60% of eyes are reported to have a final VA of 20/50 or better even without treatment. 7 One important prognostic factor for fi- nal VA in BRVO is initial VA. Studies have shown that the cases of BRVO with an initial VA of 20/200 or worse have a statistically significant poorer visu- al prognosis than those with an initial VA of 20/50 or better. 7,8 Optical coherence tomography (OCT) is a non- invasive imaging tool routinely used to document the severity and type of macular edema in BRVO and to monitor treatment. OCT allows observation of the structural changes in the retina caused by BRVO. Previous studies in literature have identi- fied the presence of subretinal fluid, 9-12 foveal hard exudates, 13,14 increased number of hyperreflective dots, 15 and loss of the photoreceptor layer 16,17 on From Narayana Nethralaya Super Speciality Eye Hospital, Bangalore, India. Originally submitted January 28, 2020. Revision received April 7, 2020. Accepted for publication April 28, 2020. The authors report no relevant financial disclosures. Address correspondence to Ramesh Venkatesh, MS, Narayana Nethralaya Super Speciality Eye Hospital, #121/C, Chord Road, 1st R block Rajaji Nagar, Bangalore, India 560010; email: vramesh80@yahoo.com. doi: 10.3928/23258160-20200603-02

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