Baseline macular structural and vascular changes as predictive markers of visual improvement in central retinal vein occlusion.

Abstract

Objective: This study aims to evaluate the changes in posterior segment parameters that affect visual prognosis in patients with central retinal vein occlusion (CRVO).

Methods: This retrospective study included 58 eyes of 58 CRVO patients. Best-corrected visual acuity (BCVA), intraocular pressure, central macular thickness (CMT), hyperreflective foci (HRF), ellipsoid zone (EZ) loss, disorganization of retinal inner layers (DRIL), intraretinal cystic changes, posterior vitreous detachment (PVD), and macular superficial and deep vascular density (VD), as well as superficial and deep foveal avascular zone (FAZ) areas, were assessed at baseline and 3 months follow-up after treatment. The treatments (intravitreal injections and laser) received were recorded.

Results: The mean age was 63.02±9.91 years, 37 (63.8%) were female, and 39 (67.3%) were classified as having non-ischemic CRVO. The mean baseline BCVA was 0.64±0.85 logMAR; at 3 months, it improved to 0.39±0.65 logMAR (p<0.001). The mean baseline CMT was 478.9±82.6 µm, and at 3 months, it reduced to 288.56±72.39 µm (p<0.001). At baseline, HRF in 31% of eyes, EZ disruption in 44.8% of eyes, DRIL in 17.2% of eyes, intraretinal cysts in 55.2% of eyes, and PVD in 43.1% of eyes. A significant decrease in BCVA was observed in patients with EZ loss (p<0.001), while the presence of intraretinal cysts had significant impact on CMT (p=0.007). Furthermore, a statistically significant negative correlation was observed between foveal and superior VD in both the superficial and deep capillary plexus (SCP, DCP) and changes in BCVA (logMAR). In contrast, a positive correlation was found between superficial FAZ area and BCVA (logMAR). Additionally, a statistically significant positive correlation was noted between foveal VD in both the SCP and DCP and changes in CMT.

Conclusion: The study emphasizes the importance of structural and vascular changes in predicting functional outcomes and suggests the utility of optical coherence tomography (OCT) and OCT angiography in early visual prognosis and treatment planning.