Macular Edema Resistance in Retinal Vein Occlusion and the Protective Role of PAMM Subtypes.

IF 4.2 1区 医学 Q1 OPHTHALMOLOGY
Maria Vittoria Cicinelli,Enrico Maria Pepe,Beatrice Tombolini,Marco Romanelli,Stefano Albertini,Maria Pia de Carlo,Sebastiano Del Fabbro,Chiara Giuffré,Francesco Bandello,Rosangela Lattanzio
{"title":"Macular Edema Resistance in Retinal Vein Occlusion and the Protective Role of PAMM Subtypes.","authors":"Maria Vittoria Cicinelli,Enrico Maria Pepe,Beatrice Tombolini,Marco Romanelli,Stefano Albertini,Maria Pia de Carlo,Sebastiano Del Fabbro,Chiara Giuffré,Francesco Bandello,Rosangela Lattanzio","doi":"10.1016/j.ajo.2025.09.029","DOIUrl":null,"url":null,"abstract":"PURPOSE\r\nTo characterize eyes without macular edema (ME) at presentation in retinal vein occlusion (RVO), evaluate incidence and predictors of ME during follow-up, and assess the prognostic significance of paracentral acute middle maculopathy (PAMM) subtypes.\r\n\r\nDESIGN\r\nRetrospective cohort study.\r\n\r\nPARTICIPANTS\r\n405 treatment-naïve RVO eyes.\r\n\r\nMETHODS\r\nClinical and imaging features were compared between eyes with and without baseline ME. PAMM was classified as arteriolar, fern-like, or globular. Peripheral ischemia was quantified using ultra-widefield fluorescein angiography.\r\n\r\nMAIN OUTCOME MEASURES\r\nPredictors of ME at baseline and during follow-up identified with logistic and Cox regression. Cumulative ME risk in eyes with PAMM assessed with Kaplan-Meier and multinomial regression analyses.\r\n\r\nRESULTS\r\nAt baseline, 72 eyes (18%) were ME-free. These eyes were younger (49.8±16.6 vs. 65.8±13.6 years), more frequently had CRVO (85% vs. 50%), and had fewer systemic comorbidities. PAMM was a strong protective factor against baseline ME (OR 0.05; P<0.01). During follow-up, cumulative ME incidence reached 42% at 1 year and stabilized thereafter. Higher baseline central macular thickness (HR 2.39/100 µm; P=0.002) and ischemic index (HR 1.03/1%; P=0.03) were risk factors, while age <50 years and early anti-VEGF therapy were protective. Globular PAMM, frequently associated with a cilioretinal artery, identified the lowest ME risk profile.\r\n\r\nCONCLUSIONS\r\nYounger patients with CRVO often present without ME. Although nearly half of these eyes develop ME over time, baseline imaging-particularly presence and subtype of PAMM-helps stratify risk. Globular PAMM defines a paradoxical ischemic profile with preserved vascular integrity and minimal susceptibility to fluid accumulation.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"40 1","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajo.2025.09.029","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

PURPOSE To characterize eyes without macular edema (ME) at presentation in retinal vein occlusion (RVO), evaluate incidence and predictors of ME during follow-up, and assess the prognostic significance of paracentral acute middle maculopathy (PAMM) subtypes. DESIGN Retrospective cohort study. PARTICIPANTS 405 treatment-naïve RVO eyes. METHODS Clinical and imaging features were compared between eyes with and without baseline ME. PAMM was classified as arteriolar, fern-like, or globular. Peripheral ischemia was quantified using ultra-widefield fluorescein angiography. MAIN OUTCOME MEASURES Predictors of ME at baseline and during follow-up identified with logistic and Cox regression. Cumulative ME risk in eyes with PAMM assessed with Kaplan-Meier and multinomial regression analyses. RESULTS At baseline, 72 eyes (18%) were ME-free. These eyes were younger (49.8±16.6 vs. 65.8±13.6 years), more frequently had CRVO (85% vs. 50%), and had fewer systemic comorbidities. PAMM was a strong protective factor against baseline ME (OR 0.05; P<0.01). During follow-up, cumulative ME incidence reached 42% at 1 year and stabilized thereafter. Higher baseline central macular thickness (HR 2.39/100 µm; P=0.002) and ischemic index (HR 1.03/1%; P=0.03) were risk factors, while age <50 years and early anti-VEGF therapy were protective. Globular PAMM, frequently associated with a cilioretinal artery, identified the lowest ME risk profile. CONCLUSIONS Younger patients with CRVO often present without ME. Although nearly half of these eyes develop ME over time, baseline imaging-particularly presence and subtype of PAMM-helps stratify risk. Globular PAMM defines a paradoxical ischemic profile with preserved vascular integrity and minimal susceptibility to fluid accumulation.
黄斑水肿抵抗视网膜静脉阻塞及PAMM亚型的保护作用。
目的探讨视网膜静脉阻塞(RVO)患者无黄斑水肿(ME)的特征,评价ME在随访期间的发病率和预测因素,并评估旁中央急性中黄斑病变(PAMM)亚型的预后意义。设计回顾性队列研究。参与者405 treatment-naïve RVO眼睛。方法比较两组患者的临床和影像学特征。PAMM分为小动脉状、蕨类和球状。采用超宽视场荧光素血管造影定量外周缺血。主要结局指标:通过logistic回归和Cox回归确定ME在基线和随访期间的预测指标。用Kaplan-Meier和多项回归分析评估PAMM患者的累积ME风险。结果基线时,72只眼(18%)无me。这些患者的眼睛更年轻(49.8±16.6岁vs. 65.8±13.6岁),CRVO发生率更高(85% vs. 50%),并且系统性合并症更少。PAMM对基线代谢能有较强的保护作用(OR 0.05; P<0.01)。随访期间,ME累计发病率在1年时达到42%,此后趋于稳定。较高的基线黄斑中央厚度(HR 2.39/100µm, P=0.002)和缺血指数(HR 1.03/1%, P=0.03)是危险因素,而年龄<50岁和早期抗vegf治疗是保护因素。通常与纤毛视网膜动脉相关的球状PAMM确定了最低的ME风险概况。结论年轻CRVO患者常无ME表现。尽管随着时间的推移,这些眼睛中有近一半会发展为ME,但基线成像——尤其是ppam的存在和亚型——有助于对风险进行分层。球状PAMM定义了一种矛盾的缺血剖面,保留了血管完整性,对液体积聚的易感性最小。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
9.20
自引率
7.10%
发文量
406
审稿时长
36 days
期刊介绍: The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信