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
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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.
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of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant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.