Long-term dynamic changes of choroidal thickness and choroidal vascular index in patients with different types of retinal vein occlusion after intravitreal Ranibizumab
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Purpose
To observe the long-term dynamic changes of choroidal thickness and choroidal vascularity index (CVI) in patients with different types of retinal vein occlusion (RVO) after multiple intravitreal injections of Ranibizumab.
Methods
A retrospective cohort study. A total of 70 patients (70 eyes) were treated with intravitreal injection of Ranibizumab from Jan/2022 to Mar/2023 in our hospital. There were 25 cases (25 eyes) of central retinal vein occlusion (CRVO), 45 cases (45 eyes) of BRVO, 10 cases (10 eyes) of DRT, 25 cases (25 eyes) of CME and 35 cases (35 eyes) of MIX. 3+PRN therapy was used. OCT was used to obtain images of the macular region, EDI-OCT was used to obtain clear images of the choroid. Central retina thickness (CRT), subfoveal choroidal thickness (SFCT), the nasal choroidal thickness at 1.5mm of macula (CT N1.5mm), the temporal choroidal thickness at 1.5mm of macula (CT T1.5mm) were measured. Mean macular thickness (CT mean) was calculated. Image J software for binarization processing of choroidal images was used to analyze luminal area (LA), stromal area (SA) and total choroidal area (TCA), and choroidal vascularity index (CVI) was calculated. All above indexes were recorded at baseline, 1 month after each injection, at least 6 months after last injection, and the changes of choroidal indexes in patients with different types of RVO or RVO-ME were compared, and explore the significances of choroidal thickness and CVI as evaluative indicators to predict the therapeutic effects of RVO.
Results
1) BCVA in CRVO group was significantly lower than that in BRVO group, and CRT was significantly higher than that in BRVO group ( P <0.01). SFCT in CRVO group was higher than that in BRVO group, LA and TCA in CRVO group were lower than those in BRVO group, all the differences were statistically significant ( P ≤0.05). 2) The CRT, CT of CME group were lower than those of DRT and mixed type, and the differences were statistically significant ( P ≤0.05). 3) There was no statistically significant difference in CVI between CRVO and BRVO, and no statistically significant difference in CVI between the three different types of macular edema. 4) Regardless of the type of RVO of RVO-ME, BCVA and CRT were significantly improved after multiple injections, and the differences were statistically significant ( P <0.01). CT, LA, SA, TCA and CVI all decreased gradually after the 1 st and 2 nd injection compared with baseline, with statistical significance (P <0.01), and remained relatively stable after the 2 nd injection. 5) BCVA was further improved compared with the last injection, and CRT, CT, LA, TCA, CVI remained relatively stable with the last injection. There were no statistically significant changes of CVI between the acute stage and the stable stage. 6) CT at baseline was positively correlated with BCVA (LogMAR) and CRT, while CVI at baseline had no correlation with BCVA (LogMAR) and CRT. 7) The CT at baseline was positively correlated with the improvement of BCVA and CRT after treatment, while the CVI at baseline was not correlated with the improvement of BCVA, but was negatively correlated with the improvement of CRT. 8) CVI changes were more pronounced in men compared to women and BRVO was more likely to cause CVI changes than CRVO.
Conclusions
RVO not only affects the structure of the retina, but also has certain effects on choroid morphology and blood perfusion. The choroid thickness in the CRVO group was larger than that in the BRVO group. CVI did not significantly differ across RVO or RVO-ME subtypes. After intravitreal Ranibizumab of RVO, choroidal thickness, LA, SA, TCA, and CVI all decreased and remained relatively stable, and choroidal vessels were further remodeled. CVI has no significant correlations with age, visual acuity, type of macular edema and CRT. CVI is a reliable indicator for evaluating choroidal blood perfusion. Choroid thickness and CVI at baseline could be used as predictors of BCVA and CRT improvement after anti-VEGF treatment.
