Central Retinal Vein Occlusion after mRNA COVID-19 Vaccination.

A 47-year-old man presented with visual loss in the right eye 8 h after the first dose of a coronavirus disease 2019 (COVID-19) vaccine developed by Pfizer/BioNTech (BNT162b2). The best corrected visual acuity (BCVA) was 20/200. Fundus examination showed dilated and tortuous retinal veins at the posterior pole, retinal hemorrhages throughout the fundus, and macular edema. Fluorescein angiography showed multiple hypofluorescent spots that appeared to be fluorescent block due to retinal hemorrhages and hyperfluorescent leakage from the retinal veins. The eye was diagnosed with central retinal vein occlusion (CRVO). For the treatment of macular edema, intravitreal injection of aflibercept (IVA) was administered and treated with one plus pro re nata regimen. Five IVAs were performed over a 10-month follow-up period, with resolution of macular edema, and the BCVA recovered to 20/20. The patient was young and had no history of diabetes mellitus, hypertension, or atherosclerotic diseases, and his blood tests showed no abnormal findings. Both antigen test and polymerase chain reaction test for COVID-19 were negative, and the antibody test was positive due to vaccination. The development of CRVO in this patient may have been related to COVID-19 vaccination, and the appropriate IVA treatment resulted in a good visual prognosis.

Multimodal Imaging of Microvascular Abnormalities in Retinal Vein Occlusion.

The technologies of ocular imaging modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have progressed remarkably. Of these in vivo imaging modalities, recently advanced OCT technology provides high-resolution images, e.g., histologic imaging, enabling anatomical analysis of each retinal layer, including the photoreceptor layers. Recently developed OCTA also visualizes the vascular networks three-dimensionally, which provides better understanding of the retinal deep capillary layer. In addition, ex vivo analysis using autologous aqueous or vitreous humor shows that inflammatory cytokine levels including vascular endothelial growth factor (VEGF) are elevated and correlated with the severity of macular edema (ME) in eyes with retinal vein occlusion (RVO). Furthermore, a combination of multiple modalities enables deeper understanding of the pathology. Regarding therapy, intravitreal injection of anti-VEGF drugs provides rapid resolution of ME and much better visual improvements than conventional treatments in eyes with RVO. Thus, the technologies of examination and treatment for managing eyes with RVO have progressed rapidly. In this paper, we review the multimodal imaging and therapeutic strategies for eyes with RVO with the hope that it provides better understanding of the pathology and leads to the development of new therapies.

Morphologic Classifications and Locations of Microaneurysms and Clinical Relevance in Branch Retinal Vein Occlusion.

PURPOSE: To classify microaneurysms (MAs) and investigate the relationships with retinal edema in eyes with branch retinal vein occlusion (BRVO). STUDY DESIGN: Retrospective, observational, consecutive case series. METHODS: Eyes with MAs due to BRVO that underwent optical coherence tomography angiography (OCTA) were enrolled. MAs on OCTA images were morphologically classified into six types: focal bulge, saccular, fusiform, mixed (saccular/fusiform), pedunculated, and irregular. The frequency, size, location, and relationships with retinal edema also were investigated. RESULTS: Twenty-four eyes of 23 patients (12 men, 11 women; mean age, 68.0 years) were enrolled. A total of 244 MAs were detected on the OCTA images. The focal bulge and saccular types accounted for over 70% of all MAs. Smaller MAs such as the focal bulge or saccular type also were detected both at the edge of the nonperfused areas (NPAs) and in collateral vessels. In contrast, larger MAs such as the pedunculated or irregular types tended to form at the edges of the NPAs. Older age, the presence of MAs in the collateral vessels, and the absence of pedunculated type were independent predictive factors for retinal edema but not the MA size, or presence in the retinal deep capillary plexus. After treatment, the mean retinal thickness decreased significantly, but the mean MA size remained unchanged. CONCLUSION: OCTA enables morphologic classification, three-dimensional analysis, and investigation of the longitudinal changes of MAs with noninvasive volumetric quantification, leading to a better understanding of the pathology of MAs in eyes with BRVO.

Peripheral Microvascular Abnormalities Detected by Wide-Field Fluorescein Angiography in Eyes with Branch Retinal Vein Occlusion.

PURPOSE: To evaluate the location of microvascular abnormalities using wide-field fluorescein angiography (WFFA) and investigate the impact on visual outcome in eyes with branch retinal vein occlusion (BRVO). METHODS: Forty eyes of 39 patients (24 males and 15 females with an average age of 71 years) were retrospectively reviewed. One patient had BRVO bilaterally. WFFA was performed in all patients to evaluate perfusion status and detect microvascular abnormalities. The WFFA images were divided into 3 zones: zone 1, posterior pole; zone 2, mid-periphery; zone 3, far periphery, in order to document the presence of microvascular abnormalities. Scatter retinal photocoagulation (PC) was performed for retinal neovascularization (NV) and/or widespread nonperfused areas (NPAs). RESULTS: The incidence of microvascular abnormalities in zone 3 was significantly (p < 0.0001) less than in zones 1 and 2. The presence of larger NPAs in zone 1, but not in zone 3, was associated with the incidence of NV and vitreous hemorrhage. The presence of peripheral lesions and the application of PC did not affect the visual outcome. CONCLUSION: The presence of peripheral abnormalities or scatter PC for NPAs did not affect the visual outcome in eyes with BRVO.

Collateral vessels on optical coherence tomography angiography in eyes with branch retinal vein occlusion.

AIMS: To detect collateral vessels using optical coherence tomography angiography (OCTA) in eyes with branch retinal vein occlusion (BRVO) and to investigate the associations with visual outcomes and macular oedema. METHODS: Eyes with macular oedema secondary to BRVO that underwent OCTA at baseline and were followed up for more than 6 months were enrolled. The presence of collaterals, whether the collaterals were leaky or not, and the associations with visual outcomes and macular oedema were investigated. RESULTS: Twenty-eight eyes of 28 patients (8 men and 20 women; mean age, 68 years) were enrolled. Collaterals were detected in 23 eyes (82%) and already existed at the initial visit. Collaterals were more frequently detected in eyes with major BRVO or ischaemic type. One-third of the collaterals were leaky and all of the leaky collaterals had microaneurysms (MAs) inside. Macular oedema in eyes with collaterals was more quickly and frequently resolved than that in eyes without collaterals, but there were no significant differences. Collateral vessel formation did not seem to impact on visual outcomes, but the mean baseline central retinal thickness (CRT) was significantly higher in eyes with collaterals, and the mean CRT reduction at 6 months after treatments was significantly greater than in eyes without collaterals. CONCLUSIONS: These results suggest that collateral vessels are formed at the acute phase in eyes with BRVO. In addition, the presence of collaterals might be associated with absorption of macular oedema, but MAs formed in collaterals sometimes can cause macular oedema.

Structural and Functional Analyses of Retinal Ischemia in Eyes with Retinal Vein Occlusion: Relationship with Macular Edema or Microaneurysm Formation.

PURPOSE: To study the structural and functional changes of retinal ischemia and investigate their association with macular edema (ME) or microaneurysm (MA) formation in eyes with retinal vein occlusion (RVO). METHODS: Sixty eyes of 30 patients (27 eyes with branch [b]RVO, 3 with central RVO, and 30 fellow eyes) were retrospectively reviewed. Optical coherence tomography (OCT), OCT angiography (OCTA), and microperimetry were performed simultaneously to measure retinal thickness and sensitivity. The presence of ME or MA was also assessed using OCT and fluorescein angiography. RESULTS: The mean retinal sensitivity in the nonperfused areas (NPAs) deteriorated, and this was significantly (r = -0.379, p = 0.0391*) and inversely correlated with duration from disease onset. ME and MA were unlikely to be observed around the area where the retinal sensitivity decreased. In the NPAs, the mean retinal thickness of the superficial capillary plexus (SCP) (p < 0.0001), deep capillary plexus (DCP) (p = 0.0323), and outer retina (p = 0.0008) were significantly thinner than those in the fellow eyes, respectively. Multivariate regression analysis revealed that the thicknesses of the DCP (ß: 0.3107, p = 0.0007) and outer retina (ß: 0.3482, p = 0.0001) were the independent correlative factors of the retinal sensitivity, but that SCP thickness was not. CONCLUSION: Deep retinal thinning in NPAs was correlated significantly with a decreased retinal sensitivity, which might be a negative predictor of ME and MA in eyes with RVO.

Multimodal Imaging in a Case of Idiopathic Neuroretinitis.

A 37-year-old woman presented with painful visual loss in the left eye for 2 weeks. The best-corrected visual acuity was 20/200. Ophthalmic examination of the left eye revealed vitreous cells, optic disc swelling, serous retinal detachment, and macular star-figure hard exudates. Swept-source optical coherence tomography showed both inner and outer retinas were swollen, the choroid was thickened, and the corresponding retinal pigment epithelium was elevated. Wide-field indocyanine green angiography disclosed multiple hypofluorescent spots in the mid-periphery. Taken together, an involvement of optic disc, entire retina, and choroid was considered in the current case.

Preoperative optical coherence tomography visualization of epiretinal membranes enhances surgical strategies.

PURPOSE: The aim of this study was to evaluate the usefulness of preoperative optical coherence tomography (OCT) findings in patients with macular epiretinal membrane (ERM) for the planning of surgical strategy. PATIENTS AND METHODS: One hundred twenty-three eyes of 121 patients (49 men, 72 women; mean age, 66 years) with an idiopathic ERM were enrolled. All patients underwent an ophthalmic examination including indirect ophthalmoscopy and OCT (Cirrus HD-OCT 4000 and/or 5000). OCT images obtained using model 4000 were transferred to the model 5000 system for vitreoretinal interface (VRI) analysis. The retinal thickness in each area, occurrence rate, and locations of the edges and partial detachments of the ERMs were evaluated using OCT. RESULTS: OCT detected identifiable edges in 61 (50%) eyes and partial detachments in 116 (94%) of the 123 eyes. The edges and partial detachments were seen more frequently in the inferior macula. VRI analysis also detected the edges and partial detachments. Excluding the central area, the superior quadrant was the thickest in patients with an ERM. CONCLUSION: Preoperatively acquired OCT images are useful for planning surgical strategies and performing the surgeries smoothly.

Retinal Hemodynamics Seen on Optical Coherence Tomography Angiography Before and After Treatment of Retinal Vein Occlusion.

PURPOSE: This study evaluates the retinal hemodynamics using optical coherence tomography angiography (OCTA) before and after anti-vascular endothelial growth factor (VEGF) therapy in patients with macular edema associated with retinal vein occlusion (RVO). METHODS: Twelve patients (23 eyes; mean age, 64 years) were included (eight eyes with branch RVO, four with central RVO, and 11 unaffected fellow eyes. The best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and 6 months after treatment. The foveal avascular zone (FAZ), nonperfused areas (NPAs), and flow area were evaluated with OCTA before and after treatment. RESULTS: The BCVA and CRT improved significantly after treatment. In eyes with RVO, the baseline FAZ in the retinal deep capillary layer was larger than in fellow eyes and enlarged in the retinal superficial and deep capillary layers after therapy; NPAs decreased after therapy, especially in the retinal deep capillary layer; and the baseline flow area was smaller than in fellow eyes and improved after therapy, especially in the retinal deep capillary layer. CONCLUSIONS: Optical coherence tomography angiography can evaluate the retinal hemodynamics in patients with RVOs. Anti-VEGF therapy reduced the NPA size and improved retinal blood flow, especially in the retinal deep layer. The current results suggested that anti-VEGF therapy might improve retinal deep ischemia in patients with RVO in the retinal deep layer, which is abundant in capillaries.