Multifocal electroretinogram in branch retinal vein occlusion.

PURPOSE: To describe the response from multifocal electroretinography in branch retinal vein occlusion. DESIGN: Prospective observational case control series. METHODS: Multifocal electroretinography was recorded in 15 patients with temporal branch retinal vein occlusion and 21 control subjects using a visual evoked response imaging system. RESULTS: There were significant differences in mean amplitude (P =.01) and latency (P =.001) between thrombotic and nonthrombotic retina in the same eyes, as well as in patients compared with control subjects. CONCLUSION: Responses from multifocal electroretinography demonstrate retinal dysfunction in branch retinal vein occlusion; additional studies will demonstrate whether multifocal electroretinography has a prognostic value.

Clinical and electrophysiologic outcome in patients with neovascular glaucoma treated with and without bevacizumab.

PURPOSE: To investigate the clinical and electrophysiologic effect of a single intravitreal injection of bevacizumab for neovascular glaucoma (NVG) after ischemic central retinal vein occlusion (iCRVO). METHODS: Nineteen eyes from 19 patients with NVG secondary to iCRVO were randomly allocated to either an intravitreal bevacizumab injection and panretinal photocoagulation (PRP) (10 eyes) or PRP alone (9 eyes). The primary outcome measure was the change in the total retinal function 6 months after treatment, demonstrated by full-field electroretinography (ERG). Secondary outcomes included visual acuity, intraocular pressure (IOP), glaucoma medication, additional IOP-lowering treatment, and the presence of ocular neovascularization before treatment, and 1 week, 2 months, and 6 months after treatment. RESULTS: The regression of ocular neovascularization in the bevacizumab/PRP group was confirmed 1 week after injection. Patients in both study groups had very poor visual acuity at baseline. This remained unchanged. There was no significant difference in the mean IOP between the groups at any point in time. The a-wave amplitudes of combined rod-cone response were significantly decreased after 6 months in the bevacizumab/PRP group (p=0.028), compared with the baseline values. The a- and b-wave amplitudes of combined rod-cone response and the b-wave amplitudes of the 30-Hz flicker response were also markedly reduced compared with the PRP group (-60%, -43%, -47% vs +23%, -36%, -16%, respectively). CONCLUSIONS: This study suggests that intravitreal injection of bevacizumab is valuable in the treatment of NVG by hastening the resolution of neovascularization, while the full-field ERG results indicate that bevacizumab may reduce the photoreceptor function in NVG patients.

Vitrectomy for non-ischaemic macular oedema in retinal vein occlusion.

PURPOSE: To evaluate the effect of vitrectomy in eyes with non-ischaemic macular oedema secondary to hemi and central retinal vein occlusion. METHODS: This retrospective study analysed the outcome of eight patients with non-ischaemic macular oedema without posterior vitreous detachment. Six patients had a central retinal vein occlusion and two had a hemi retinal vein occlusion. A standard three-port vitrectomy was performed in all patients. Retinal mapping by optical coherence tomography and visual acuity (VA) testing were performed before vitrectomy and at 1, 2 and 12 months postoperatively. RESULTS: At the 1-month follow-up there was a statistically significant reduction in retinal thickness (Wilcoxon; p = 0.04) that persisted at 2 months (Wilcoxon; p = 0.04). However, at 12 months there was no difference compared with baseline. LogMAR VA was significantly improved at 1 month (Wilcoxon p = 0.04), but at 2 and 12 months there was no difference compared with baseline. CONCLUSIONS: Vitrectomy in hemi and central retinal vein occlusion has the potential to reduce macular oedema and improve VA in the early postoperative phase but does not seem to improve the longterm outcome of the disease.

Multifocal electroretinography and fluorescein angiography in retinal vein occlusion.

PURPOSE: To interpret the responses of multifocal electroretinography (mfERG) of the central macula in retinal vein occlusion and correlate them with findings of fluorescein angiography, optical coherence tomography (OCT), and visual acuity. METHODS: In a prospective observational case series, 25 patients with branch or hemiretinal vein occlusion were examined by means of mfERG, fluorescein angiography, OCT, and visual acuity. RESULTS: In eyes with macular ischemia shown by fluorescein angiography, the implicit time was significantly longer than that in eyes without macular ischemia (P = 0.006; Mann-Whitney test). The amplitudes in the first-order kernel responses in the ischemic eyes were more reduced (P = 0.04; Mann-Whitney test), and the amplitudes in the central macula correlated well with visual acuity (P = 0.006; Pearson correlation). There was no significant correlation between the degree of retinal thickening as measured by OCT and the mfERG responses, although there was a trend toward reduced amplitudes in the maculae with central retinal thickening (P = 0.08; Pearson correlation). CONCLUSION: Macular ischemia as measured by fluorescein angiography correlates well with the prolonged implicit time on the first-order kernel response in mfERG, but no significant correlation was detected between the responses of mfERG and the OCT findings. Further investigations will demonstrate if this can be used as a prognostic instrument in the selection of patients, who will most likely benefit from future treatments.

Is optic nerve head swelling of prognostic value in central retinal vein occlusion?

PURPOSE: To investigate the prognostic value of optic nerve head swelling (ONHS) in central retinal vein occlusion (CRVO) and compare it to other prognostic factors. METHODS: Seventy-four patients with CRVO were studied retrospectively. The parameters analysed were the initial presence of ONHS, the fluorescein angiographic appearance, the implicit time in the 30-Hz flicker ERG and the initial visual acuity. The aspects of outcome studied were the development of neovascular complications and the visual acuity 1 year after the thrombotic event. RESULTS: Fluorescein angiography, ERG and initial visual acuity were of prognostic value in CRVO, whereas ONHS was of questionable value. CONCLUSION: ONHS is most likely of no prognostic value in CRVO.