Intravitreal injections during COVID-19 outbreak: Real-world experience from an Italian tertiary referral center.

We report our experience during COVID-19 outbreak for intravitreal injections in patients with maculopathy. We proposed a treatment priority levels and timings; the "High" priority level includes all monocular patients; the "Moderate" is assigned to all patients with an active macular neovascularization; the patients affected by diabetic macular edema or retinal vein occlusion belong to the "Low" class. This organization allowed us to treat the most urgent patients although the injections performed had a 91.7% drop compared to the same period of 2019.

Use of Anti-VEGF Drugs in Retinal Vein Occlusions.

Retinal vein occlusion (RVO) is one of the most prevalent causes of visual loss in the Western World. Its pathogenesis is still not completely known. Chronic macular edema and ischemia compromise the functional and anatomical status of the retina. Antivascular endothelial growth factor (anti-VEGF) injections have demonstrated better results than other previous options, including observation or laser therapy. This narrative review aims to analyze the current aspects related to these drugs.

Reliability of Ischemic Index Grading in Common Retinal Vascular Diseases.

BACKGROUND AND OBJECTIVE: Retinal nonperfusion is closely associated with vision-threatening complications such as neovascularization and macular edema. The purpose of this study is to investigate the reliability of a calculated ischemic index (ISI) by means of intergrader and intragrader agreement on ultrawide-field fluorescein angiography (UWFFA) in common retinal vascular diseases. PATIENTS AND METHODS: Eight trained graders evaluated 15 UWFFA images provided digitally and re-graded on a different day. They included five eyes with diabetic retinopathy (DR), five with branch retinal vein occlusion (BRVO), and five with central retinal vein occlusion (CRVO). To assess intergrader and intragrader agreement and variability among different diseases, the replicate inter- and intragrader standard deviations (SDs) and coefficients of variation (CVs) were calculated. RESULTS: Mean ISI was 46% for images of DR, 26% for images of BRVO, and 61.3% for images of CRVO. Combined intragrader and intergrader replicate SDs were 17.8% for DR, 3.8% for BRVO and 13.0% for CRVO. Combined intragrader and intergrader replicate coefficients of variation were 38.6% (percent of mean ISI) for DR, 14.7% for BRVO, and 21.2% for CRVO. CONCLUSION: Intergrader and intragrader variability was high when assessing DR. This may be due to the chronic nature of DR progression, which can lead to patchy areas of ischemia. Intergrader and intragrader variability was better for CRVO and best for BRVO. This may be due to the acute or subacute nature of retinal vein occlusions.

Fundus changes in branch retinal vein occlusion.

PURPOSE: To investigate systematically the retinal changes in branch retinal vein occlusion (BRVO) and their natural history. METHODS: The study comprised 214 consecutive patients with BRVO (144 major BRVO and 72 macular BRVO eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. RESULTS: Initially, retinal hemorrhages were moderate to severe in the perifovea and macula in at least 65% in major and 52% in macular BRVO; at the fovea, it was 51% in major and 36% in macular BRVO. Initially, macular edema was more marked in major BRVO than in macular BRVO (P = 0.007). Major BRVO had a significantly higher rate of development of serous macular detachment (P = 0.002), epiretinal membrane (P = 0.008), serous retinal detachment (P = 0.002), perivenous sheathing (P < 0.0001), optic disk pallor (P < 0.0001), and lipid deposit (P < 0.0001) compared with macular BRVO. Retinal and disk neovascularization was seen only in major BRVO. The time to resolution of BRVO was significantly longer for major BRVO compared with macular BRVO (P = 0.0002). CONCLUSION: Major and macular BRVOs are two distinct clinical entities. Initial and final fundus findings in the two types differ markedly.

Retinal vein occlusion and the optic disk.

PURPOSE: To investigate the effect of cup to disk (C/D) ratio in various types of retinal vein occlusion (RVO) on the severity of retinopathy, visual outcome, and resolution of retinopathy and validity of the concept of the "compartment syndrome" in RVO. METHODS: The study comprised 1,222 consecutive eyes (768 central retinal vein occlusion [CRVO], 183 hemi-CRVO, and 271 branch retinal vein occlusion). Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. RESULTS: Compared to sex-matched and age-matched normal eyes, C/D ratio ≥0.5 was significantly more common in all CRVOs and hemi-CRVO eyes but not in branch retinal vein occlusion. Retinal hemorrhages were significantly more severe in nonischemic CRVO with C/D ratio ≥0.5 compared to those with no or small cup, but no difference was found in hemi-CRVO and branch RVO. In ischemic CRVO, moderate hemorrhages were more with C/D ≥0.5 but severe hemorrhages were more with no cup. In various types of RVO, there was no significant association of C/D ratio with macular edema, retinopathy resolution, visual acuity, and visual field defect. CONCLUSION: The findings of our study contradict the concept that the "compartment syndrome" plays any role in the prevalence of various types of RVO or in their severity, the resolution of retinopathy, or the visual outcome. This indicates that the advocated procedure of radial optic neurotomy, based on the compartment syndrome, is not a logical treatment for CRVO.

[From scientific evidence to clinical practice: treatment regimens for macular edema secondary to retinal vein occlusion]. / De la evidencia cientifica a la practica clinica: pautas de tratamiento del edema macular secundario a oclusion venosa retiniana.

Retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease after diabetic retinopathy. Despite the existence of several possible treatment options, none was entirely satisfactory and many patients suffered irreversible visual loss. As a result of the BRAVO, CRUISE and GENEVA trials, ranibizumab and the intravitreal biodegradable implants of dexamethasone has recently been approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of RVO secondary edema. In this paper we begin by describing the current treatment options for RVO associated macular edema and continue with the description of the treatment regimen with ranibizumab.

Hemicentral retinal vein occlusion: natural history of visual outcome.

PURPOSE: To investigate the natural history of visual outcome in hemicentral retinal vein occlusion (HCRVO). METHODS: The study comprised 65 consecutive HCRVO patients (67 eyes) seen within 3 months of onset. At first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Hemicentral retinal vein occlusion was classified into nonischemic (57 eyes) and ischemic (10 eyes) at initial visit. RESULTS: Nonischemic HCRVO involved superior and inferior half of the retina in 39% and 56%, respectively, and in ischemic HCRVO in 50% and 40%, respectively. In nonischemic HCRVO, initial visual acuity was 20/60 or better in 73.7% and minimal to mild visual field loss in 96% and in ischemic HCRVO in 40% and 55.5%, respectively. After resolution of macular edema, in nonischemic HCRVO eyes, cumulative chance of improvement was 50% with 20/70 or worse initial visual acuity, and deterioration in only 6% with 20/60 or better initial visual acuity, and in 5% with minimal to mild visual initial field loss. CONCLUSION: This study suggests a good prognosis in the natural history of visual outcome in nonischemic HCRVO.

Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study system for evaluation of stereoscopic color fundus photographs and fluorescein angiograms: SCORE Study Report 9.

OBJECTIVE: To describe the procedures and reproducibility for grading stereoscopic color fundus photographs and fluorescein angiograms of participants in the SCORE Study. METHODS: Standardized stereoscopic fundus photographs and fluorescein angiograms taken at 84 clinical centers were evaluated by graders at a central reading center. Type of retinal vein occlusion (RVO), area of retinal thickening, and area of retinal hemorrhage are evaluated from fundus photographs; area of fluorescein leakage and area of capillary nonperfusion are measured on fluorescein angiography. Temporal reproducibility consisted of annual regrading of a randomly selected dedicated subset of fundus photographs (60 subjects) and fluorescein angiograms (40 subjects) for 3 successive years. Contemporaneous reproducibility involved monthly regrading of a 5% random selection of recently evaluated fundus photographs (n = 73). RESULTS: The intergrader agreement for RVO type and presence of retinal thickening was greater than 90% in the 3 annual regrades. The intraclass correlation (ICC) for area of retinal thickening in the 3 years ranged from 0.39 to 0.64 and for area of retinal hemorrhage, 0.87 to 0.96. The ICC for area of fluorescein leakage ranged from 0.66 to 0.75 and for capillary nonperfusion, 0.94 to 0.97. The contemporaneous reproducibility results were similar to those of temporal reproducibility for all variables except area of retinal thickening (ICC, 0.84). CONCLUSIONS: The fundus photography and fluorescein angiography grading procedures for the SCORE Study are reproducible and can be used for multicenter longitudinal studies of RVO. A systematic temporal drift occurred in evaluating area of retinal thickening.

Plasma thiols and taurine levels in central retinal vein occlusion.

PURPOSE: To determine the plasma levels of the sulfur-containing amino-acids homocysteine, cysteine, cysteinylglycine, glutamylcysteine, glutathione, and taurine in patients with central retinal vein occlusion (CRVO) and in healthy subjects and to ascertain whether there are statistically significant differences between patients and controls. METHODS: Laser-induced fluorescence capillary electrophoresis was used to measure the plasma levels of homocysteine, cysteine, cysteinylglycine, glutamylcysteine, glutathione, and taurine in 29 patients with CRVO and 80 age- and gender-matched control subjects. Wilcoxon or Student's t-test was used, when appropriate, to determine differences between groups. Multivariate logistic regression analysis was used to determine the risks for CRVO. RESULTS: CRVO patients showed significantly higher concentrations of cysteine (p = 0.032) and significantly lower concentrations of cysteinylglycine (p = 0.009) and taurine (p = 0.0002) than controls. Conversely, there were no significant differences in plasma homocysteine, glutamylcysteine, and glutathione between CRVO patients and controls. When categorized by CRVO type (ischemic/non-ischemic), taurine was still lower in both subgroups than in controls, whereas cysteine, cysteinylglycine, as well as homocysteine, were significantly higher only in the ischemic subgroup. In non-ischemic CRVO, cysteinylglycine fell just short of statistical significance (p = 0.06). Logistic regression analysis revealed an odds ratio of 1.02 (95% confidence interval (CI): 1.01-1.04, p = 0.001) for cysteine, 0.79 (95% CI: 0.70-0.89, p = 0.0002) for cysteinylglycine, and 0.94 (95% CI: 0.90-0.97, p = 0.002) for taurine. CONCLUSIONS: Results suggest that reduced plasma levels of cysteinylglycine and taurine may contribute to the pathogenesis of both CRVO types. Furthermore, this study also demonstrated an association between ischemic CRVO and higher concentrations of homocysteine and cysteine.

Branch retinal vein occlusion: classification and treatment.

Branch retinal vein occlusion (BRVO) refers to a heterogeneous group of disorders with different clinical aspects, courses, and probably therapy. Depending on the site of the arteriovenous crossing, we can roughly divide BRVO into 3 main groups: major BRVO, hemispheric retinal vein occlusion, and macular BRVO. Main treatment options include laser treatment, corticosteroid administration, anti-VEGF drugs, and sheathotomy with or without vitrectomy. Laser photocoagulation, as demonstrated by the Branch Vein Occlusion Study, represents the gold standard for the treatment of macular edema and ocular neovascularization following BRVO. The limited functional outcomes achievable by means of laser treatment have prompted researchers to try alternative options, with varying results. The recent introduction of combined therapies for macular edema may provide a superior approach in an attempt to improve and stabilize visual acuity over a long-term follow-up.

[Analysis of visual prognosis and correlative factors in retinal vein occlusion].

OBJECTIVE: To investigate the visual prognosis, risk factors, complications and the causes of visual deterioration in patients with various types of retinal vein occlusion (RVO). METHODS: Nine hundred and forty-four eyes of 913 patients with various types of RVO were analyzed. The age range of patients was 15 - 89 years (average 52.8 +/- 11.9), and the average follow-up was 20.7 months. The data of the patients were studied by SPSS software. RESULTS: (1) RVO was classified into central RVO (CRVO) in 406 eyes of 391 cases (43.0%), hemi-RVO (HRVO) in 60 eyes of 60 cases (6.4%) and branch RVO (BRVO) in 478 eyes of 462 cases (50.6%). (2) They were subdivided into ischemic type in 633 eyes (67.1%) and non-ischemic type in 311 eyes (32.9%). (3) The visual prognosis: the average initial visual acuity (VA) in CRVO, HRVO and BRVO was 0.36, 0.38 and 0.40 respectively. The average final VA was 0.40 in CRVO (P > 0.05), 0.50 in HRVO (P > 0.05) and 0.58 in BRVO (P < 0.05). (4) The initial VA and prognosis: there was close relationship between initial VA and visual prognosis. If the initial VA >/= 0.5, the final acuity maintained >/= 0.5 in 70.6% in CRVO, 75.0% in HRVO and 84.9% in BRVO. The patients with initial VA