Luke Nicholson1, Clara Vazquez-Alfageme1, Namritha V Patrao1, Ioanna Triantafyllopolou1, James W Bainbridge1, Philip G Hykin1, Sobha Sivaprasad2. 1. National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom. 2. National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom. Electronic address: senswathi@aol.com.
Abstract
PURPOSE: To review the definition of ischaemic central retinal vein occlusion (CRVO) and stratify the risk of neovascular complication based on wider areas of visible retinal non-perfusion. DESIGN: Retrospective consecutive case series and image analysis study. METHODS: Setting: Moorfields Eye Hospital, London, United Kingdom. STUDY POPULATION: Forty-two consecutive treatment-naïve eyes with CRVO imaged with ultra-widefield angiography with a minimum of 12 months follow-up. OBSERVATION PROCEDURE: The spatial location and total area of retinal nonperfusion (measured in disc areas, DA) were determined using the validated concentric rings method. The area was corrected for projection distortion. The images were graded by 2 retinal physicians and average measurements used. MAIN OUTCOME MEASURES: Development of neovascular complications. RESULTS: The percentage of eyes developing new vessels increased from none in eyes with less than 10 DA of nonperfusion in total to 14.3% in eyes with 10-30 DA, 20.0% for 30-75 DA, and 80% risk with 75-150 DA of nonperfusion. From 13 (31.0%) eyes with a perfused posterior pole (an area encompassing a 5 disc diameter radius centered at the fovea) and more than 10 DA of nonperfusion isolated in the periphery (beyond the posterior pole), only 1 (7.7%) eye developed new vessels, odds ratio (OR) 0.12 [95% confidence interval (CI): 0.01, 1.03]. Comparatively, for 13 (31.0%) eyes with more than 10 DA of nonperfusion in the posterior pole, 11 (84.6%) developed new vessels, OR 74.25 [95% CI: 9.26, 595.30], P < .001. CONCLUSION: With ultra-widefield angiography, we have ascertained that posterior pole nonperfusion of more than 10 DA remains the key risk factor for new vessel development compared to areas of nonperfusion confined to the periphery.
PURPOSE: To review the definition of ischaemic central retinal vein occlusion (CRVO) and stratify the risk of neovascular complication based on wider areas of visible retinal non-perfusion. DESIGN: Retrospective consecutive case series and image analysis study. METHODS: Setting: Moorfields Eye Hospital, London, United Kingdom. STUDY POPULATION: Forty-two consecutive treatment-naïve eyes with CRVO imaged with ultra-widefield angiography with a minimum of 12 months follow-up. OBSERVATION PROCEDURE: The spatial location and total area of retinal nonperfusion (measured in disc areas, DA) were determined using the validated concentric rings method. The area was corrected for projection distortion. The images were graded by 2 retinal physicians and average measurements used. MAIN OUTCOME MEASURES: Development of neovascular complications. RESULTS: The percentage of eyes developing new vessels increased from none in eyes with less than 10 DA of nonperfusion in total to 14.3% in eyes with 10-30 DA, 20.0% for 30-75 DA, and 80% risk with 75-150 DA of nonperfusion. From 13 (31.0%) eyes with a perfused posterior pole (an area encompassing a 5 disc diameter radius centered at the fovea) and more than 10 DA of nonperfusion isolated in the periphery (beyond the posterior pole), only 1 (7.7%) eye developed new vessels, odds ratio (OR) 0.12 [95% confidence interval (CI): 0.01, 1.03]. Comparatively, for 13 (31.0%) eyes with more than 10 DA of nonperfusion in the posterior pole, 11 (84.6%) developed new vessels, OR 74.25 [95% CI: 9.26, 595.30], P < .001. CONCLUSION: With ultra-widefield angiography, we have ascertained that posterior pole nonperfusion of more than 10 DA remains the key risk factor for new vessel development compared to areas of nonperfusion confined to the periphery.
Authors: Philip Hykin; A Toby Prevost; Sobha Sivaprasad; Joana C Vasconcelos; Caroline Murphy; Joanna Kelly; Jayashree Ramu; Abualbishr Alshreef; Laura Flight; Rebekah Pennington; Barry Hounsome; Ellen Lever; Andrew Metry; Edith Poku; Yit Yang; Simon P Harding; Andrew Lotery; Usha Chakravarthy; John Brazier Journal: Health Technol Assess Date: 2021-06 Impact factor: 4.014
Authors: Luke Nicholson; Jayashree Ramu; Errol W Chan; James W Bainbridge; Philip G Hykin; Stephen J Talks; Sobha Sivaprasad Journal: JAMA Ophthalmol Date: 2019-06-01 Impact factor: 7.389
Authors: Stephan Szegedi; Nikolaus Hommer; Martin Kallab; Stefan Puchner; Doreen Schmidl; René M Werkmeister; Gerhard Garhöfer; Leopold Schmetterer Journal: Transl Vis Sci Technol Date: 2020-06-25 Impact factor: 3.283
Authors: Luke Nicholson; Roxanne Crosby-Nwaobi; Joana C Vasconcelos; A Toby Prevost; Jayashree Ramu; Amy Riddell; James W Bainbridge; Philip G Hykin; Sobha Sivaprasad Journal: Invest Ophthalmol Vis Sci Date: 2018-08-01 Impact factor: 4.799