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Liefert die OCT-Morphologie Hinweise für die Visusprognose nach Venenverschluss?

SD-OCT-Analyse bei retinalem Venenverschluss vor und nach Resorption des initialen Makulaödems

Does OCT morphology provide indications for prognosis of visual acuity after venous occlusion?

SD-OCT analysis in retinal vein occlusion before and after resolution of initial macular edema

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An Erratum to this article was published on 30 May 2016

Zusammenfassung

Hintergrund

Trotz Resorption des infolge eines retinalen Venenverschlusses (RVV) entstandenen Makulaödems (MÖ) nach intravitrealer Anti-VEGF-Therapie (IVOM) persistiert die Visusminderung häufig.

Ziel der Arbeit

Durch qualitative und quantitative Auswertung von Spectral-Domain optische Kohärenztomographie (SD-OCT)-Aufnahmen bei RVV-Patienten mit nach Therapie zurückgebildetem MÖ sollen morphologische und funktionelle Resultate korreliert werden.

Material und Methoden

Foveale SD-OCT-Scans von 13 RVV-Patienten wurden nach vollständigem Rückgang des initialen MÖ nach IVOM retrospektiv ausgewertet. Die Dicke der inneren Netzhautschichten bis zur Membrana limitans externa (ELM) und der Photorezeptoren [ELM bis retinales Pigmentepithel (RPE)] wurde mittels automatischer Segmentierungssoftware bestimmt. Die foveale Kontinuität der 4 äußeren hyperreflektiven Bänder [ELM, ellipsoide Zone der Innensegmente (ISe), Interdigitationszone (IZ), RPE] sowie die Lage des initialen MÖ wurden beurteilt. Patienten mit gutem ≤ log(MAR) 0,3 (n = 10) und schlechtem Endvisus ≥ log(MAR) 1,0 (n = 3) wurden verglichen.

Ergebnisse

Die inneren Netzhautschichten bis zur ELM waren in der schlechteren Visusgruppe dünner. Bei gutem Endvisus lag das initiale MÖ signifikant häufiger oberhalb der ISe und die ISe war nach MÖ-Resorption tendenziell häufiger morphologisch intakt.

Diskussion

Bei fehlendem Visusanstieg trotz trockenem Makulabefund zeigten sich die inneren Netzhautschichten bis zur ELM in der SD-OCT dünner, was als Atrophie zu werten ist. Im Bereich der Photorezeptoren zeigten sich qualitative Unterschiede. Mögliche Erklärungen könnten Ischämie und sowie eine Mitbeteiligung der äußeren Netzhautschichten im Rahmen des initialen MÖ darstellen, die zu einer dauerhaften Schädigung der ISe führen.

Abstract

Background

Even though macular edema (ME) in patients with retinal vein occlusion (RVO) is resolved after intravitreal treatment with anti-vascular endothelial growth factor (VEGF), impairment of visual acuity (VA) often persists.

Objective

A qualitative and quantitative evaluation of spectral domain optical coherence tomography (SD-OCT) images was carried out in patients with RVO and resolved ME to investigate a correlation between retinal morphology and functional results.

Material and methods

Foveal SD-OCT scans of 13 patients with RVO and resolved ME after treatment were retrospectively evaluated. The thickness of inner retinal layers up to the external limiting membrane (ELM) and up to the photoreceptors in the retinal pigment epithelium (RPE) was measured by automatic segmentation software. Foveal continuity of the four outer hyperreflective bands, the ellipsoid zone of the inner segments (ISe), the ELM, the interdigitation zone (IZ), the RPE and the location of the initial ME were evaluated. Patients with good  (≤ 0.3 logMAR, n = 10) and poor VA (≥ 1.0 logMAR, n = 3) were compared.

Results

Inner retinal layers up to ELM were thinner in the the poor VA group. In the good VA group the initial ME was significantly more often above the ISe and after resolution of ME the ISe tended to be intact more frequently.

Conclusion

In patients with poor VA despite resolved ME the inner retinal layers up to the ELM were significantly thinner, which could be a sign of atrophy. Qualitative differences were seen at the photoreceptor level, which could be explained by ischemia or an involvement of the outer retina during initial ME that leads to permanent destruction of the ISe.

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Authors and Affiliations

  1. Augenklinik Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    K. Schröder, P. Ackermann, M. Brachert, S. Bairov, G. Geerling & R. Guthoff

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  1. K. Schröder
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  2. P. Ackermann
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  3. M. Brachert
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  4. S. Bairov
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  5. G. Geerling
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  6. R. Guthoff
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Correspondence to K. Schröder.

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Interessenkonflikt

K. Schröder, P. Ackermann, M. Brachert, S. Bairov, G. Geerling und R. Guthoff geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Die Ergebnisse wurden auf dem DOG-Kongress 2014 als Poster publiziert.

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Schröder, K., Ackermann, P., Brachert, M. et al. Liefert die OCT-Morphologie Hinweise für die Visusprognose nach Venenverschluss?. Ophthalmologe 113, 500–506 (2016). https://doi.org/10.1007/s00347-016-0234-8

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  • DOI: https://doi.org/10.1007/s00347-016-0234-8

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