RETİNAL VEN VE DAL TIKANIKLIĞINA BAĞLI MAKULA ÖDEMİNDE UZUN DÖNEM SONUÇLAR VE POTANSİYEL PROGNOSTİK FAKTÖRLER

Abstract

ABSTRACT Kargalı KA. Long-Term Outcomes and Potential Prognostic Factors in Macular Edema Secondary to Central and Branch Retinal Vein Occlusion, Hacettepe University Faculty of Medicine, Department of Ophthalmology, Specialization Thesis, Ankara, 2025. Retinal vein occlusion (RVO) is the second most common retinal vascular disorder after diabetic retinopathy and may cause severe visual loss. This study aimed to evaluate long-term functional (BCVA) and anatomical outcomes in patients with central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO), to compare the efficacy of different treatment regimens, and to analyze the impact of optical coherence tomography (OCT) biomarkers on visual prognosis. This retrospective cohort study included data from 124 eyes of 124 patients with RVO who were followed for at least one year at the Department of Ophthalmology, Hacettepe University, between January 1, 2010, and January 1, 2025. Patients were classified as CRVO (n=49) or BRVO (n=75). The mean follow-up period was 52.27 ± 37.6 months, and the mean number of injections was 11.15 ± 9.33 BCVA (ETDRS letters) and OCT parameters (central macular thickness (CMT), macular volume (MV), outer nuclear layer thickness (ONLT), external limiting membrane (ELM) and ellipsoid zone (EZ) integrity, disorganization of retinal inner layers (DRIL), hyperreflective foci (HRF), intraretinal fluid (IRF), subretinal fluid (SRF), vitreomacular traction (VMT), vitreomacular adhesion (VMA), posterior vitreous detachment (PVD), prominent middle limiting membrane (p-MLM), epiretinal membrane (ERM), and foveal bulge) were evaluated. Of the patients, 51.6% were female and 48.4% were male; BRVO was more common in females, whereas CRVO predominated in males (p<0.001). Following anti-VEGF therapy, both groups demonstrated significant anatomical improvement (decrease in CMT, p<0.001) and functional gain (increase in BCVA, p<0.001). Although visual improvement was greater in BRVO than in CRVO, the difference was not statistically significant (p=0.055). V In the CRVO group, the presence of DRIL, HRF count >20, and disruption of ELM/EZ were associated with poorer BCVA, while VMA, VMT, SRF height >150 μm, HRF count >20, and cystic/diffuse/mixed IRF were significantly correlated with increased CMT (p<0.05). In the BRVO group, ELM/EZ disruption was significantly associated with reduced BCVA (p<0.001), and both VMT and SRF height >150 μm correlated with higher CMT (p<0.001). Preservation or disruption of ELM/EZ integrity was identified as the strongest predictor of visual prognosis in both groups. In BRVO eyes, changes in BCVA were significantly correlated with changes in CMT (p=0.007) and ONLT (p=0.034). There were no significant differences in anatomical or functional outcomes among treatment subgroups (anti-VEGF, steroid, or combination therapy) (p>0.05). Anti-VEGF therapy provides significant long-term anatomical and functional improvement in both CRVO and BRVO. Integrity of the outer retinal layers (ELM/EZ), hyperreflective foci, and DRIL were identified as the most reliable OCT biomarkers predicting visual prognosis. The presence of vitreomacular traction, as well as subretinal and intraretinal fluid, was found to delay macular edema resolution and adversely affect the rate of anatomical recovery. Keywords: Retinal vein occlusion, anti-VEGF, optical coherence tomography, macular edema, ETDRS