Link Between Baseline Peripheral Vascular Leakage and Treatment Response in Patients with Central Retinal Vein Occlusion: A Pilot Study.

PURPOSE: To explore the potential link between quantitative measures of retinovascular function and response to intravitreal bevacizumab in patients with central retinal vein occlusion (CRVO).

PATIENTS AND

METHODS

This retrospective, observational cohort study included 28 eyes with CRVO that satisfied the following inclusion criteria: age over 18 years; bevacizumab treatment for at least 4 months; best corrected visual acuity (BCVA) measurements at baseline and post-treatment; and pre-treatment ultra-wide field fluorescein angiography (UWF-FA). The RETICAD software was used for quantitative analysis of baseline UWF-FA, generating measures of blood flow, perfusion, and blood-retina barrier (BRB) in the central and peripheral retina. Responders and non-responders were defined based on BCVA stratification method developed by the DRCR network. Baseline differences between responders and non-responders were assessed using the Wilcoxon Rank Sum test. The discriminative performance of baseline measures in distinguishing responders from non-responders was evaluated using logistic regression.

RESULTS

At baseline, responders had significantly higher peripheral leakage (p = 0.034), but not central leakage (p = 0.444), compared to non-responders. No significant baseline differences were observed in perfusion or blood flow. The highest discriminative performance for treatment response was observed for baseline BRB leakage in the nasal-peripheral and inferior-peripheral regions (AUC = 0.77 and 0.75, respectively). Baseline blood flow, perfusion, central macular thickness (CMT), and BCVA demonstrated lower discriminative performance.

CONCLUSION

High peripheral BRB leakage at baseline may be associated with an increased likelihood of benefiting from bevacizumab treatment. While this pilot study highlights the potential of quantitative UWF-FA analysis to guide CRVO therapy, these findings require validation in a larger, prospective, multicenter study with a standardized treatment protocol.