The clinical relevance of ultra-widefield angiography findings in patients with central retinal vein occlusion and macular oedema receiving anti-VEGF therapy

Aims:
To report, using ultra-widefield angiography (UWFA) the area, distribution, and change in retinal capillary nonperfusion (RCNP) at baseline and 100 weeks in eyes with central retinal vein occlusion (CRVO) receiving anti-VEGF formacula oedema.
Methods:
Prospective longitudinal multi-centre cohort study. Adults with CRVO treated with anti-VEGF therapy formacular oedema underwent UWFA at baseline and week-100. The area, distribution, and change in total, peripheral andposterior pole RCNP were determined.
Results:
Of 153 eyes at baseline, mean area of RCNP was 34.3DA and 12 (7.8%) had ≥75DA RCNP. More than 10DARCNP was present in the temporal periphery in 75.8% of eyes vs. 10.5% in the nasal periphery. At week-100, mean RCNPwas 42.1DA with a median change from baseline of 3.3DA 95% CI [0.4, 7.3]; p < 0.01. Of 146 eyes with ≤10DA ofposterior pole RCNP at baseline, 16/146 (11.0%) progressed to >10DA at week-100. These eyes had a median increase intotal RCNP of 69.7DA [95% CI 27.2–85.4] vs 0DA [0.0–1.4]; p < 0.001 for those who did not, and two developedneovascular glaucoma. Larger baseline area of RCNP and history of glaucoma were risk factors for posterior pole RCNPdeveloping.
Conclusions:
With UWFA, significant baseline RCNP was identified in the majority of CRVO patients, notably in thetemporal periphery, but large increases over 100 weeks were uncommon. Development of >10DA posterior pole RCNP is amarker for widespread RCNP and in such cases the risk of anterior segment neovascularisation is not abolished byconcomitant anti-VEGF therapy.