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Significance of this study <p>Reduced pulse pressure (PP) reflects impaired systemic perfusion and may exacerbate retinal ischemia in central retinal vein occlusion-induced macular edema (CRVO-ME) by compromising ocular blood flow autoregulation. This hemodynamic dysfunction is hypothesized to worsen clinical outcomes and neovascular risks.</p> Purposes <p>To investigate the associations between potential prognostic biomarkers and clinical outcomes in treatment-naïve CRVO-ME and assess their predictive utilities.</p> Methods <p>In this retrospective cohort study conducted from March 2019 to March 2024, we analyzed 101 treatment-naïve CRVO-ME patients stratified by outcomes: favorable (endpoint best-corrected visual acuity [BCVA] ≥ 20/100 without CRVO-induced neovascular glaucoma [CRVO-NVG]) versus unfavorable (endpoint BCVA &lt; 20/100 or CRVO-NVG development). We compared demographic characteristics, baseline blood pressures, ocular features, and systemic biomarkers between groups.</p> Results <p>Multivariable logistic regression analysis identified two independent predictors of unfavorable outcomes: suboptimal 1-month post-injection BCVA (odds ratio [OR] = 1.824 per 0.1 log MAR unit increase, 95% confidence intervals [CI] 1.236–2.691, <i>P</i> = 0.002) and diminished PP (OR = 1.147 per mmHg decrease, 95% CI 1.028–1.279, <i>P</i> = 0.015). Receiver operating characteristic analysis demonstrated strong predictive accuracy for both parameters (1-month post-injection BCVA: area under the receiver operating characteristic curve [AUROC] = 0.843, cutoff 0.85 logarithm of the minimum angle of resolution [log MAR], <i>P</i> = 0.000; PP: AUROC = 0.812, cutoff 57&#xa0;mmHg,<i> P</i> = 0.000). In the ischemic CRVO-ME subgroup (n = 27), the optical coherence tomography (OCT)-defined “over-response to the first intravitreal injection (ORIVI)” emerged as the sole significant predictor of CRVO-NVG development (OR = 15.167, 95% CI 1.509–152.464, <i>P</i> = 0.026).</p> Conclusion <p>This study establishes baseline PP &lt; 57&#xa0;mmHg and suboptimal 1-month post-injection BCVA &gt; 0.85 log MAR as key prognostic indicators in CRVO-ME, while identifying the ORIVI sign as a specific predictor of CRVO-NVG in ischemic cases. These findings introduce easily obtainable systemic parameter (PP) for risk assessment, define 1-month visual response as key treatment evaluation point, propose ORIVI sign as an imaging biomarker for ischemic CRVO complications.</p>

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Prognostic biomarkers in treatment-naïve central retinal vein occlusion with macular edema

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月8日

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  • Yu Song,
  • Qian Wang,
  • Yu Du,
  • Hong Tian,
  • Yangyang Xu,
  • Rui Min Chen,
  • Shancheng Si

摘要

Significance of this study

Reduced pulse pressure (PP) reflects impaired systemic perfusion and may exacerbate retinal ischemia in central retinal vein occlusion-induced macular edema (CRVO-ME) by compromising ocular blood flow autoregulation. This hemodynamic dysfunction is hypothesized to worsen clinical outcomes and neovascular risks.

Purposes

To investigate the associations between potential prognostic biomarkers and clinical outcomes in treatment-naïve CRVO-ME and assess their predictive utilities.

Methods

In this retrospective cohort study conducted from March 2019 to March 2024, we analyzed 101 treatment-naïve CRVO-ME patients stratified by outcomes: favorable (endpoint best-corrected visual acuity [BCVA] ≥ 20/100 without CRVO-induced neovascular glaucoma [CRVO-NVG]) versus unfavorable (endpoint BCVA < 20/100 or CRVO-NVG development). We compared demographic characteristics, baseline blood pressures, ocular features, and systemic biomarkers between groups.

Results

Multivariable logistic regression analysis identified two independent predictors of unfavorable outcomes: suboptimal 1-month post-injection BCVA (odds ratio [OR] = 1.824 per 0.1 log MAR unit increase, 95% confidence intervals [CI] 1.236–2.691, P = 0.002) and diminished PP (OR = 1.147 per mmHg decrease, 95% CI 1.028–1.279, P = 0.015). Receiver operating characteristic analysis demonstrated strong predictive accuracy for both parameters (1-month post-injection BCVA: area under the receiver operating characteristic curve [AUROC] = 0.843, cutoff 0.85 logarithm of the minimum angle of resolution [log MAR], P = 0.000; PP: AUROC = 0.812, cutoff 57 mmHg, P = 0.000). In the ischemic CRVO-ME subgroup (n = 27), the optical coherence tomography (OCT)-defined “over-response to the first intravitreal injection (ORIVI)” emerged as the sole significant predictor of CRVO-NVG development (OR = 15.167, 95% CI 1.509–152.464, P = 0.026).

Conclusion

This study establishes baseline PP < 57 mmHg and suboptimal 1-month post-injection BCVA > 0.85 log MAR as key prognostic indicators in CRVO-ME, while identifying the ORIVI sign as a specific predictor of CRVO-NVG in ischemic cases. These findings introduce easily obtainable systemic parameter (PP) for risk assessment, define 1-month visual response as key treatment evaluation point, propose ORIVI sign as an imaging biomarker for ischemic CRVO complications.