Predictive value of OCT biomarkers on visual outcome in retinal vein occlusion
Reviewed by Sofia Rokerya

This was a retrospective study. The cohort included 163 eyes from patients diagnosed with retinal vein occlusion (RVO) aged 18 years or older. The primary endpoints were the mean change in best corrected visual acuity (BCVA) at baseline to follow-up at 6, 12, and 18 months. The optical coherence tomography (OCT) imaging biomarkers, including ellipsoid zone (EZ) alterations, disorganisation of the retinal inner layers (DRILs), neurosensorial detachment, subretinal fibrosis and vitreomacular traction that influenced the functional visual outcome. Visual outcome was defined as a BCVA improvement of ≥5 ETDRS letters. Secondary outcomes included the proportion of patients achieving a BCVA gain of ≥5 letters, as well as changes in central retinal thickness (CRT) and macular volume (MV) at the 3 follow-up time points. Mean BCVA increased significantly from 49.6 (1.8) letters at diagnosis to 54.6 (1.8) letters at month 6 (p=0.0069), 54.3 (1.9) letters at month 12 (p=0.0071), and 53.6 (1.9) letters at month 18 (p=0.0313). In multivariate analysis, the presence of EZ alterations at diagnosis (odds ratio (OR) 0.19; p=0.0008) and their persistence to month 12 (OR 0.34; p=0.0043) were associated with a reduced probability of achieving a BCVA improvement of ≥5 ETDRS letters at month 12. By month 18, significant predictors of visual outcome included EZ alterations at diagnosis (OR 0.19; p=0.0008), sustained EZ alterations through 18 months (OR 0.34; p=0.0043), and DRIL at month 18 (OR 0.38; p=0.0321). The study concluded that the presence of EZ alterations at diagnosis and their persistence at 12 and 18 months, along with DRIL at 18 months, were adverse prognostic markers for BCVA outcomes in patients with RVO. Limitations include the retrospective design. Additionally, OCT angiography biomarkers, such as vessel density and the foveal avascular zone, were not evaluated. Although fluorescein angiography was used to classify ischemic status, macular ischemia or vascular leakage was not analysed in detail. Furthermore, the analysis did not adjust for baseline macular thickness or its changes during treatment. Another limitation of this study is that the images were obtained and analysed by 2 different investigators, without an assessment of inter observer variability or agreement. Strengths include a large sample size, protocolised medium-term follow-up and comprehensive analysis of OCT biomarkers.

Predictive value of optical coherence tomography biomarkers on visual outcomes in patients with retinal vein occlusion.
El-Jarroudi RB, Díaz-Aljaro PE, Castellví-Manent J, et al. 
OPHTHALMOLOGICA 
2026;249:145–57.