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Normalized Reflectivity of Middle Limiting Membrane on SD-OCT: A Measure of Acute Ischemia in CRVO
Sebastian Bemme1, Sheila Büchel2, Hans Hoerauf1
1Department of Ophthalmology, University Medical Center Goettingen, Goettingen, Germany.
Purpose:
To validate the quantification of the prominent middle limiting membrane (PMLM) sign, a marker of mild-to-moderate acute ischemic damage on optical coherence tomography (OCT), by measuring middle limiting membrane (MLM) reflectivity in patients with central retinal vein occlusion (CRVO) and to investigate the prognostic impact of this measure.
Methods:
Spectral Domain (SD)-OCT B-scans of 30 patients with CRVO, either sole CRVO or combined central retinal artery and vein occlusion (CCRAVO), were analyzed retrospectively and graded as PMLM present or absent. Normalized MLM reflectivity was calculated as a ratio of the maximum reflectivity within a MLM target layer and the average reflectivity of the retinal pigment epithelium (RPE).
Results:
Discrimination between OCT B-scans graded as PMLM present or absent based on ROC analysis was far superior with normalized MLM reflectivity (AUC >0.90) than using MLM reflectivity without normalization (AUC = 0.70). Normalized MLM reflectivity was significantly higher in study eyes than healthy fellow eyes as well as in patients with CCRAVO versus sole CRVO. Although normalized MLM reflectivity correlated significantly with baseline and outcome BCVA, we found no significant difference comparing patients with ischemic CRVO versus non-ischemic CRVO.
Conclusions:
Quantifying MLM reflectivity requires normalization due to shadowing, which is usually caused by retinal haemorrhages in CRVO. RPE reflectivity proved to be a suitable reference layer. Greater normalized MLM reflectivity as a measure of mild-to-moderate acute ischemic damage indicated a worse prognosis regarding visual function in CRVO, however, it allows no risk assessment regarding the development of capillary non-perfusion or anterior segment neovascularization.
Insights
Normalized middle limiting membrane (MLM) reflectivity on optical coherence tomography (OCT) effectively quantifies acute ischemic damage in central retinal vein occlusion (CRVO). Higher reflectivity indicates a worse visual prognosis in CRVO patients.
Area of Science:
- Ophthalmology
- Retinal Imaging
- Vascular Retinopathies
Background:
- Central retinal vein occlusion (CRVO) is a significant cause of vision loss.
- Optical coherence tomography (OCT) is crucial for diagnosing retinal conditions.
- The prominent middle limiting membrane (PMLM) sign on OCT indicates mild-to-moderate acute ischemic damage.
Purpose of the Study:
- To validate the quantification of the prominent middle limiting membrane (PMLM) sign using middle limiting membrane (MLM) reflectivity in patients with CRVO.
- To assess the prognostic impact of normalized MLM reflectivity on visual function in CRVO.
Main Methods:
- Retrospective analysis of Spectral Domain (SD)-OCT B-scans from 30 CRVO patients.
- Calculation of normalized MLM reflectivity using RPE reflectivity as a reference.
- Receiver Operating Characteristic (ROC) analysis to evaluate diagnostic performance.
Main Results:
- Normalized MLM reflectivity demonstrated superior discrimination (>0.90 AUC) for PMLM presence compared to unnormalized reflectivity (0.70 AUC).
- Higher normalized MLM reflectivity was observed in CRVO eyes versus healthy eyes and in combined central retinal artery and vein occlusion (CCRAVO) versus sole CRVO.
- Normalized MLM reflectivity correlated with baseline and outcome best-corrected visual acuity (BCVA).
Conclusions:
- Normalization of MLM reflectivity is essential for accurate quantification in CRVO due to shadowing from hemorrhages.
- RPE reflectivity serves as a reliable reference for normalization.
- Increased normalized MLM reflectivity signifies greater acute ischemic damage and predicts a worse visual prognosis in CRVO, but not capillary non-perfusion or neovascularization risk.
