Predictive Value of Optical Coherence Tomography Biomarkers on Visual Outcomes in Patients with Retinal Vein Occlusion

INTRODUCTION: This article aimed to evaluate the prognostic significance of different optical coherence tomography (OCT) imaging biomarkers in predicting visual outcomes in patients with retinal vein occlusion (RVO). METHODS: This was a retrospective study conducted on consecutive patients diagnosed with RVO, who were referred to or treated at a third-level university hospital. The primary endpoints were the mean change in best corrected visual acuity (BCVA) from baseline to the month 6, month 12, and month 18 follow-up visits, and the influence of OCT imaging biomarkers, including ellipsoid zone (EZ) alterations, disorganization of the retinal inner layers (DRILs), hyperreflective foci, neurosensorial detachment, and fibrosis on functional outcomes, defined as a BCVA improvement of ≥5 ETDRS letters. RESULTS: One hundred and sixty-three eyes were included. In the overall study sample, mean (standard error) 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 (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 outcomes 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). CONCLUSIONS: 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.