Iko Hidasa,1,* Kai-Bo Yang,1,* Mo-Luan Zhang,2 Bing-Yu Wang,1 Gui-Qi Zhang,1 Zhi-Yu Gao,3 Zhi-Yu Liu,1 Peng Qi,1 Jing Xie,1 Heng Wang,1 Lei Liu,4 Han Zhang1 

1Department of Ophthalmology, the First Hospital of China Medical University, Shenyang, People’s Republic of China; 2School of Medicine, Gifu University, Gifu City, Japan; 3Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Key Lens Research Laboratory of Liaoning Province, Shenyang, People’s Republic of China; 4Department of Ophthalmology, Guangdong Eye Institute; Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Han Zhang, Department of Ophthalmology, the First Hospital of China Medical University, Shenyang, People’s Republic of China, Email hanzh@cmu.edu.cn Lei Liu, Department of Ophthalmology, Guangdong Eye Institute; Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China, Email liulei@gdph.org.cn

Purpose: This study investigates the role of retinal venous pressure (RVP) in determining visual and anatomical outcomes in eyes affected by macular edema (ME) secondary to central retinal vein occlusion (CRVO) and treated with anti-vascular endothelial growth factor (VEGF) therapy.
Methods: A retrospective observational study analyzed data from 31 eyes of 31 patients with CRVO-induced ME. RVP was quantified using an ophthalmodynamometer, and participants were divided into two cohorts: low RVP (19 eyes) and high RVP (12 eyes). Treatment involved three monthly intravitreal ranibizumab (IVR) injections, followed by a pro re nata (PRN) approach. Visual and anatomical metrics, injection frequencies, RVP levels, and diastolic central retinal artery pressure (CRAP) were monitored over 12 months.
Results: At baseline, the low RVP group demonstrated superior mean best-corrected visual acuity (BCVA) in logMAR (P = 0.017), lower central retinal thickness (CRT) (P = 0.018), and higher diastolic CRAP (P =  0.028) compared to the high RVP group. Both groups exhibited significant improvements in BCVA and CRT after 12 months of IVR therapy, with more pronounced gains in the low RVP group for BCVA (P = 0.005) and CRT (P = 0.030). RVP and diastolic CRAP improved in both groups over the study period, with the low RVP group showing greater changes in RVP (P = 0.005) and diastolic CRAP (P = 0.002). Additionally, fewer injections were required in the low RVP group compared to the high RVP group (6.3 vs 7.8, P = 0.017).
Conclusion: Eyes with CRVO-associated ME and lower RVP levels exhibit superior baseline visual function, lower CRT, and more favorable outcomes following IVR treatment. Lower RVP is also associated with a reduced injection burden, underscoring its potential as a predictive marker for therapy response.

Keywords: central retinal vein occlusion, central retinal venous pressure, macular edema, anti-vascular endothelial growth factor, ranibizumab