Effect of Intravitreal Corticosteroid on DRIL Regression and Visual Outcomes in Retinal Vein Occlusion
DOI:
https://doi.org/10.48560/rspo.43705Keywords:
Biomarkers, Glucocorticoids/therapeutic use, Intravitreal Injections, Macular Edema, Retinal Vein Occlusion/drug therapy, Tomography, Optical Coherence, Visual AcuityAbstract
INTRODUCTION: Retinal vein occlusion (RVO) is a common cause of sudden, painless visual loss, usually due to macular edema. Disorganization of the retinal inner layers (DRIL) is a key optical coherence tomography (OCT) biomarker of visual prognosis, but data on its response to corticosteroid therapy in RVO are limited. This study evaluated the short-term effects of intravitreal injection (IVI) of corticosteroids on DRIL and other OCT biomarkers, and their associations with visual and anatomical outcomes.
METHODS: This retrospective study included eyes with macular edema secondary to central or branch RVO that received a single corticosteroid IVI (triamcinolone, dexamethasone, or fluocinolone acetonide), between January 2018 and December 2024. OCT and clinical evaluations were performed at baseline and 3 months. Images were independently graded by two masked ophthalmologists (agreement 89.8%). DRIL was graded (0-3) according to the number of retinal layers involved and classified by foveal or parafoveal location. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed using paired tests. Correlations were evaluated using Spearman's coefficient (q), and multivariable regression identified predictors of final BCVA.
RESULTS: Eighty-three eyes from 83 patients (mean age, 73.4 ± 9.8 years) were included. Median BCVA improved from 0.48 to 0.40 logMAR (p = 0.015) and CMT decreased from 447 to 314 μm (< 0.001), after corticosteroid IVI. DRIL regressed in 21.3% of eyes with foveal DRIL, decreasing from 85.5% to 71.1% (p = 0.012). Final BCVA correlated with DRIL grade (q = 0.41; p < 0.001) and CMT (q = 0.24; p = 0.033). In multivariable regression analysis (R² = 0.231; p < 0.001), DRIL persistence, residual CMT and intraretinal cysts independently predicted poorer BCVA. Treatment-naive eyes showed greater CMT reduction (p = 0.025) and DRIL regression (57.1% vs 17.6%; p = 0.034). Eyes with baseline DRIL had poorer final BCVA (0.40 vs 0.15 logMAR; p = 0.025)
CONCLUSION: Intravitreal corticosteroid therapy provides early anatomical and functional improvement in RVO and promotes regression of retinal disorganization. Persistent DRIL and residual edema independently predict poorer visual outcomes, confirming DRIL as a clinically relevant OCT biomarker beyond macular thickness measures. Earlier corticosteroid use may favour structural reorganization, warranting prospective confirmation.
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