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However, despite all of these indications, visual improvement reached statistical significance only in the nonischemic group. This finding contrasts with previous report of intravitreal injection of anti-VEGF agents, in which eyes with ischemic and nonischemic CRVO both benefited from treatment of anti-VEGF agents [15]. The current study also differs from another report, in which eyes with ischemic CRVO showed significant visual improvement [11]. Recent reports have shown that anti-VEGF agents may reverse retinal nonperfusion and that VEGF promotes retinal nonperfusion in patients with retinal vein occlusion [16]. Since full-thickness retinochoroidal incisions and bisecting retinal veins actually render the distal tributary area of the bisecting veins even more ischemic by completely blocking the venous return before the development of RCVA, the procedures may induce more VEGF release postoperatively, which may further deteriorate the macular nonperfusion status. This may explain why there is no visual improvement in eyes with ischemic CRVO, despite the resolution of macular edema. For the nonischemic group, postoperative foveal perfusion also seemed to play an important role determining the prognosis. Eyes with improvement had statistically smaller mean FAZ postoperatively than that in eyes in the nonimproved group (P = 0.043, Mann-Whitney U test, Table 4). Eyes with improvement also had on average a reduced FAZ postoperatively in contrast to the nonimproved eyes in which the FAZ enlarged postoperatively (Table 4). The results show that in the nonischemic group, even though the venous flow was reestablished postoperatively, the changes of the avascular zone secondary to the surgical procedures were probably the determining factor of visual improvement. In the nonischemic eyes, preoperative BCVA and younger age were noted as a marginally positive and positive prognostic factor for visual improvement (P = 0.052 and 0.009, resp., Mann-Whitney U test, Table 4). According to Epstein et al., younger age was a positive prognostic factor for visual improvement in patients treated with anti-VEGF agents, and patients older than 70 years of age fared less from intravitreal injection of bevacizumab for the treatment of CRVO [17]. This may reflect the fact that patients with better preoperative BCVA and younger ages tend to have a better preserved perifoveal capillary network, which would be more resistant to increased hydrostatic pressure brought by CRVO and also more resistant to the deleterious effect of postoperative VEGF-surge on foveal perfusion. Thus, a visual gain could be obtained after reestablishment of the venous return.
In addition to the improvement of venous flow, reperfusion of the nonperfused area is another goal for RCVA. Unfortunately, in our serial follow-up, reperfusion was noted to develop in only 1 eye in the ischemic group (Figure 2). Further, progression of nonperfusion was noted in 1 eye (ischemic group). The persistent or even aggravated nonperfusion in the ischemic group could explain why recurrent vitreous hemorrhage and NVG developed in 5 cases of ischemic CRVO, even though all the eyes had laser photocoagulation performed at the distal tributary area of the bisecting veins. For this reason, PRP should be performed in every case of ischemic CRVO undergoing bypass surgery. The failure of reperfusion in most eyes may also indicate that the resolution of macular edema was largely due to the reduction of venous pressure by the functioning RCVA instead of the reduction of VEGF.
Back in October, we announced the new reporting tool for DataAccessioner was ready for download. The DA Metadata Transformer (DA:MT) tool was developed by Seth Shaw to transform the raw XML output from DataAccessioner into .csv and HTML files so that they are much easier to read. Many people had asked for documentation to provide more detailed instructions on how to use the tool. We are pleased to announce that a document has been created that provides instructions and screenshots for using this reporting tool to aid in preservation processing.
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1, 2, 3, All Eyes on Me is a 2020 short film directed by Emil Gallardo and starring Farelle Walker, Blanca Ordaz, Armand Munoz, Samuel Ieremia, Favianna Brown and Olivia Gardner[^1^] [^2^]. It tells the story of a fourth-grade teacher who gets caught in a crisis that engulfs her campus and threatens the kids in her care[^2^].
You can watch 1, 2, 3, All Eyes on Me online on Hulu or HBO[^1^] [^2^]. You can also rent or purchase the movie and download it to your device[^1^].
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