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Vol. 27, Art. 42 (pp. 1037-1068)    |    2026       

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Ischemic maculopathy as a limiting factor for functional outcomes of retinal vein occlusion therapy: pathogenesis, monitoring, and preventive perspectives

Ogneva T.R.1, Tultseva S.N.1

1Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of the Russian Federation. Russia, 197022,
Saint-Petersburg, Lva Tolstogo street, 6-8

Brief summary

Retinal vein occlusion (RVO) remains one of the leading causes of irreversible vision loss in the Russian Federation. Considerable progress has been achieved in the treatment of macular edema, which may complicate the course of RVO in several cases, primarily through anti-vascular endothelial growth factor therapy and corticosteroid implants. At the same time, another complication—ischemic maculopathy (IM) — represents a key limiting factor preventing the restoration of visual function. The progressive nature of capillary nonperfusion and the lack of effective methods for achieving retinal reperfusion highlight the need to search for new diagnostic markers and preventive strategies. The aim of this review is to systematize current data on the epidemiology, pathogenesis, and imaging modalities of IM in patients with RVO, as well as to substantiate new approaches to diagnosis and pathogenetically oriented treatment aimed at stabilizing the vascular wall and retinal microcirculation. The review provides a detailed analysis of the temporal dynamics of nonperfusion zone formation, from the acute phase to the development of an “empty” retina after 12 months of follow-up. The role of systemic hemodynamic factors, including arterial hypertension and nocturnal arterial hypotension, as well as local factors such as intraocular pressure and the compressive effect of macular edema, in the development and progression of IM is analyzed. Particular attention is paid to current classifications of IM and quantitative biomarkers obtained using optical coherence tomography angiography (OCT-A), including the area of the foveal avascular zone (FAZ) and capillary vessel density in the deep capillary plexus. A pathogenetic association between FAZ enlargement, disorganization of the retinal inner layers (DRIL), and the presence of hyperreflective foci as markers of microglial activation is substantiated. The diagnostic value of microperimetry as a functional test and OCT-A as an objective imaging method is critically analyzed in comparison with fluorescein angiography. The need for an optimized multimodal approach to the diagnosis of IM in patients with RVO has been substantiated. This approach is based on a comprehensive assessment of FAZ parameters, macular microcirculation, structural OCT biomarkers, and visual function. Such a strategy enables the early detection of subclinical signs of retinal ischemia and may serve as a foundation for the development of preventive interventions aimed at preserving pericyte integrity, stabilizing the blood-retinal barrier, and maintaining retinal microvascular perfusion. The transition from passive monitoring to early active angioprotective intervention in the initial stages of ischemia is considered one of the most promising approaches to reducing disability among patients with vascular retinal diseases.


Key words

Retinal vein occlusion, ischemic maculopathy, OCT-angiography, foveal avascular zone, capillary nonperfusion, DRIL, microperimetry, fluorescein angiography

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