Glaucoma as a prognostic factor of central retinal vein occlusion: visual and anatomical outcomes and occurrence of ischaemic central retinal vein occlusion.

Abstract

To compare the functional and anatomical outcomes of central retinal vein occlusion (CRVO) according to the presence of glaucoma before the onset of CRVO, and to assess whether pre-existing glaucoma affects the prognosis of CRVO in terms of development and conversion to ischaemic CRVO. In this retrospective cohort study, patients with treatment-naïve CRVO were enrolled between December 2009 and February 2019. The patients were classified into two groups according to the presence of pre-existing primary open-angle glaucoma at CRVO diagnosis. We reviewed medical records regarding basic demographics, ocular characteristics and treatments. The effects of pre-existing glaucoma on the occurrence of ischaemic CRVO were also investigated using Cox proportional hazard models. Of 166 eyes from 166 patients, 26 (15.7%) had pre-existing glaucoma. The pre-existing glaucoma group revealed significantly older (69.4±13.3 versus 56.5±15.9) and lower BCVA at baseline (1.06±0.75 versus 0.64±0.58, logMAR) and final visits (1.56±1.35 versus 0.64±0.48, logMAR) (all p<0.05) than non-glaucomatous group. In terms of perfusion status of CRVO, the glaucoma group showed higher incidence of ischaemic CRVO (30.8% versus 5.3%, p=0.052) at initial and last visits as well as more disorganization of retinal inner layers (DRIL) at 3months (76.0% versus 49.6%, p=0.015). Pre-existing glaucoma (hazard ratio (HR)=2.141, p=0.014), lower vision at baseline (HR=2.071, p=0.001) and DRIL at 3months (HR=2.905, p=0.011) were significant risk factors for the occurrence of ischaemic CRVO. In patients with CRVO, pre-existing glaucoma was associated with poorer visual and anatomical outcomes, and played as a significant risk factor for the development and conversion to ischaemic CRVO with lower vision and presence of DRIL at early phase of CRVO.