Retinal Vein Occlusion and Angle Closure

Abstract

To describe a series of patients who have sustained a retinal vein occlusion (RVO) and also have primary angle-closure (PAC). We retrospectively ascertained demographic characteristics (age, sex, and ethnicity), presentation (history and examination findings), investigations undertaken, features of angle-closure or occludable angles (symptoms, method of diagnosis, and treatment), and outcome (intraocular pressure (IOP) and visual acuity). Nineteen subjects were included in the study, comprising 9 males and 10 females, with an average age of 69 years (range 44 to 86 y). The ethnicity of the group was diverse. The mode of presentation in 75% of patients was that RVO and PAC were diagnosed at the same clinical visit. In the remaining 25% of cases, the diagnosis of PAC was delayed and ranged from 4 months to 9 years after the RVO. Increased IOP on dilation was found to have raised the suspicion of PAC in some patients, either at the time of first presentation with RVO or at a later date during follow-up for the RVO, leading to gonioscopy and a diagnosis of PAC. In 1 patient, an observed asymmetrical cup-to-disc ratio led to gonioscopy and diagnosis of PAC. Fourteen patients sustained a central retinal vein occlusion (CRVO), 2 subjects sustained a hemicentral retinal vein occlusion (HRVO), and 3 patients had a branch retinal vein occlusion. In the vast majority of cases in this series (18/19), no additional systemic risk factors were identified during follow-up apart from those that were present before the RVO. The diagnosis of PAC was made in all patients on the basis of static and dynamic gonioscopy. None of these patients had experienced any symptoms of acute or intermittent IOP rises as a consequence of angle-closure. Fifteen patients were diagnosed with PAC glaucoma in 1 or both eyes. Sixteen subjects (84.0%) underwent peripheral laser iridotomies and 7 patients (37.0%) had lens extraction to improve angle configuration. Our study supports the belief that angle-closure may be associated with retinal vein occlusions, and should be borne in mind and excluded when investigating the patient with RVO, especially CRVO/HRVO. We suggest that gonioscopy should be done in all patients presenting with RVO.