Bilateral Central Retinal Vein Occlusion Research Articles

Case report: Bilateral simultaneous central retinal vein occlusion in Waldenström's macroglobulinemia

Background We report a case of bilateral simultaneous central retinal vein occlusion (CRVO) in Waldenström's macroglobulinemia. Methods We report the case of a 60-year-old woman who presented with decreased vision in both eyes. Results Ophthalmoscopic examination showed scattered retinal hemorrhages and venous tortuosity with macular edema bilaterally. The patient had a history of hypertension and was under investigation for lethargy, recurrent epistaxis, and fainting episodes. Serum protein electrophoresis showed an M-spike in the gamma region. Bone marrow trephine biopsy confirmed the diagnosis of Waldenström's macroglobulinemia. The patient was treated with plasmapheresis and subsequent chemotherapy, resulting in improvement of ocular and systemic symptoms. Conclusions We report this case to emphasize that in any case of bilateral CRVO, hyperviscosity should be suspected. Serum electrophoresis along with coagulation profiles should be performed as a standard practice in patients with bilateral simultaneous CRVO.

Bilateral central retinal vein occlusion in a young person with storm syndrome.

To report the presence of previously undescribed retinal abnormalities in patients with Storm and other progeric syndromes. Review of the clinical and photographic records of a patient with Storm syndrome who developed bilateral central retinal vein occlusion. A 43-year-old woman with a diagnosis of Storm (Werner-like) syndrome, a connective tissue disease characterized by premature aging, presented with bilateral nonsimultaneous central retinal vein occlusion. The patient was also observed to have bilateral peripheral retinal pigment epithelial alterations. Retinal abnormalities can be observed in patients with premature aging syndromes. These abnormalities include the development of venous occlusive disease and peripheral retinal pigment epithelial alterations at a relatively young age and may be related to the underlying genetic mutation.

Bilateral central retina vein occlusion associated with obesity-hypoventilation syndrome (pickwickian syndrome).

To describe bilateral central retinal vein occlusion (CRVO) as a clinical manifestation of obesity-hypoventilation syndrome (pickwickian syndrome). Case report. A 37-year-old Hispanic man with morbid obesity and obstructive sleep apnea who suddenly developed bilateral loss of vision. Laboratory studies disclosed the following: hematocrit, 81%; body mass index, 55 kg/m; PaCO2, 52 mmHg; and blood oxygen saturation (SaO2), 54%. Polysomnography demonstrated 45 obstructive apneas and 133 obstructive hypopneas, with abnormal movements of the inferior limbs during sleep. Hypoxia and hypercapnia produce severe erythrocytosis that causes a change in blood viscosity. This may facilitate thrombus formation at the lamina cribrosa of both eyes manifested as bilateral CRVO.

Bilateral simultaneous central retinal vein occlusion secondary to hyperviscosity in Waldenstrom's macroglobulinaemia

Central retinal vein occlusions (CRVOs) are rarely treatable; most therapy is directed towards prevention or treatment of complications. Bilateral CRVO can be due to serum hyperviscosity, which affects 15% of all patients with Waldenstrom's macroglobulinaemia (WM). Although previously reported in a handful of cases, bilateral CRVO is a rare presenting feature. Illustrated case reports of three patients presenting with bilateral CRVO due to undiagnosed WM. Plasma exchange, which successfully restored vision in two patients, was followed by long-term cytotoxic therapy. Plasma electrophoresis should be performed in all patients with retinal vein occlusions to exclude a paraproteinaemia. In patients with bilateral venous changes, there should be a very high level of suspicion of hyperviscosity, with the possibility of effective early therapy.

Bilateral combined central retinal artery and vein occlusion in systemic lupus erythematosus resulting in complete blindness

Bilateral combined central retinal artery and vein occlusion in systemic lupus erythematosus resulting in complete blindness

Malnutrition and bilateral central retinal vein occlusion in a young woman: a case report

IntroductionCan vitamin B12 and folate deficiency cause central retinal vein occlusion? We conducted a literature search to find out whether nutritional deficiency of vitamin B12 and folate can lead to impaired vision.Case presentationThe patient in the article presented in an eye-casualty department in the North East of England with gradual painless visual loss over six weeks. She was found to have bilateral central retinal vein occlusion with significant anaemia and vitamin B12 and folate deficiency.ConclusionVitamin B12 and folate deficiency can lead to elevated levels of homocysteine. We found a large amount of published data relating central retinal vein occlusion to elevated homocysteine levels, but there was a lack of conclusive evidence for this association Patients should be asked about their dietary history where a thrombotic event is suspected or confirmed.

Oblitération bilatérale de la veine centrale de la rétine sur un rejet aigu léger de greffe cardiaque

We report a case of bilateral central retinal vein occlusion following moderate acute rejection of a cardiac transplant. A 27-year-old man was admitted for sudden bilateral decreased vision due to bilateral central retinal vein occlusion. Visual acuity was 20/63 in the right eye and 20/25 in the left eye. This patient had undergone a heart transplant 6 months before and had presented with moderate acute rejection for a few days. The moderate acute rejection phenomenon includes inflammatory lymphocyte infiltrates, reflecting persistent immune response activation. Moderate acute rejection of a cardiac transplant graft might cause a bilateral central retinal vein occlusion.

Systemic considerations in bilateral central retinal vein occlusion

Background Central retinal vein occlusion (CRVO) is a common cause of visual impairment and can occur at any age. Nonetheless, 90% of patients with CRVO are older than 50 years, and only 10% of CRVO patients are younger than 40 years. Systemic vascular diseases, such as hypertension and diabetes, are common risk factors for the development of CRVO. However, when a patient less than 50 years of age has bilateral and simultaneous central retinal vein occlusions, a hyperviscosity syndrome or inflammatory condition is also suspected. Case report This article presents the case of a 40-year-old man with bilateral ischemic CRVO and the differential diagnoses considered, including systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APAS), dysproteinemias, and hyperhomocysteinemia. Conclusion When a CRVO is observed in a young patient, more obscure underlying etiologies must be explored. As primary care providers, optometrists need to consider common (and atypical) vascular risk factors for vein occlusion to prevent further ocular morbidity and systemic complications.

Occlusions veineuses rétiniennes survenant chez des patients traités par anticoagulants et/ou antiagrégants plaquettaires: À propos de 5 cas

Retinal vein occlusions (RVOs) are a common cause of severe or total loss of vision. Although the disease entity has long been known, its management is still controversial. We report five patients (six eyes) who experienced RVO even though they were taking anticoagulants or antiplatelet agents.Two patients developed a central retinal vein occlusion (two eyes), two patients a branch retinal vein occlusion (two eyes), and one patient a bilateral central retinal vein occlusion (two eyes). Three patients were treated with anticoagulants, two for hemostatic pathologies and one for cardiopathy; two patients were treated with antiplatelet agents, one for auricular fibrillation and one for a cardiac graft. Retinal photocoagulation was performed in all cases to treat retinal ischemia. Neovascular glaucoma occurred in a single eye.Treatments for thromboembolic disorders are more and more commonly used for various indications. Nevertheless, many patients develop RVO while taking such treatments, even though the International Normalized Ratio (INR) shows good patient compliance. Many case reports and small case series illustrate the occurrence of RVO with such treatments. These examples seem to illustrate the lack of efficacy of anticoagulants and platelet aggregation inhibitors in preventing vascular complications in the retinal venous circulation.Anticoagulants and platelet aggregation inhibitors must only be used to treat systemic factors or thromboembolic disorders associated with RVO. These five case reports illustrate that anticoagulants and platelet aggregation inhibitors cannot guarantee that a severe RVO will not occur. A prospective study would be useful to analyze their advantages in RVO management.

Bilateral Central Retinal Vein Occlusion in Primary Antiphospholipid Syndrome

목적 : 원발성 항인지질증후군 환자에서 발생한 양안의 망막중심정맥폐쇄를 경험하였기에 보고하고자 한다. 대상과 방법 : 38세 남자가 1개월 전부터 발생한 양안시력저하를 주소로 내원하였다. 결과 : 내원 당시 양안 교정시력은 0.3이었고, 안저검사상 양안의 망막중심정맥폐쇄를 보였다. 혈액응고이상을 포함한 전반적인 혈액학적 검사를 시행하였다. 일반적인 혈액응고검사상 특이소견은 보이지 않았다. 항핵항체 및 류마티스인자는 음성이었으나, 6주간격으로 시행한 항인지질항체 검사상 항카디오리핀 항체가 증가되어 있었다. 원발성 항인지질증후군에 의한 양안 망막중심정맥폐쇄로 진단하였고, 아스피린 경구복용과 유리체강내 아바스틴 주입술을 시행하였다. 결론 : 본 증례와 같이 기저질환을 가지지 않은 젊은 사람에서 양안에 망막중심정맥폐쇄가 발생한 경우 항인지질항체 검사를 시행해 보는 것이 필요할 것으로 생각된다.

Successful Anticoagulation for Bilateral Central Retinal Vein Occlusions Accompanied by Cerebral Venous Thrombosis

Concurrent development of retinal venous drainage and cerebral venous thrombosis has not been reported. Case Description We describe a 23-year-old man with bilateral central retinal vein occlusions and cerebral venous thrombosis. Initially observed bilateral hemorrhagic retinopathy and thrombus in the right transverse sinus of the patient began to resolve after 2 weeks of low-molecular-weight heparin. Hemorrhagic retinopathy progressively improved to previous visual acuity and the right lateral sinus remained patent by maintenance of anticoagulation with warfarin. The present case shows effectiveness of low-molecular-weight heparin for the initial management of hemorrhagic retinopathy of central retinal vein occlusion combined with cerebral venous thrombosis.

Bilateral Combined Cilioretinal Artery and Central Retinal Vein Occlusion

A rare case with bilateral combined cilioretinal artery and central retinal vein occlusion (CRVO) is reported in a 45-year-old man. Work-up was positive only for already-present type 2 diabetes. The patient first developed ischemic-type CRVO and cilioretinal artery occlusion in his right eye, and underwent successful trabeculectomy with mitomycin-C following panretinal and grid macular photocoagulation. The fellow eye developed a nonischemic type of CRVO and cilioretinal artery occlusion 4 years after the first episode with good visual outcome.

Bilateral CRAO and CRVO From Thrombotic Thrombocytopenic Purpura: OCT Findings and Treatment With Triamcinolone Acetonide and Bevacizumab

A patient with thrombotic thrombocytopenic purpura secondary to adult-onset Still's disease presented with bilateral combined central retinal artery occlusion and central retinal vein occlusion, a rare complication reported only once before. Fundus appearance and fluorescein angiography were similar to the previous case. Optical coherence tomography findings demonstrated aspects consistent with both central retinal artery occlusion and central retinal vein occlusion. Treatment of one eye with intravitreal triamcinolone acetonide (4 mg) was not effective in improving visual acuity. Treatment of both eyes with intravitreal bevacizumab (1.25 mg) and panretinal photocoagulation was effective in eliminating iris neovascularization, although the patient lost all visual function.

Trombose de veia central da retina bilateral associada à síndrome de hiperviscosidade sanguínea: relato de caso

The authors report the case of a 16-year-old male patient who presented with blurred vision and bilateral optic disc edema, then developing bilateral central retinal vein occlusion. On laboratory work-up, he was found to have multiple myeloma IgA along with hyperviscosity syndrome, which led to the ophthalmological features. After proper treatment, the patient recovered visual acuity and normalized his eye fundus changes. Bilateral central retinal vein occlusion finding may yield the diagnosis of major systemic diseases. Fundoscopic features may serve as parameters on treatment evaluation.

Clinical Case Notes

Three cases are reported where life-threatening haematological disorders requiring urgent medical intervention presented initially to the ophthalmologist. Case one, chronic myeloid leukaemia, presented with bilateral leukaemic retinopathy and central retinal vein obstruction due to hyperviscosity. Case two, acute myeloid leukaemia, presented with bilateral haemorrhagic retinopathy. Case three, aplastic anaemia, presented with bilateral retinopathy due to anaemia and thrombocytopaenia resembling bilateral central retinal vein occlusion. In all three cases the presence of simultaneous bilateral retinal vascular involvement and white-centred haemorrhages suggested an underlying haematological disorder and differentiated them from typical retinal venous obstruction. Prompt identification of the underlying haematological disorder allows timely referral for potentially life-saving treatment.

Use of telemedicine in screening for diabetic retinopathy

Background: A diabetic retinopathy screening program was introduced in September 2000 at a university-affiliated hospital in Montreal to meet the demands of an overburdened health care system. In this article we describe our initial experience with this program.Methods: A Canon CR6-45NM nonmydriatic 45° camera was installed in the outpatient endocrinology clinic of the hospita1. All patients who visited the clinic between September 2000 and January 2001 agreed to participate in the program. For each patient, a short questionnaire (age, sex, type of diabetes mellitus, time since diagnosis, prior retinal laser therapy and presence of end-organ involvement) was filled in. Subsequently at least two photographs were obtained of each eye. The photographs were sent via the hospital intranet to a retinal specialist within the hospita1. The specialist reviewed the images unchanged and sent a report (grading of the level of diabetic retinopathy, presence or absence of macular hard exudates, quality of the images obtained and follow-up recommendations) via the hospital intranet to the endocrinology service. If the images were judged to be of poor quality and could not be read by the retina specialist, the patient was asked to see his or her regular ophthalmologist.Results: Images of 830 eyes of 415 patients (211 men and 204 women with a mean age of 57.5 years) were obtained. Most (83.6%) had type 2 diabetes. The average duration of disease was 13.3 years. Macular hard exudates were observed in 50 eyes (6.0%). Nonproliferative diabetic retinopathy was noted in 117 eyes (14.1 %) and proliferative diabetic retinopathy in 15 eyes (1.8%). Unexpected findings included epiretinal membranes (in three eyes), macular holes (in two), bilateral cottonwool spots (in one patient) and central retinal vein occlusion (in one eye). Overall, 10% of the patients were referred to a retina specialist based on the screening photographs. The main difficulty encountered with the screening program was image inconsistency. Overall, 35% of the images graded were felt to be of poor quality, the most common reason being poor exposure (84.40. The quality of the images improved significantly over the study period (p < 0.0 1). Images obtained from patients aged 65 years or more were consistently poorer than those obtained from patients less than 65 years of age (p < 0.001).Interpretation: Despite the imperfections of such a system, our experience was favourable, allowing us to screen large numbers of patients in a costeffective, reliable manner.

Bilateral central retinal vein occlusion with multiple intracerebral hemorrhage in a neonate

Central retinal vein occlusion and intracerebral hemorrhage are rare diseases during infancy and are both related to venous thrombosis. We present the case of a full-term male hydrops infant without specific neurologic symptoms initially but later demonstrating bilateral central retinal vein occlusion and intracerebral hemorrhage. We conclude that routine funduscopic examination in high-risk newborns should be seriously considered.

Intravitreal triamcinolone acetonide as treatment of macular edema in central retinal vein occlusion.

To report the clinical outcome of a patient receiving an intravitreal injection of triamcinolone acetonide as treatment of bilateral, long-standing, cystoid macular edema due to central retinal vein occlusion. A 70-years-old patient suffering from bilateral central retinal vein occlusion for 2 years and 1.5 years, respectively, received transconjunctivally an intravitreal injection of 25 mg of crystalline triamcinolone acetonide in each eye, with 10 weeks between injections. During the follow-up period of 4 months (OD) and 6 weeks (OS), respectively, visual acuity increased from 0.05 to 0.25 in his right eye and from 0.125 to 0.25 in his left eye. Fluorescein angiography showed a decrease of fluorescein leakage in the macular area. Intravitreal injection of triamcinolone acetonide may be a therapeutic option for long-standing cystoid macular edema due to central retinal vein occlusion.

Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less than 56 years of age

Purpose To investigate whether hypercoagulability plays a role in thrombus formation in patients with central retinal vein occlusion (CRVO) who are less than 56 years of age. Design Prospective, observational case series with retrospective comparative controls. Participants and controls Participants included 55 consecutive patients with CRVO less than 56 years of age. The laboratory’s age-matched control groups were used to compare results for the same tests. Methods Fifty-five patients with CRVO less than 56 years old (mean age, 44 years) underwent laboratory evaluation for homocysteine, activated protein C resistance, protein C activity, protein S activity, antithrombin III activity, antiphospholipid antibodies, and anticardiolipin antibodies. The results were compared with previously drawn age-matched control groups obtained by the same laboratory for statistical significance. Main outcome measures Patients were considered to have a positive test if their results were outside the laboratory’s established range. Results Fifteen of 55 patients (27%) had one positive test result suggesting hypercoagulability. Compared with the control groups, these patients less than 56 years old with CRVO had a higher incidence of coagulation abnormalities by laboratory testing. Among the parameters tested, hyperhomocysteinemia and circulating antiphospholipid antibodies were significantly more common in the CRVO patients ( P < 0.05) compared with age-matched controls. Conclusions Hypercoagulability may play a role in the pathogenesis of CRVO in patients less than 56 years old. The cause of CRVO remains multifactorial, and laboratory tests suggesting hypercoagulable states alone cannot account for the cause in most of these patients less than 56 years of age. The authors recommend examining blood pressure, intraocular pressure, complete blood count, glucose levels, and a lipid panel on all patients with CRVO. When tests for these common risk factors for CRVO are negative, consider ordering selected tests in young patients with CRVO to rule out thrombophilias, especially in patients with bilateral CRVO, a history of previous thrombosis, or family history of thrombosis.

Bilateral central retinal vein occlusion in eisenmenger syndrome

PURPOSE: To report a case of bilateral central retinal vein occlusion in a patient with Eisenmenger syndrome. METHODS: Case report. A 60-year-old woman with Eisenmenger syndrome secondary to a congenital ventricular septal defect presented with a 2-week history of decreased vision in both eyes. RESULTS: Ophthalmic examination revealed bilateral central retinal vein occlusion. Laboratory findings included hematocrit of 50.3% and pO 2 of 52 mm Hg while on O 2 5 L/min per nasal cannula, despite having undergone phlebotomy 2 weeks earlier. CONCLUSION: Chronic hypoxia caused by Eisenmenger syndrome may result in polycythemia with resultant hyperviscosity and bilateral central retinal vein occlusion.