Central Retinal Venous Occlusion Research Articles

Effects of intravitreal Bevacizumab (Avastin) monotherapy in central retinal vein occlusion in young subjects.

To evaluate the efficacy of anti-angiogenic agent Bevacizumab in central retinal venous occlusion treatment. To determine the efficacy of Bevacizumab and ophthalmological parameters such as best corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography (OCT) in central retinal venous occlusion in patients aged less than 30. This is a prospective, interventional study, done on 25 eyes of 25 patients aged 30 years and below with central retinal venous occlusion, who received intravitreal Bevacizumab injections for three consecutive months. The mean change in best corrected visual acuity (BCVA), and central macular thickness (CMT) measured by optical coherence tomography were compared and correlated at baseline after 3 months and 6 months follow-up. The mean best corrected visual acuity and the central macular thickness on OCT improved significantly from 1.08±0.29 and 454.80±114.5µm at baseline to 0.77±0.32 logMAR units and 339.7±82.5µm after 6 months follow up. The current study showed that intravitreal Bevacizumab at a dose of 1.25 mg and with strict control of systemic contributory parameters seemed to improve BCVA and CMT and macular edema measured at baseline to 3 months and 6 months follow-up after three consecutive monthly injections.

Retrospective analysis of outcomes of biosimilar ranibizumab (BSR) in treating cystoid macular oedema (CME) in ischaemic central retinal venous occlusion (CRVO)

Retrospective analysis of outcomes of biosimilar ranibizumab (BSR) in treating cystoid macular oedema (CME) in ischaemic central retinal venous occlusion (CRVO)

Retrospective Cohort Study of Sickle Cell Disease and Large Vessel Retinal Vascular Occlusion Risk in a National United States Database

To determine if differences exist in the risk of developing large vessel retinal vascular occlusions in patients with sickle cell states. Retrospective cohort study. Patients with sickle cell disease or trait evaluated by an ophthalmologist were compared to matched controls without sickle cell disease or trait also evaluated by an ophthalmologist. This study used deidentified data from a national database (2006-2024), using International Classification of Diseases 10 codes to select for retinal vascular occlusions. Propensity score matching was performed with respect to age, sex, race, ethnicity, smoking, hypertension, diabetes, dyslipidemias, and obesity, resulting in HbSS, HbSC, and sickle cell trait (SCT) cohorts and matched control cohorts. Risk ratios and 95% confidence intervals (CI) of retinal vascular occlusion diagnosis, including central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), central retinal venous occlusion (CRVO), branch retinal venous occlusion (BRVO), and corneal dystrophy as a negative control, given sickle cell disease or trait. After propensity score matching, HbSS (n=10,802, mean ± standard deviation age of 38.6 ± 20.6 years), HbSC (n=4,296, 34.3 ± 17.8 years), and SCT (n=15,249, 39.8 ± 23.7 years) cohorts were compared to control cohorts (n=10,802, 38.7 ± 20.7 years; n=4,296, 34.6 ± 18.0 years; n=15,249, 39.9 ± 23.8 years, respectively). Patients with sickle cell disease (HbSS) had higher risk of developing any retinal vascular occlusion (RR 2.33; 95% CI 1.82-3.00), CRAO (RR 2.71; 95% CI 1.65-4.47) and BRAO (RR 4.90; 95% CI 2.48-9.67) than matched controls. Patients with HbSC disease had higher risk (RR 3.14; 95% CI 1.95-5.06) of developing any retinal vascular occlusion than matched controls without sickle cell disease. Patients with sickle cell trait did not have higher risk of developing retinal vascular occlusions (RR 1.01; 95% CI 0.81-1.26) than matched controls. In a retrospective cohort study, patients with HbSS sickle cell disease have an increased risk of developing retinal vascular occlusions, and more specifically CRAO and BRAO compared to patients without sickle cell disease.

Bilateral Retinal Venous Occlusion in Atypical Hemolytic-Uremic Syndrome Due to Complement Factor H Mutation

ABSTRACT Purpose Atypical hemolytic uremic syndrome (aHUS) is a rare progressive thrombotic microangiopathy caused by overactivation in the alternative complement pathway. A wide spectrum of environmental triggers, such as viruses, vaccination, drugs, pregnancy, neoplasms, transplant, and autoimmune diseases can cause aHUS in genetically susceptible individuals. In this report, the diagnosis and treatment process of aHUS and bilateral retinal venous occlusion (RVO) will be presented. Methods Single-case, retrospective management of ophthalmological and systemic manifestations. Results A 28-year-old G2P2 female with acute blurred vision and history of acute renal failure. She was diagnosed with preeclampsia in her gestation history. After the laboratory work-up, the diagnosis of aHUS was confirmed. She was treated with eculizumab following 14 days of plasmapheresis. However, her visual acuity was 20/20 on the right and 20/60 on the left at the time of admission. Retinal examination revealed flame-shaped hemorrhages, exudation, and macular edema. The patient was diagnosed with branch RVO in the right eye. Subsequently, central RVO was occurred in the left eye. Intravitreal dexamethasone implant was administered for both eyes since there was no reasonable regression in retinal findings with bevacizumab treatment. She went into remission and her BCVA reached 20/25 during the 12-month follow-up period under the eculizumab therapy. Conclusion Diagnosis of aHUS is challenging especially during pregnancy and the postpartum period. Although ocular involvement is quite rare, we described bilateral RVO in aHUS case with homozygous nonsense mutation (c.2134 G > T p.G712). Dexamethasone implant should be considered for the treatment of RVO in aHUS cases.

Vessel Pulse Amplitude Mapping in Eyes With Central and Hemi Retinal Venous Occlusion.

The purpose of this study was to describe vessel pulse amplitude characteristics in eyes with central retinal vein occlusion (CRVO), hemiretinal vein occlusion (HVO), normal eyes (N1 N1), and the unaffected contralateral eyes of CRVO and HVO eyes (N1 CRVO and N1 HVO), as well as the unaffected hemivessels of HVO eyes (N2 HVO). Ophthalmodynamometry estimates of blood column pulse amplitudes with modified photoplethysmography were timed against cardiac cycles. Harmonic analysis was performed on the vessel reflectance within 0.25 to 1mm from the disc center to construct pulse amplitude maps. Linear mixed modeling was used to examine variable effects upon the log harmonic pulse amplitude. One hundred seven eyes were examined. Normal eyes had the highest mean venous pulse amplitude (2.08 ± 0.48 log u). CRVO had the lowest (0.99 ± 0.45 log u, P < 0.0001), followed by HVO (1.23 ± 0.46 log u, P = 0.0002) and N2 HVO (1.30 ± 0.59 log u, P = 0.0005). N1 CRVO (1.76 ± 0.34 log u, P = 0.52) and N1 HVO (1.33 ± 0.37 log u, P = 0.0101) had no significantly different mean amplitudes compared to N1 N1. Arterial amplitudes were lower than venous (P < 0.01) and reduced with venous occlusion (P < 0.01). Pulse amplitude versus amplitude over distance decreased along the N1 N1 vessels, with increasing slopes observed with CRVO (P < 0.01). Pulse amplitude reduction and attenuation characteristics of arteries and veins in venous occlusion can be measured and are consistent with reduced vessel wall compliance and pulse wave transmission. Retinal vascular pulse amplitudes can be measured, revealing occlusion induced changes, suggesting a role in evaluating the severity and progression of venous occlusion.

Diabetes a major risk factor for blinding condition of Neovascular Glaucoma

Importance: Neovascular glaucoma (NVG) is a severe form of secondary glaucoma has a varying prevalence of 0.01 to 3.9% of all glaucoma in different regions of world. Majority of them are affected with proliferative diabetic retinopathy. Although NVG overall prevalence is low but it is a dreadful condition led to blindness. If not detected earlier of the disease by latest investigating majors and treated systematically on different stages of the disease along with taking care of the alleviation of different aggravating factors for retinal hypoxia. Objectives: To summarize published evidence on etiopathogenesis, clinical feature, stages of NVG and to provide treatment recommendation on different stages of the NVG for ophthalmologists based on published evidence. Evidence Review: A literature search of PubMed was conducted from January 1, 1974 to June 30, 2022. Publications describing prevalence, etiopathogenesis, clinical staging, investigation and treatment modality were included in the study. Findings: NVG is characterized by development of new vessels on iris and fibrovascular tissue proliferation in the anterior chamber angle with increase in IOP, principally driven by Retinal ischemia and among the commonest causes are proliferative diabetic neuropathy (PDR), central retinal venous occlusion, and ocular ischemic syndrome (OIS).

Both Central Retinal Venous Occlusion and Cilioretinal Artery Occlusion Secondary to Hyperhomocysteinemia. A Case Report

A 50 YO female patient with no medical history presented to the ophthalmologic emergency department for an acute decreasing of visual acuity in the left eye without any redness nor ocular pain. Ophthalmic examination revealed a best corrected VA of ‘finger counting’ in the LE. The LE slit lamp examination was normal. Fundus evaluation showed a retinal white edema in the cilioretinal artery territory associated with pre retinal hemorrhage. The foveola was spared (Figure 1).

Role of Ayurveda in the Management of Central Retinal Vein Occlusion- A Case Report

Retinal Venous Occlusion (RVO) is one among the most common retinal vascular diseases. It is of two types, central retinal venous occlusion and branch retinal venous occlusion. In the management of CRVO various modulators of the hemorrheological factors have been tried such as anticoagulants, thrombolytic and hemodilution but none of them is of proven benefit so far. In Ayurveda this condition is managed as Urdhwagaraktapitta (Bleeding through upper orifices) causing Drishtigatavikara (visual impairment) and emergency managements mainly include Rakta-pittasamana Vataanulomana and Raktaprasadana. Illustrating a case of 36-year-old male patient presented with sudden onset of blurry vision of left eye for 4 days. Further investigations confirmed the diagnosis of non‐ischemic CRVO with cystoid macular oedema and serous foveal detachment of left eye. This ocular emergency is then managed with Virechanam (purgation) in daily dose and internal medicines. After 7 days of treatment patient got marked relief and vision improved from 6/60 to 6/9 for left eye. The assessment was done using Visual Acuity, Fundus examination, and Optical Coherence Tomography (OCT), which showed marked reduction in macular oedema also. This case encapsulating the role of Ayurveda treatments in management and restoration of visual status in serious illness like CRVO.

Retinal Manifestations in Rhinoorbito-cerebral Mucormycosis: A Cross-sectional Study

Introduction: Rhino-orbito-cerebral Mucormycosis (ROCM) is an uncommon but devastating fungal infection caused by Mucoraceae family fungi, which are angiotropic and filamentous, with significantly high morbidity and mortality despite treatment. Post Coronavirus Disease-2019 (COVID-19), there was a sudden surge in ROCM cases nationwide due to immunologically and metabolically compromised status. Aim: To describe retinal manifestations in ROCM in a tertiary eye care centre of Northern India. Materials and Methods: An analytic, cross-sectional and hospitalbased study was conducted in Regional Institute of Ophthalmology, PGIMS Rohtak, Haryana, India, from May 2021 to September 2021. This study was conducted on 200 admitted patients of RCOM in the institute, which was only designated Nodal centre in Haryana, India. Detailed history was recorded in every patient regarding presenting symptoms, history of COVID-19, hospital stay, oxygen inhalation, steroid intake and immunisation. Thorough ocular examination was done in every patient including visual acuity, ocular movements and pupillary reactions. Dilated fundus examination was done by Indirect Ophthalmoscopy (IDO) for posterior segment evaluation. Contrast Enhanced Magnetic Resonance Imaging (CE-MRI) brain with orbit and Paranasal Sinus (PNS) was done in every patient to see the extent of spread and planning further management. Results: Out of 200 patients of ROCM, majority of patients (64/200) were of 51-60 year age group (32%) followed by 41-50 year age group (28%). Out of 200 cases of ROCM, 146 patients (73%) had history of COVID-19 infection in past and 134 (67%) patients had history of hospital stay during COVID-19 infection. Oxygen (O2 ) supplementation was given to 98 patients either at home or during hospital stay. History of steroid intake was present in 34 patients and 46 patients received injection Remedsivir. Only 12 patients had vaccine against COVID-19 and none of them were fully vaccinated. Most common presenting symptom was unilateral nasal stiffness (22%) followed by loss of vision (17%). Most common predisposing factor was Diabetes Mellitus (DM) in 78 patients (39%) followed by steroid intake in 34 patients (17%). Out of 200 patients, only 60 patients had retinal manifestations and most common was Central Retinal Artery Occlusion (CRAO) (35/60) and the main mechanism is the direct infiltration of central retinal artery due to angioinvasion of fungi from the orbit. Conclusion: CE-MRI brain with orbit is an important tool in diagnosing and monitoring progression of RCOM but it cannot provide information regarding retinal findings like CRAO, central retinal venous occlusion (CRVO), disc pallor and optic atrophy. Thus, the fundus examination of every ROCM patient should be emphasised, as it not only helps in categorising ROCM but also tells about the visual potential of affected eye. Patients with CRAO and combined vascular occlusion should be considered for exenteration on urgent basis, so that intracranial spread can be prevented and patient’s life can be saved.

Neovascular Glaucoma: An Update on Etiopathogenesis, Diagnostics and Management

Neovascular glaucoma (NVG) is a severe secondary and refractory *severe secondary conditio, that accounts for a varying prevalence between 0.01% to 5.1% of all glaucoma those studied in different regions of the world. **This is a pathological condition, which is caused by the new vessels over iris surface and followed by fibrovascular membrane formation over the trabecular meshwork, secondary to a local angiogenic stimulus. The fibrovascular membrane over trabecular meshwork obstructs the aqueous outflow at an angle of the anterior chamber. ***The obstruction in outflow of the aqueous results increase of intraocular pressure (IOP), within the eyeball. NVG results from a number of ocular and systemic conditions with retinal ischemia leading to anoxia as a mediator in over 95% of cases. Most of them are affected with proliferative diabetic retinopathy (PDR) followed by central retinal venous occlusion (CRVO), and ocular ischemic syndrome (OIS) along with other uncommon causes or all those causes that causes retinal anoxia which led to angiogenic activity in retina and iris of eye. Although NVG overall prevalence is low, but it is a dreadful condition led to blindness. The objective of this review is to provide detailed information on its basic and clinical aspects, to enable us to manage it logically. Here its etiopathogenesis, methods of early diagnosis and management are discussed. It was concluded that if NVG is detected earlier and managed systematically (both medical and surgical) along with an eye on alleviation of different aggravating factors of the retinal hypoxia, it could be a sight-saving measure to the affected person.

Central Retinal Arterial and Venous Occlusion in a Patient with Systemic Sclerosis and a Review of the Related Literature

Systemic sclerosis (SSc) is known to cause serious complications at an advanced stage. However, serious ocular complications such as central retinal artery occlusion (CRAO) and/or central retinal vein occlusion (CRVO) have only been reported in a few cases to date. A 51-year-old man with severe Raynaud’s phenomenon, scleroderma up to the forearm and a negative anti-nuclear antibody (ANA) finding developed pulmonary fibrosis (PF) and was admitted to the hospital for the treatment of dyspnea under the diagnosis of SSc. A transbronchial lung biopsy performed 10 days after admission demonstrated mucoid intimal thickening (MIT) of the small arteries in the peripheral lung tissue and the bronchial wall. Prednisolone (PSL), ciclosporin and nintedanib were prescribed for PF treatment but failed to induce any apparent improvement in dyspnea. Finally, methylprednisolone pulse therapy (1.0 g, 3 times) and intravenous cyclophosphamide (IVCY, 500 mg, 6 times) therapy were instituted with a subsequent decrease in the patient’s Krebs von den Lungen 6 (KL-6) and surfactant protein D (SP-D) levels. During IVCY therapy, the patient experienced blurred vision in the right eye, and this was diagnosed as being due to CRAO and CRVO. However, the patient did not manifest any embolic, coagulopathic, or vasculitic symptoms, and there were no abnormal laboratory data suggesting these diseases in relation to this symptom. Therefore, the ocular occlusion was presumed to be due to MIT of small arteries, in addition to severe Raynaud’s phenomenon. Thus, we report the findings of this important case, despite the fact that it lacks a retinal pathology.

Case report \u2013 Acute Corneal Subepithelial Hydrops (ACSH) during Micropulse Transscleral Cyclophotocoagulation (MPTSC)

BackgroundTo present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC).Case presentationA 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer – acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10–15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP.ConclusionACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.

Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

Reply: Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

Reply: Ischemic central retinal venous occlusion as a possible differential diagnosis of Purtscher-like retinopathy

Safety of 6000 intravitreal dexamethasone implants

PurposeTo evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions.MethodsRetrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including...

Genetic and Risk Factors in Central Retinal Venous Occlusion with Macular Edema

Retinal venous occlusions are the most common cause of blindness after diabetic retinopathy. The incidence of the disease increases with age. There are systemic, genetic, and ocular risk factors that set the background of the disease. Methyltetrahydrofolate reductase (MTHFR) enzyme gene mutation (MTHFR C677T) increases the plasma levels of homocysteine and the thrombosis tendency. Factor V Leiden polymorphism FVR506Q, prothrombin (FII) G20210A, angiotensin-converting enzyme (ACE) ins287del and angiotensinogen (AGT) T235M are other common gene mutations for thromboembolic events. Systemic risk factors such as hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and obesity are diseases that make atherosclerosis. Other ocular risk factors are glaucoma, orbital masses with inflammation, and glob trauma.

Optical coherence tomography angiography image quality assessment at varying retinal expertise levels

PurposeTo compare optical coherence tomography angiography (OCT-A) image quality gradings performed by readers of varying retinal expertise levels in different retinal diseases. MethodsCentral 3 × 3 mm2 OCT-A images (AngioVue, Optovue) of 57 healthy controls (50.9 ± 22.4 years) and 148 patients (66.5 ± 14.1 years) affected by various chorioretinal diseases were retrospectively analyzed including early age-related macular degeneration (AMD, n = 26), neovascular AMD (nAMD, n = 22), and geographic atrophy due to AMD (GA, n = 6), glaucoma (n = 28), central serous chorioretinopathy (CSC, n = 14), epiretinal membrane (EM, n = 26), retinitis pigmentosa (RP, n = 16), and retinal venous occlusion (RVO, n = 10). A senior expert in medical retina (SE), an ophthalmology resident (OR), and a non-ophthalmologic medical doctor (MD) independently assessed OCT-A image quality using the motion artifact score (MAS) and the segmentation accuracy score (SAS). ResultsRegarding MAS, inter-reader agreement between SE and OR was 93.7% (Cohen's kappa = 0.907) and 85.4% (Cohen's kappa = 0.786) between SE and MD. Regarding SAS, inter-reader agreement between SE and OR was 95.1% (Cohen's kappa = 0.92) and 92.2% (Cohen's kappa = 0.874) between SE and MD. In the SAS analysis, signal strength index (SSI) and presence of retinal pathology had a significant influence on the overall agreement (P = 0.046; P < 0.001). ConclusionsOCT-A image quality assessment can be performed most reliably by an ophthalmologist with knowledge in retinal image analysis. Yet, well-instructed non-ophthalmologic assessors show only slightly inferior results and, thus, may be integrated in routine OCT-A image quality assessment as well.

Congenital protein C deficiency with renal vein thrombosis and central retinal venous occlusion in a term neonate due to novel mutation in the PROC gene

Severe protein C (PC) deficiency is a rare disorder caused by homozygous or compound heterozygous genetic anomalies. PC deficiency is inherited as autosomal dominant, and most patients are heterozygous for a genetic defect. Homozygous or compound heterozygous for a mutation or other genetic defect affecting PC is typically due to inheritance of an abnormal allele from both parents. In the neonatal period, homozygous PC deficiency is usually associated with the development of severe, and often fatal, purpura fulminans and disseminated intravascular coagulation and if untreated is incompatible with life. Here, we report a case of congenital PC deficiency due to novel homozygous mutation in the protein coding gene (PROC) in a term neonate which presented with severe purpura fulminans, perinatal right renal vein thrombosis (RVT), bilateral adrenal hemorrhage, and early neonatal central retinal venous occlusion with retinal detachment. Perinatal RVT and early neonatal central retinal vein occlusion have not been reported previously in the literature.

Impending Central Retinal Vein Occlusion

Central retinal vein occlusion (CRVO) may present with varied clinical manifestations, ranging from mild blurred vision and scattered retinal hemorrhages to severe vision loss, optic nerve swelling, pronounced retinal hemorrhages, collateral retinal vessel formation and neovascularization. Impending CRVO, also known as partial CRVO, is a relatively poorly-defined sub-classification of the CRVO condition. Those affected are either asymptomatic or may complain of mild, often transient episodes of blurring of vision and present with venous dilation and tortuosity but only a few widely scattered flame-shaped retinal hemorrhages. As an impending CRVO may be the prodromal phase of an acute CRVO, this diagnosis requires careful monitoring of the patient for progression. The following case outlines the differential diagnosis, sequelae and inter-professional management of an impending central retinal venous occlusion.

Outcomes of combination therapy with dexamethasone implant and bevacizumab in macular edema related to vascular occlusions

AimTo evaluate the anatomical and visual outcomes as well as the safety of combination therapy with dexamethasone intravitreal implant (0.7 mg) and bevacizumab in macular edema secondary to vascular occlusions. MethodsIn this interventional, prospective case series all patients received dexamethasone implant and bevacizumab in a single sitting. Patients diagnosed with retinal venous occlusion were monitored for changes in visual acuity and macular thickness. All patients underwent detailed ocular examination, best corrected visual acuity (BCVA), and optical coherence tomography examination at baseline and at Week 1, Month 1, and monthly thereafter for 6 months. ResultsTwenty four eyes of 24 treatment-naïve patients (central retinal venous occlusion, n = 9; branch retinal venous occlusion, n = 15) were identified. BCVA improved in 23 patients (95.83%) during the study period. Mean BCVA gained was 0.313 ± 0.26 (85.3% of final gain) and 0.367 ± 0.34 at Week 1 and Month 6, respectively. The percentage of patients who gained ≥2 lines were 52% at Week 1 and 68% at Month 6. The mean macular thickness reduced by 350.9 μm at Week 1 and the maximum treatment effect was seen at Month 2 (379.1 μm). Recurrence of macular edema was seen in 37.5% (9/24) of the eyes. Reinjection was needed, on average, at approximately 3.7 months from the first injection. ConclusionThis study demonstrates that the combination therapy of bevacizumab and dexamethasone implant given simultaneously is safe and synergistic resulting in significantly early and sustained visual recovery and decreased macular edema in patients having retinal vein occlusions.