Ischemic Central Retinal Vein Occlusion Research Articles

Apport des anti-VEGF dans le traitement de la néovascularisation du segment antérieur compliquant les occlusions veineuses rétiniennes

To evaluate the benefit of anti-VEGF in the treatment of anterior segment neovascularization (ASNV), a severe complication of ischemic central retinal vein occlusion (CRVO). This is a retrospective case series of consecutive patients with ASNV secondary to CRVO treated with anti-VEGF. Ophthalmic parameters were recorded for each visit: measurement of best visual acuity (VA), intraocular pressure (IOP), iris examination, gonioscopy and fundus examination, and as necessary, fluorescein angiography and optical coherence tomography. Minimum follow-up was 6 months. Nineteen patients (19 eyes) received intravitreal injections of anti-VEGF in association with panretinal photocoagulation (PRP). In patients who had uncomplicated rubeosis iridis without elevated IOP (n=6), after a mean of 3 injections, VA was stable in 4 patients and improved by two lines in 2 patients. In patients with early neovascular glaucoma (NVG) (n=13), IOP reduction was observed in all eyes within 1 week after injection but increased secondarily after an average of 45 days, although the rubeosis had definitively disappeared, which suggested that the change in IOP was independent of ASNV. After a mean of 6 injections in combination with filtering or cyclodestructive surgery, IOP finally stabilized, but VA decreased in all patients. Three patients (50%) with stage III ASNV progressed to stage IV ASNV in spite of anti-VEGF treatment. In all eyes, anti-VEGF treatment stopped neovascularization and helped to control IOP. However, vision was preserved only in the eyes with uncomplicated rubeosis at the time of diagnosis. Since only 32% of eyes were diagnosed at this stage, the authors suggest the prevention of ASNV by careful screening and follow-up of patients at risk, and the performance of PRP in CRVO with extensive retinal non-perfusion prior to the onset of rubeosis.

Outcomes of Patients Initially Treated with Intravitreal Bevacizumab for Central Retinal Vein Occlusion: Long-Term Follow-Up

Background and objective: To assess outcomes of visual acuity (VA) and central retinal thickness (RT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO) who were initially treated with bevacizumab and followed for up to four years. Study design/Materials and methods: In this observational case series, 51 patients with non-ischemic and ischemic CRVO who had initial treatment with bevacizumab were included. Main outcome measures were VA and RT at one year, with follow-up of up to four years. Results: Mean VA improved from 20/214 at baseline to 20/107 at one year (p = 0.0009) and this improvement was maintained clinically at four years. RT decreased from 595 μm to 339 μm at one year (p = 0.0027) and this was maintained at four years. Conclusion: Patients who received bevacizumab as initial therapy for ME from CRVO maintained VA and RT improvement for up to four years.

Hyperhomocysteinemia, a biochemical tool for differentiating ischemic and nonischemic central retinal vein occlusion during the early acute phase.

PurposeThe purpose of the study was to differentiate ischemic central retinal vein occlusion (CRVO) from nonischemic CRVO during the early acute phase using plasma homocysteine as a biochemical marker.MethodsFasting plasma homocysteine, serum vitamin B12, and folate levels were measured in 108 consecutive unilateral elderly adult (age >50 years) ischemic CRVO patients in the absence of local and systemic disease and compared with a total of 144 age and sex matched nonischemic CRVO patients and 120 age and sex matched healthy control subjects.ResultsHomocysteine level was significantly increased in the patients with ischemic CRVO in comparison with nonischemic CRVO patients (p = 0.009) and also in comparison with control subjects (p < 0.001). Analysis also showed that hyperhomocysteinemia was associated with increased incidence of ischemic CRVO (odds ratio, 18) than that for nonischemic CRVO (odds ratio, 4.5). Serum vitamin B12 and folate levels were significantly lower (p < 0.001) in CRVO patients compared to the control but were not significantly different between nonischemic and ischemic CRVO patients (p > 0.1).ConclusionsHyperhomocysteinemia can be regarded as useful in differentiating nonischemic and ischemic CRVO during the early acute phase in absence of local and systemic disease in the elderly adult (age >50 years) population.

New Methods of Diagnosis and Treatment of Ophthalmic Artery Stenosis in Patients with Ischemic Central Retinal Vein Occlusions

Introduction: The purpose of this report was to examine if correlations exist in patients with Ischemic Central Retinal Vein Occlusion syndromes and significant narrowing’s of the ophthalmic arteries. Further, we wanted to see if a minimally invasive technique could accurately indicate low orbital arterial perfusion and predict which patients may benefit from cerebral angiography. By identifying proximal ophthalmic artery lesions which may contribute to retinal hypo perfusion and severe visual loss, ophthalmic artery revascularization may be a reasonable recommendation in selected cases. One patient who underwent revascularization experienced dramatic improvement in visual function and retinal morphology. If ophthalmic artery disease proves to be a relatively consistent finding in Ischemic Central Retinal Vein occlusive disease, techniques for intervention could be offered. Methods: In nine patients with ischemic central vein occlusion who had sudden or rapidly progressive visual loss, studies of choroidal perfusion and cerebral angiography were obtained. Binocular Fundus Reflectometry was used in all patients to evaluate choroidal perfusion. OPG and ODM were also evaluated in each patient. Cerebral angiography was used with special attention to orbital filling details with use of subtraction and magnification views. In all patients other metabolic factors, lesions causing mass effect producing lesions, and cardiac factors were ruled out unusual causes of ischemic central vein occlusion syndromes. Additionally, each patient had evaluation for present or past history of ocular infections. In one of the patients who suffered from rapid progressive visual loss with a diagnosis of ischemic central retinal vein occlusion and had an identifiable focal proximal ophthalmic artery narrowing, a microsurgical bypass of the ophthalmic artery was performed to reverse hypo perfusion. Results: All patients had a negative workup for other cardiac, metabolic and radiologic factors that could cause a picture of ischemic central retinal vein occlusion No patient had evidence of ocular infection or a past history of ocular infection. All patients had abnormalities of perfusion indicated by abnormal reflectograms on the affected side. Three of the nine patients had contralateral abnormalities of ocular perfusion according to BFR. In each of these cases arteriography indicated abnormalities of the ophthalmic artery on the opposite side that would account for the abnormal perfusion indicated by BFR. In six of the nine cases a definite focal abnormality in the proximal orbital portion of the ophthalmic artery could be identified. In the other three cases where no definite proximal obstructing lesion could be seen, clear evidence of distal diffuse arterial disease was seen. These abnormalities include abrupt narrowing of filling in the main trunk of the ophthalmic artery, slow or absent filling of the choroid blush, and nonvisualization of the ciliary or distal branches of the ophthalmic artery such as the lacrimal and supra orbital arteries. In the patient who underwent the bypass of the ophthalmic artery, dramatic and sustained improvement in visual acuity and visual fields were seen as well as resolution on ophthalmoscopy of the retinal hemorrhages and congestion. Conclusions: Syndromes of ischemic central retinal vein occlusion that presents as sudden and severe visual loss may have significant narrowing’s of the orbital ophthalmic artery which can be detected by minimally invasive technology. Binocular fundus reflectometry appears to be a sensitive indicator of low ocular perfusion and valuable to select patients for arteriography. These stenotic lesions may account significantly for decreased perfusion and may go unappreciated unless systematically searched for. Some of these lesions may be treatable by microsurgical revascularization which may result in visual improvement. Identification of a consistent in Ischemic Central Retinal Vein Occlusion syndrome would greatly expand our ability to manage this disorder. It may become helpful to correlate ocular perfusion and ophthalmic artery anatomy when assessing and classifying Ischemic Central Retinal Vein Occlusion.

Fundus changes in central retinal vein occlusion.

To investigate systematically the retinal and optic disk changes in central retinal vein occlusion (CRVO) and their natural history. This study comprised 562 consecutive patients with CRVO (492 nonischemic [NI-CRVO] and 89 ischemic CRVO [I-CRVO] eyes) seen within 3 months of onset. Ophthalmic evaluation at initial and follow-up visits included recording visual acuity, visual fields, and detailed anterior segment and fundus examinations and fluorescein fundus angiography. Retinal and subinternal limiting membrane hemorrhages and optic disk edema in I-CRVO were initially more marked (P < 0.0001) and took longer to resolve (P < 0.015) than that in NI-CRVO. Initially, macular edema was more marked in I-CRVO than that in NI-CRVO (P < 0.0001) but did not significantly differ in resolution time (P = 0.238). Macular retinal epithelial pigment degeneration, serous macular detachment, and retinal perivenous sheathing developed at a higher rate in I-CRVO than that in NI-CRVO (P < 0.0001). Ischemic CRVO had more retinal venous engorgement than NI-CRVO (P = 0.003). Fluorescein fundus angiography showed significantly more fluorescein leakage, retinal capillary dilatation, capillary obliteration, and broken capillary foveal arcade (P < 0.0001) in I-CRVO than NI-CRVO. Resolution time of CRVO was longer for I-CRVO than NI-CRVO (P < 0.0001). Characteristics and natural history of fundus findings in the two types of CRVO are different.

Full-thickness retinochoroidal incision in the management of central retinal vein occlusion.

Purpose. To evaluate the clinical outcomes in patients with central retinal vein occlusion (CRVO) treated with full-thickness retinochoroidal incisions and to compare whether there is difference in treatment response in ischemic and nonischemic CRVO. Methods. Retrospective study of patients of CRVO receiving full-thickness retinochoroidal incisions in Changhua Christian Hospital. Fluorescein angiography (FA), slit-lamp biomicroscopy, indirect funduscopy, best corrected visual acuity, and central macular thickness (CMT) measured by optical coherence tomography were performed pre- and postoperatively. Patients were divided into an ischemic and nonischemic group according to the findings of FA. Patients were followed up for at least 1 year. Results. Twenty-eight eyes (14 ischemic and 14 nonischemic CRVO) were included. Functional retinochoroidal venous anastomosis (RCVA) was achieved in 48 of the 65 retinochoroidal incisions (73.8%). Central macular thickness (CMT) and retinal hemorrhage decreased significantly after the surgery. Significant visual gain was observed postoperatively in the nonischemic group, but not in the ischemic group. Postoperative complications included vitreous hemorrhage (17.8%), neovascular glaucoma (7.1%), and preretinal fibrovasular membrane (10.7%), all of which were in the ischemic group. Conclusions. RCVA formation induced by retinochoroidal incisions could improve venous flow, and decrease CMT and retinal hemorrhage. However, only eyes with nonischemic CRVO showed visual improvement.

Progressive retinal nonperfusion in ischemic central retinal vein occlusion.

Serial wide-field fluorescein angiography was performed on eyes with preproliferative (ischemic) central retinal vein occlusion to evaluate retinal perfusion. Serial wide-field fluorescein angiography was performed on 12 preproliferative central retinal vein occlusion eyes in the 3-year Rubeosis Anti-VEGF (RAVE) trial using the Staurenghi lens (Ocular Staurenghi 230SLO Retina Lens) with a scanning laser ophthalmoscope (Heidelberg HRA Spectralis). "Disk area" was defined anatomically for each eye. Mean total field of gradable retina was 290 disk areas (range, 178-452). All eyes demonstrated extensive areas of retinal nonperfusion; at baseline, mean area of retinal perfusion was 106 disk areas (range, 37-129), correlating with a mean of 46.5% perfused retinal area (range, 19.1-56.4%). The area of retinal nonperfusion increased in all eyes with a mean loss of approximately 8.1% of perfused retinal area per year (range, 4.3-12.4%), which corresponded to a mean 15-disk areas (range, 12-35) of retina evolving from perfused to nonperfused annually. The extent of baseline and final nonperfusion was not significantly different between eyes that developed neovascularization and eyes that did not. In this population of severe central retinal vein occlusion eyes, profound retinal nonperfusion was observed with wide-field fluorescein angiography at baseline and the extent of nonperfusion progressed while undergoing anti-vascular endothelial growth factor therapy.

Central Retinal Artery Occlusion Following Central Retinal Vein Occlusion- A Case Report

A 73-year-old gentleman with diabetes mellitus was found to have impending central retinal vein occlusion (CRVO), on routine eye check-up. Despite initiation of anti-platelet agent, he developed ischaemic CRVO two months later, with severe macula oedema. His systemic investigations showed good diabetic control, no blood dyscrasia/hypercoagulable state, normal lipid profile and inflammatory markers. Echocardiogram was normal. A month later, arteriolar attenuation was noted with rubeosis irides, and fluorescein angiogram study confirmed central retinal artery occlusion (CRAO). After ruling out the systemic risk factors, we postulate two possible anatomical related patho-mechanism of CRAO following CRVO: 1, CRVO converts the retinal circulation into a closed loop, results in complete hemodynamic block of the retinal circulation, and hence secondary CRAO; 2, swollen retinal nerve fibres at the optic nerve head secondary to CRVO cause compression to the retinal artery at the level of the lamina cribrosa, this compression is further aggravated by the increased in intraocular pressure (IOP), and hence secondary CRAO.

Neovascular glaucoma after central retinal vein occlusion in pre-existing glaucoma

BackgroundTo determine the outcome of central retinal vein occlusion (CRVO) in pre-existing glaucoma and the predisposing factors of developing neovascular glaucoma (NVG).MethodsWe retrospectively assessed a pre-existing glaucoma CRVO group and a non-glaucoma CRVO group to elucidate the demographics, clinical course and ocular parameters of these two cohorts. Among the pre-existing glaucoma cases, the predisposing factors for the development of NVG were monitored, including the retinal capillary non-perfusion status, intraocular pressure (IOP) and best-corrected visual acuity (BCVA) at presentation.ResultsOf 642 CRVO patients reviewed in this 10-year cohort study, 60 (9.3%) had pre-existing glaucoma at a mean follow-up of 30.8 months, including 28 (4.4%) primary open angle glaucoma (POAG), 27 (4.2%) primary angle closure glaucoma (PACG), and 5 (0.8%) normal tension glaucoma (NTG) cases. Although the presence of glaucoma in the CRVO eyes was not significantly associated with the risk of developing NVG, the incidence of developing NVG in pre-existing glaucoma eyes was significantly higher in the group with IOP greater than 20 mmHg at CRVO presentation (P = 0.02, Chi-square test) as well as in the ischemic CRVO group compared to the non-ischemic patients (P = 0.005, Fisher’s exact test). Overall, 20% of pre-existing glaucoma patients needed glaucoma surgery after a CRVO event, including 11.7% of patients who developed iris neovascularisation (INV) and 8.3% of patients who developed a high IOP without INV.ConclusionsBoth the retinal non-perfusion status and uncontrolled IOP contribute to NVG in patients with pre-existing glaucoma after CRVO. Following CRVO, glaucoma surgery is necessary for pre-existing glaucoma cases with intractable elevated IOP with or without INV.

The differences of horizontal optic disc diameter and cup/disc ratio in eyes with different kinds of retinal vein occlusion

Objective To observe the differences of horizontal optic disc diameter and cup/disc (C/D) ratio in eyes with different kinds of retinal vein occlusion (RVO).Methods A total of 392 eyes from 385 RVO patients diagnosed by fundus fluorescein angiography (FFA) were included in this study.The patients included 192 males and 193 females.The average age was (58.30±11.51) years.The disease duration was from 7 days to 1 month.The eyes were divided into RVO group (356 eyes),RVO combining diabetes mellitus (DM) group (20 eyes) and RVO combining high blood pressure (HP) group (16 eyes).One hundred normal eyes examined by FFA in the same testing period were selected as the control group.Among the 356 eyes in the RVO group,there were 201 eyes with branch RVO (BRVO),100 eyes with central RVO (CRVO),17 eyes with hemi CRVO (H-CRVO),and 38 eyes with macular BRVO (M-BRVO).Among the 101 non-ischemic RVO eyes,there were 17 eyes with BRVO,53 eyes with CRVO,6 eyes with H-CRVO,and 25 eyes with M-BRVO.Among the 255 ischemic RVO eyes,there were 184 eyes with BRVO,47 eyes with CRVO,11 eyes with H-CRVO and 13 eyes with M-BRVO.The diameter of optic cup and disk,and the C/D ratio was measured on fundus infrared radiation (IR) IR30°image by Heidelberg confocal laser fundus imaging system.Results There was no significant difference of horizontal optic disc diameter among 4 groups (F=1.17,P＞0.05).The difference of C/D ratio was significant among 4 groups (F=82.24,P＜0.05).The differences of horizontal optic disc diameter and C/D ratio in different kinds of RVO in normal group and RVO group were significant (F=4.49,61.396; P＜0.05).The horizontal optic disc diameter of eyes with CRVO was a little smaller than normal eyes (P＜0.05).There was no difference of horizontal optic disc diameter between the eyes with BRVO,M-BRVO,H-CRVO and normal eyes (P＞0.05).The difference of C/D ratio was significant between the eyes with BRVO,CRVO,M-BRVO,H-CRVO and normal eyes (P＜0.05).The differences of horizontal optic disc diameter and C/D ratio were significant between RVO group (in different kinds of RVO eyes) and control group (F=3.94,33.16; P＜0.05).Compared the horizontal optic disc diameters of RVO eyes with the same subtype,the difference was significant between non-ischemic H-CRVO and ischemic H-CRVO (P＜0.05),while the differences were not significant between other non-ischemic RVO and ischemic CRVO (BRVO:P=0.35,CRVO:P =0.86,M-BRVO:P=0.22).The difference of C/D ratio between non-ischemic RVO and ischemic CRVO was not significant (BRVO:P=0.35,CRVO:P=0.48,H-CRVO:P=1.00,M-BRVO:P=1.00).Conclusions The C/D ratio increased with varying degrees in RVO eyes.There is no obvious change in horizontal optic disc diameters except for CRVO eyes. Key words: Retinal vein occlusion/etiology; Optic disk

The use of Ozurdex intravitreal implant to treat post-RVO macular edema

This reports on the efficacy and safety of Ozurdex intravitreal implant (1 up to 3 injections) in different types of retinal vein occlusion (RVO) was based on examination data of 26 patients, referred to the ophthalmology clinic of the First Pavlov Sate Medical University of St. Petersburg. Ophthalmic examination, fluorescein angiography, optical coherence tomography, fundus photography, and microperimetry were all routinely used to follow these patients. Intravitreal injections of Ozurdex in post-RVO macular edema resulted in a statistically significant visual acuity improvement and decrease in retinal thickness. No cases of lens opacity progression were observed. Ocular hypertension was transient and controlled by topical IOP-lowering therapy. In cases of ischemic central retinal vein occlusions, to prevent and treat neovascular complications it is necessary to resort to additional treatment methods.

Clinico-epidemiological characteristics of central retinal vein occlusion in a tertiary level eye care center of Nepal.

Central retinal vein occlusion (CRVO) is one of the common retinal disorders causing severe visual impairment. To study the clinical profile, risk factors and visual outcome in central retinal vein occlusion. Seventy-four eyes of 74 patients with central retinal vein occlusion were retrospectively enrolled during the period of one year. All the patients in the study were classified with regard to their ischemic status into two groups, ischemic CRVO and non-ischemic CRVO. The demographic pattern of the patients was recorded. The other parameters studied were visual acuity, history of glaucoma, hypertension, diabetes mellitus and hyperlipidemia. The patients were followed up at 1 month, 3 months and 6 months after treatment. The majority of the patients (n = 49, 66.2 %) had the ischemic type of CRVO, whereas, 25 (33.8 %) of them had the non-ischemic type. The CRVO was more commonly observed in males in both the groups. Hypertension was the most common risk factor associated with CRVO. The visual improvement was significantly better in non-ischemic CRVO (RR = 0.04, 95% CI = 0.01 - 0.31, p = 0.000). The CRVO was more common in males than in females. It was associated with systemic hypertension. The ischemic type of the CRVO was more prevalent than the non-ischemic one in this study. Visual outcome was better in the non-ischemic CRVO.

Plasma homocysteine concentrations in acute and convalescent changes of central retinal vein occlusion in a Chinese population.

Homocysteine is a potential risk factor for central retinal vein occlusion (CRVO), but this remains controversial. We measured fasting total plasma homocysteine (tHcy) concentrations immediately after CRVO and in the convalescent period to investigate this controversy. We measured fasting tHcy concentrations in 36 consecutive patients with CRVO within three days; and at 1, 3, and 6 months after CRVO; and once in 36 control subjects. The vitamin B12 and folate levels, and the presence of C677T MTHFR polymorphisms, were analyzed in all patients and controls. Median tHcy concentrations were not significantly higher than in matched control subjects in the acute phase of CRVO (9.66 [10.75 ± 4.09] vs. 9.25 [9.96 ± 4.02] μmol/L, P = 0.371) and 1 month after CRVO (P = 0.119). However, tHcy levels increased significantly in the convalescent period and were significantly higher than in control subjects at 3 CRVO (P = 0.010) and 6 (P < 0.001) months after CRVO. Furthermore, tHcy levels of the ischemic CRVO patients at 6 months after CRVO were significantly higher than in nonischemic CRVO patients (P = 0.028). However, these observations did not appear to be explained by alteration in serum folate, vitamin B12 concentrations, and the MTHFR C677T genotype. The tHcy levels are not immediately elevated after CRVO, but increase in the convalescent period. These data do not support the hypothesis that raised tHcy concentrations are independent risk factor for CRVO. Instead, it is possible that elevated tHcy levels may be caused by the disease process itself.

OPTICAL COHERENCE TOMOGRAPHY PREDICTS VISUAL OUTCOME IN ACUTE CENTRAL RETINAL VEIN OCCLUSION

To investigate the clinical features of central retinal vein occlusion (CRVO) in relation to the presence of a prominent middle limiting membrane (p-MLM) sign on presenting optical coherence tomography, which may suggest macular ischemia and poor visual outcome. Fifty consecutive eyes with acute CRVO of <1 month of symptom duration before presentation were retrospectively reviewed. A hyperreflective line located in the outer plexiform layer (p-MLM) in optical coherence tomography was used as a sign of acute ischemia. Cases with p-MLM were grouped and compared with the group of eyes with no p-MLM sign (non-MLM group) for clinical features including visual acuities, central fovea thickness, and CRVO types. Among the 50 eyes, 14 (28%) eyes showed a p-MLM sign, 21 (42%) eyes did not, and others had equivocal findings. Eyes with p-MLM sign presented worse initial and final best-corrected visual acuity compared with the non-MLM group (1.10 ± 0.72 vs. 0.47 ± 0.49 logMAR in the initial best-corrected visual acuity, P = 0.007; and 1.08 ± 0.86 vs. 0.32 ± 0.41 logMAR in the final best-corrected visual acuity, P = 0.044) in patients with a follow-up duration of 6 months or longer. The p-MLM group eyes showed a higher tendency toward being classified as ischemic type CRVO (57.1 vs. 4.8%, P = 0.001). Central retinal vein occlusion showing p-MLM on optical coherence tomography had worse visual outcome with higher incidence of being classified into ischemic type CRVO.

Ocular vascular occlusive disorders: natural history of visual outcome.

Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO - much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen within 7 days of onset, central VF defect improved in 47% and peripheral VF in 52%, and in transient BRAO central and peripheral VFs were normal at follow-up. My studies showed that AION, CRVO, BRVO, CRAO and BRAO, each consist of multiple distinct clinical sub-categories with different visual outcome. Contrary to the prevalent impression, these studies on the natural history of visual outcome have shown that there is a statistically significant spontaneous visual improvement in each category. The factors which influence the visual outcome in various ocular vascular occlusive disorders are discussed.

Treatments for macular oedema following central retinal vein occlusion: systematic review

ObjectivesTo review systematically the randomised controlled trial (RCT) evidence for treatment of macular oedema due to central retinal vein occlusion (CRVO).Data sourcesMEDLINE, EMBASE, CDSR, DARE, HTA, NHSEED, CENTRAL and meeting...

The Effect of Antivascular Endothelial Growth Factor Therapy on the Development of Neovascular Glaucoma after Central Retinal Vein Occlusion: A Retrospective Analysis

Purpose. Ischemic central retinal vein occlusion (CRVO) eyes are at high risk of developing neovascular glaucoma (NVG). Our purpose is to investigate the effect of anti-VEGF therapy for macular edema after CRVO on the development of neovascular glaucoma (NVG) in ischemic CRVO eyes. Methods. This is a retrospective case series of 44 eyes from 44 patients with CRVO treated with anti-VEGF therapy for macular edema. The primary outcome was the development of NVG. Results. Of the 44 eyes, 14 eyes had ischemic CRVO, and 30 eyes had nonischemic CRVO. Nonischemic eyes received a mean of 8.4 anti-VEGF doses, over mean follow-up of 24 months. One nonischemic eye (3.3%) developed NVD but not NVG. The 14 ischemic eyes received a mean of 5.6 anti-VEGF doses, with mean follow-up of 23 months. Of these 14 ischemic eyes, two eyes (14%) developed iris neovascularization and 3 eyes (21%) developed posterior neovascularization. Three of these 5 eyes with neovascularization progressed to NVG, at 19.7 months after symptom onset, on average. Conclusion. Anti-VEGF therapy for macular edema may delay, but does not prevent, the development of ocular NV in ischemic CRVO. Significant risk of NVG still exists for ischemic CRVO eyes.

Neovascular events in eyes with central retinal vein occlusion undergoing serial bevacizumab or ranibizumab intravitreal injections: a retrospective review.

Purpose:To characterize the onset and type of neovascular events in eyes with central retinal vein occlusion (CRVO) undergoing serial anti-VEGF therapy.Methods:Consecutive eyes undergoing serial intravitreal bevacizumab or ranibizumab injections for treatment of CME secondary to CRVO were identified. Pertinent data was retrospectively collected and included type and onset of the neovascular event, and the treatment free interval from last injection until the neovascular event. Kaplan–Meier life table analysis was performed to determine the differential effects of baseline perfusion status, early initiation of anti-VEGF treatment (within 3 months of CRVO onset) versus later treatment, and continuous (1-month±2 weeks) versus discontinuous treatment interval (>1.5 months) on time until neovascular event.Results:Of 31 eligible eyes, 12 (39%) and 19 (61%) presented with perfused and ischemic CRVO, respectively. The mean duration from CRVO until the onset of any neovascular event was 17.0±10.3 months. The mean treatment-free interval prior to any neovascular event was 6.2±7.3 months. On average, 5.3±3.2 anti-VEGF injections were given prior to any neovascular event. Neovascularization of the iris or angle occurred in 18 eyes (58%), vitreous hemorrhage associated with neovascularization was observed in 9 eyes (29%) and neovascularization of the disc developed in 5 eyes (16%). Neovascular events showed a trend towards occurring later in eyes with perfused CRVO at baseline (log rank test, P=0.07).Conclusion:Neovascular events occur in eyes with CRVO undergoing serial anti-VEGF therapy, and these events may be delayed compared to the natural history of CRVO-associated neovascularization. Iris neovascularization occurred most frequently.

Aqueous flare and inflammatory factors in macular edema with central retinal vein occlusion: a case series

BackgroundThe association of inflammatory factors and the aqueous flare value with macular edema in central retinal vein occlusion (CRVO) patients remains unclear. We investigated the relations between the aqueous flare value and vitreous levels of vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and interleukin-6 (IL-6) in patients with CRVO and macular edema or patients with idiopathic macular hole (MH).MethodsIn 38 patients who underwent unilateral vitrectomy (21 CRVO patients and 17 MH patients), vitreous samples were obtained during vitrectomy to measure VEGF, sICAM-1, and IL-6. Retinal ischemia was evaluated from capillary non-perfusion on fluorescein angiography, and the CRVO patients were classified into nonischemic or ischemic groups. Aqueous flare values were measured with a laser flare meter and macular edema was examined by optical coherence tomography.ResultsThe median aqueous flare value increased significantly across the three groups (MH group < nonischemic CRVO group < ischemic CRVO group). There was a significant correlation between the flare value and vitreous levels of VEGF, sICAM-1, and IL-6 in the CRVO group. The flare value was also significantly correlated with the severity of macular edema in the CRVO group.ConclusionsInflammation and/or ischemia may increase vascular permeability and disrupt the blood-aqueous barrier by increasing levels of inflammatory factors in patients with CRVO and macular edema.

Intravitreal Triamcinolone Acetonide Compared With Bevacizumab for the Treatment of Patients With Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose: To compare 12-month outcomes achieved using intravitreal triamcinolone acetonide (IVTA) injections with those achieved using intravitreal bevacizumab (IVB) injections for the treatment of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). Materials and Methods: Between 2007 and 2011, 17 patient eyes were administered IVTA(4 mg/0.1 mL) and 30 patient eyes were administered IVB (1.25 mg/0.05 mL) injections for the treatment of ME secondary to CRVO. Patients were retrospectively evaluated within and between treatment groups. Results: Patients in both groups (IVTA and IVB) were similar in terms of demographic characteristics. Improvements in log of the minimum angle of resolution-visual acuity (logMAR-VA) at 3-month follow-up (P = 0.02), and in the logarithmic transformation of optical coherence tomography (OCT)-determined central subfoveal thickness (logOCT) at all visits, were significantly greater in the IVTA-treated group than in the group treated with IVB (P < 0.05). In patient eyes with nonischemic CRVO (n = 21), while no significant difference in improvement in logMAR-VA was seen between the groups, significantly greater improvements in logOCT were observed in the IVTA-treated group for all visits (P < 0.05). Inpatient eyes with ischemic CRVO (n = 26) treated with IVTA (n = 9), improvement in logMAR-VA was significantly greater at months 1 and 3 (P = 0.01), and was significantly greater for logOCT at months 6 and 12 (P < 0.05). A significantly higher percentage (29.4%) of eyes treated with IVTA had an intraocular pressure ≥ 30 mmHg (P = 0.004), 2 eyes (11%) developed glaucoma, and 23.5% of eyes developed cataracts at the 12-month follow-up examination (P = 0.05). Conclusion: Treatment with IVTA injections seems to be more effective in improving best-corrected visual acuity during the early postinjection period in patients with ischemic CRVO, and in decreasing central subfoveal thickness in patients with nonischemic CRVO. However, higher intraocular pressure and development of glaucoma and cataracts must be considered seriously in patients with CRVO who receive IVTA injections. Change in logOCT may be used to monitor patient response to treatments for CRVO-related ME.