Retinal Vein Obstruction Research Articles

The role of inflammation in central serous chorioretinopathy: From mechanisms to therapeutic prospects.

Central serous chorioretinopathy (CSC) is a leading cause of permanent vision loss, ranking fourth among macular diseases, trailing only age-related macular degeneration, diabetic retinopathy, and retinal vein obstruction. While mounting evidence implicates inflammation as a pivotal factor in the onset and advancement of CSC, the specific pathophysiological process and molecular mechanisms underlying inflammation remain incompletely understood. A complex network of cytokines, chemokines, and adhesion molecules interplay to trigger inflammatory and pathological cascades, highlighting the need for a comprehensive comprehension of the inflammation-related mechanisms behind CSC progression. In this piece, we examine the existing comprehension of CSC's pathology and pathogenesis. Additionally, we present an overview of the mechanisms underlying the onset and progression of CSC inflammation, followed by a thorough analysis and discussion of the potential of targeted inflammatory intervention for both preventing and treating CSC.

Retinal vessel analysis in vascular occlusions of the eye

Aims/Purpose: This cohort study investigates how the static and dynamic vessel parameters differ in patients with vascular occlusions and if there are any variations between the different types of vessel occlusion.Methods: Patients with the diagnosis of branch retinal artery obstruction BRAO, central retinal artery obstruction CRAO, branch retinal vein obstruction BRVO, central retinal vein obstruction CRVO, anterior ischaemic optic neuropathy AION and any combination of these Combo were included in our study. During their inpatient stay for cardiovascular diagnostics all patients were examined via static and dynamic vessel analysis (IMEDOS Health GmbH, Jena) to obtain the arteriovenous ratio (AVR), the central retinal artery equivalent (CRAE), the central retinal vein equivalent (CRVE) and the flicker light induced dilation of the retinal arteries (FLA) and veins (FLV). The vessel density was determined via OCT angiography (Heidelberg Engineering GmbH, Heidelberg).Results: 34 patients (70% male; 30% female; mean age 69.6 ± 11.3 years) with 9 (26.5%) CRVO, 8 (23.5%) AION, 5 (14.7%) BRAO and 4 (11.8%) CRAO, BRVO and Combo each have been included. The best visual acuity (BCVA) of the diseased eye differed significantly between the groups (AION 0.41 ± 0.61, CRAO 2.40 ± 0.20, BRAO 0.16 ± 0.05, CRVO 0.81 ± 0.86, BRVO 0.18 ± 0.10, Combo 1.53 ± 0.68; p < 0.001) whereas the BCVA of the healthy eyes were comparable. The CRVE showed a significant difference between the groups CRAO – CRVO (p = 0.008), CRAO – Combo (p < 0.001) and BRAO–Combo (p = 0.026). The FLV of the diseased eye was significantly higher in patients with AION than in the CRAO group (p = 0.049). The parameters of the static vessel analysis of the healthy eyes were comparable.Conclusions: Preliminary analysis shows significant differences of individual parameters of the retinal vessel analysis between different types of vascular occlusion. The diagnostic and research benefit for the individual patient remains to be further evaluated.

Retracted: The Correlation between Obstructive Sleep Apnea and Retinal Vein Obstruction: A Meta-Analysis and Systematic Review.

[This retracts the article DOI: 10.1155/2022/8065629.].

Alteration of perivascular reflectivity on optical coherence tomography of branched retinal vein obstruction

This study aimed to evaluate perivascular reflectivity in patients with branched retinal vascular obstruction (BRVO) using en-face optical coherence tomography (OCT). The study retrospectively analyzed 45 patients with recurrent BRVO, 30 with indolent BRVO, and 45 age- and sex-matched controls. Using a 3.0 × 3.0-mm deep capillary plexus slab on macular scans, OCT angiography (OCTA) and structural en-face OCT scans were divided into four quadrants. Obstructive quadrants of OCTA scans were binarized using a threshold value of mean + 2 standard deviation. The selected area of high signal strength (HSS) was applied to the structural en-face OCT scans, and the corrected mean perivascular reflectivity was calculated as the mean reflectivity on the HSS area/overall en-face OCT mean reflectivity. The same procedure was performed in the quadrants of the matched controls. Regression analysis was conducted on several factors possibly associated with corrected perivascular reflectivity. The perivascular reflectivity in the obstructive BRVO quadrant was significantly higher than in the indolent BRVO and control quadrants (P = 0.009, P = 0.003). Both univariate and multivariate regression analyses showed a significant correlation between the average number of intravitreal injections (anti-vascular endothelial growth factor or dexamethasone implant) per year and refractive errors and image binarization threshold and perivascular reflectivity (P = 0.011, 0.013, < 0.001/univariate; 0.007, 0.041, 0.005/multivariate, respectively). En-face OCT scans of the deep capillary plexus slab revealed higher perivascular reflectivity in recurrent BRVO eyes than in indolent BRVO and control eyes. The results also indicate a remarkable correlation between perivascular reflectivity and the average number of intravitreal injections, suggesting a link to recurrence rates.

Combined Branch Retinal Artery and Central Retinal Vein Occlusion: A Systematic Review.

We performed a systematic review and analyzed the current available data on branch retinal artery occlusion (BRAO) with simultaneous central retinal vein obstruction (CRVO), a rarely described occurrence. MEDLINE/PubMed and ISI Web of Sciences searches were performed according to MOOSE guidelines. Studies were considered eligible if they (1) described patients with simultaneous BRAO + CRVO and (2) had been published in peer-reviewed journals. We initially identified 239 records from databases. Ultimately, only 19 reports met the selection criteria. Twenty-nine patients (15 men, 14 women; mean age 43 ± 15 years) were analyzed. Seventeen (59%) patients presented vascular risk factors. Mean visual acuity at onset and final visual outcome were 20/83 and 20/45, respectively, an insignificant improvement. Vision improved in 48% of cases. A marked heterogeneity in treatment approach was found. Eight (28%) patients received no therapy, whereas for 21 (72%) a large variety of topical and/or systemic drugs was given. In the treated group, mean visual acuity at onset and final visual outcome were 20/90 and 20/44, respectively, a not statistically significant improvement. Results suggest that combined BRAO + CRVO occurs at a younger age than isolated BRAO or CRVO. At present, there is insufficient evidence to support any specific management to improve vision in simultaneous BRAO + CRVO.

Visual Results of Intravitreal Bevacizumab (Avastin) Treatment for Branch Retinal Vein Occlusion a Multi Center Study

Objective: To evaluate the visual outcomes in patients with branch retinal vein obstruction after intravitreal bevacizumab (Avastin) injection. Study Location and Duration:, Department of Ophthalmology Abaseen hospital and Khyber medical center Peshawar from January 2019 to January 2022 both department conducted this multi-center study. Methodology: Patients with BRVO received at least one intravitreal Bevacizumab (Avastin) injection of 1.25 mg in 0.05 ml. Snellen visual acuity tests, Fundus Fluorescein Angiography (FFA), and Optical Coherence Tomography were used to assess the patients (OCT). A complete eye exam was conducted before treatment began, and monthly follow-up examinations were scheduled for the following six months. Results: The total number of patients and eyes was 78, with a mean age of 60. (SD 15.1). The average number of Intravitreal bevacizumab (Avastin) injections administered to patients was four (SD 1.40) per eye. There were no negative consequences observed. Before treatment, the average central macular thickness was 568 microns, but after three months it was only 370 microns (p0.001), and by six months it had decreased to 290 microns. Three months later, the average acuity was much better than at the start (p=0.001), with log MAR = 0.30 (SD 0.22). During the most recent 6-month follow-up, the mean visual acuity was log MAR = 0.40 (SD 0.23), better than the baseline value (p 0.001). Overall, 44 eyes showed an improvement in their vision. Conclusion: Intravitreal Bevacizumab intravitreally for branch retinal vein occlusion improves vision. Bevacizumab intravitreally enhances visual acuity, macular edema, and ischemia. Bevacizumab reduces the risk of vision-threatening vitreous hemorrhage and neovascularization. Hence, Bevacizumab improves vision and treats branch retinal vein occlusion effectively. Keywords: Intravitreal Bevacizumab (Avastin), Branch Retinal Vein Occlusion (BRVO), Visual Acuity Improvement, Macular Ischemia Relief. Retinal Neovascularization Reduction

Effect of Intravitreal Triamcinolone (IVT) Injection on Visual Acuity in Patients with Ischemic CRVO

Aim: To govern the intravitreal injection effect of triamcinolone (IVT) on visual acuity in patients with ischemic central retinal vein obstruction (CRVO). Study Design: A randomized clinical trial. Methods:The patients with ischemic event of CRVO less than amonth who were referred to the ophthalmology departmentof Hayatabad Medical Complex, Peshawar and Woman Medical and Dental College, Abbottabad. Patents were included for the duration from March 2021 to August 2021.Inclusion criteria were: &lt; one month duration of CRVO, normal intraocular pressure, no symptoms of hypertensive or diabetic retinopathy, history of eye surgery or laser therapy, and no vascular disease. Patients were randomized into 2 groups: control group (no injection) and intervention group (0.1 cc IVT injection). Follow-up is scheduled for 1, 2, 3 and 6 months after injection for all patients. The main outcomes of the study were evaluated and used for statistical analysis were SPSS software version 21.0 ion test-t statistical test. Results:70 patients (36 men and 34 women) participated in the study. 62.1 ± 8.9 was the mean age of patients (range: 30-80). The time of symptoms was 20 ± 4.9 days in the control group and in the IVT group; duration was 19 ± 6 days (p = 0.65). All subjects had symptoms of ischemic CRVO. The IVT group has mean baseline visual acuity of 1.80 ± 0.19 logMAR and in the control group; it was 1.91 ± 0.08 logMAR (p = 0.1). The enhancement in VA in the IVT group was better after one month as compared to the control group (p = 0.018); though, this variance was not significant in other control studies. Also, before and after injection; the alteration in IOP was not significant (p = 0.802). Conclusions: This analysisexhibited that triamcinolone intravitreal injection had no substantial long-term outcome on visual acuity among CRVO patients. Keywords:Triamcinolone, Central Retinal Vein Occlusion

To study the effect of intravitreal ozurdex implant in cases of retinal vein occlusion

Introduction: Retinal vein obstruction is one of the leading causes of severe vision impairment and blindness with treatment options mainly including laser, vascular endothelial growth factors, and steroids. This study investigates an intravitreal dexamethasone implant (ozurdex), its efficacy, and complications in patients of retinal venous occlusion. Methods: A prospective, interventional study involving 30 patients with retinal venous occlusion. Patients diagnosed with RVO who had vision loss of at least two lines on Snellen's chart and increased central macular thickness (CMT) on OCT were included in the study. All the parameters such as best-corrected visual acuity (BCVA), CMT, and intraocular pressure (IOP) were noted at baseline for the affected eye. The patients were followed up at 1 month, 2 months, and 3 months following the implant. Result: Baseline parameters were comparable between the groups. Eyes receiving the implant had a statistically significant improvement (P < 0.001) in BCVA on the Snellen chart over the 3 months. There was also a constant decrease in macular edema and the mean difference value of CMT between baseline and 1 month, 2 months, and 3months were also found to be statistically significant. Also, a comparison of IOP between two-time points was done, between baseline and 1 month, 2 months, 3 months, and the mean difference value in IOP was also found to be significant but clinically well within the normal physiological range. Conclusion: The study concluded that an intravitreal dexamethasone implant is an effective treatment for retinal venous occlusion, and it has a statistically significant and clinically meaningful effect on BCVA and CMT. However, it may be associated with a significant rise in IOP but it is well within the physiological range.

The Correlation between Obstructive Sleep Apnea and Retinal Vein Obstruction: A Meta-Analysis and Systematic Review.

Despite of inadequate evidence, previous studies have demonstrated a potential correlation between obstructive sleep apnea (OSA) and retinal vein occlusion (RVO). In this study, a meta-analysis is conducted to investigate the correlation between OSA and RVO. Databases are searched for relevant literatures up to July 14, 2021, including PubMed, Embase, Cochrane, Web of Science, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database (CBM). The odds ratio (OR) and 95% confidence interval (CI) are estimated to evaluate the correlation between OSA and RVO. Six articles were finally enrolled, including 36,086 subjects from 5 case-controlled studies and 1 cohort study. It is clearly evident that the RVO risk is higher among OSA patients than non-OSA patients (OR = 3.24, 95% CI = 3.24). The results of sensitivity analysis indicate that the present meta-analysis is robust and reliable. Furthermore, Egger's test for publication bias is performed with P = 0.195, and the results reveal no significant publication bias. The findings demonstrate that OSA is significantly correlated with RVO, and OSA is a risk factor for RVO.

Review of intravitreal VEGF inhibitor toxicity and report of collapsing FSGS with TMA in a patient with age-related macular degeneration.

Intravitreal vascular endothelial growth factor (VEGF) receptor blockade is used for a variety of retinal pathologies. These include age-related macular degeneration (AMD), diabetic macular edema (DME) and central retinal vein obstruction. Reports of absorption of intravitreal agents into systemic circulation have increased in number and confirmation of depletion of VEGF has been confirmed. Increasingly there are studies and case reports showing worsening hypertension, proteinuria, renal dysfunction and glomerular disease. The pathognomonic findings of systemic VEGF blockade, thrombotic microangiopathies (TMAs), are also being increasingly reported. One lesion that occurs in conjunction with TMAs that has been described is collapsing focal segmental glomerulosclerosis (cFSGS). cFSGS has been postulated to occur due to TMA-induced chronic glomerular hypoxia. In this updated review we discuss the mechanistic, pharmacological, epidemiological and clinical evidence of intravitreal VEGF toxicity. We review cases of biopsy-proven toxicity presented by our group and other investigators. We also present the third reported case of cFSGS in the setting of intravitreal VEGF blockade with a chronic TMA component that was crucially found on biopsy. This patient is a 74-year-old nondiabetic male receiving aflibercept for AMD. Of the two prior cases of cFSGS in the setting of VEGF blockade, one had AMD and the other had DME. This case solidifies the finding of cFSGS and its association with chronic TMA as a lesion that may be frequently encountered in patients receiving intravitreal VEGF inhibitors.

Pathogenesis of Central Retinal Vein Obstruction and Macular Edema

Central retinal vein occlusion (CRVO) is a common retinal vascular disorder. However, the exact pathogenesis of CRVO is not known. Various local and systemic factors play a role in the CRVO. CRVO might cause visual morbidity, including macular edema (ME) and neovascularization. ME occurs when fluid and protein deposits accumulate in the macular region. The pathophysiology of ME is complex, with a variety of processes involved in its development. The pathogenesis of CRVO and ME is discussed in the current review.

Efficacy of panretinal laser in ischemic central retinal vein occlusion: A systematic review.

The aim of the present systematic review was to assess the efficacy of laser therapy for ischemic central retinal vein occlusion (CRVO). Relevant studies were retrieved by searching the PubMed, Embase, Chinese Biomedical Literature Database and, Chinese Science and Technology Periodicals databases using a combination of key words, including 'central retinal vein obstruction', 'CRVO', 'laser' and 'panretinal photocoagulation'. The titles, abstracts and full texts were screened by two independent reviewers and studies were selected according to specific inclusion criteria. Data were extracted and the quality of each study was graded using the Grading of Recommendations, Assessment, Development and Evaluation or Methodological Index for Non-Randomized Studies (MINORS) criteria. A total of 1,187 abstracts were retrieved, and finally, 11 clinical studies were selected, including 534 cases of CRVO. Of these, 8 studies compared the efficacy of laser therapy with other treatments for CRVO, two studies compared the efficacy of laser therapy and drug treatment for CRVO and one study compared the efficacy of early laser therapy with standard laser therapy (regular examinations and laser therapy performed as soon as neovascularization was identified) for CRVO. Among them, the results of five studies demonstrated that panretinal photocoagulation (PRP) for the prevention of iris neovascularization and neovascular glaucoma is inefficient regarding the improvement of visual acuity. A total of 10 studies indicated that laser therapy achieved better outcomes in neovascularization of the retina, optic disc neovascularization and iris neovascularization, neovascular glaucoma, vitreous hemorrhage, changes in the visual field, macular edema, macular thickness and intraocular pressure. Of note, it was indicated that laser photocoagulation prevents the severe vascular complications of CRVO. In addition, in the eyes of patients receiving PRP for the treatment of ischemic CRVO, significant reductions in corneal sub-basal nerve plexus parameters and average peripapillary retinal nerve fiber layer thickness were observed. Furthermore, laser photocoagulation was able to increase retinal blood flow in eyes with ischemic CRVO.

Ферментный тромболизис и «массаж» при окклюзии вен сетчатки

Введение. На сегодняшний день некоторые аспекты возникновения тромбоза ретинальных вен остаются дискутабельными. Большое количество факторов развития заболевания, отсутствие единой концепции патогенеза обтурации вен сетчатки приводят к неопределенности в тактике ведения пациентов, что снижает качество лечения. Цель исследования: проанализировать состояние микроциркуляции при окклюзии ретинальных вен на фоне применения «массажа» пораженной вены сетчатки и эпиретинального введения ферментного тромболитика. Материалы и методы. Обследовано 96 человек (49% мужчин и 51% женщин в возрасте 60,2 ± 1,9 года) с обтурацией ретинальных вен. Пациентам основной группы (n = 47) выполняли «массаж» пораженной вены сетчатки и эпиретинальное введение 500 МЕ рекомбинантной проурокиназы; пациентам группы сравнения (n = 49) однократно вводили эпиретинально 500 МЕ рекомбинантной проурокиназы на фоне традиционной фармакотерапии. Результаты. Индукция тромболизиса при помощи «массажа» пораженной вены сетчатки на фоне эпиретинального введения ферментного фибринолитика в 2 раза ускоряла восстановление кровотока в ретинальном сосуде и в 1,5 раза сокращала время резорбции отека центральных отделов сетчатки, обеспечивая эффективное (в 1,7 раза) повышение биоэлектрической ретинальной активности. Заключение. «Массаж» ретинальных вен на фоне ферментного тромболизиса, проведенный в первые 7 дней от начала заболевания, является перспективным методом лечения окклюзии вен сетчатки. Introduction. Currently some aspects of retinal vein thrombosis remain controversial. A large number of disease development factors, absence of unifi ed pathogenesis conception for retinal veins obturation lead to non-specifi city in tactics of patient management that reduces the quality of treatment. Aim: to analyze microcirculation in retinal veins occlusion under the «massage» of the aff ected retinal vein and epiretinal administration of thrombolytic enzyme. Materials and methods. We examined 96 people (49% of men and 51% of women aged 60.2 ± 1.9 years) with obturation of retinal veins. Patients of the main group (n = 47) were treated by «massage» of the aff ected retinal vein and epiretinal administration of recombinant prourokinase (500 IU); patients of the comparison group (n = 47) were treated by traditional pharmacotherapy with single epiretinal injection of recombinant prourokinase (500 IU). Results. Thrombolysis induction using the «massage» of aff ected retinal vein with epiretinal administration of thrombolytic enzyme accelerated the restoration of blood fl ow in retinal vessel in 2 times and in 1.5 times reduced the resorption time of edema in central retina parts that provided an effective (1.7 times) increasing of bioelectric retinal activity. Conclusion. «Massage» of retinal vein occlusion with enzymatic thrombolysis conducted in first 7 days from disease onset is a promising method for treatment of retinal vein occlusion.

10-year fundus tessellation progression and retinal vein occlusion.

To access the 10-year fundus tessellation progression in patients with retinal vein occlusion. The Beijing Eye Study 2001/2011 is a population-based longitudinal study. The study participants underwent a detailed physical and ophthalmic examination. Degree of fundus tessellation was graded by using fundus photographs of the macula and optic disc. Progression of fundus tessellation was calculated by fundus tessellation degree of 2011 minus degree of 2001. Fundus photographs were used for assessment of retinal vein occlusion. The Beijing Eye Study included 4403 subjects in 2001, 3468 subjects was repeated in 2011. Assessment of retinal vein obstruction and fundus tessellation progression were available for 2462 subjects (71.0%), with 66 subjects fulfilled the diagnosis of retinal vein occlusion. Of the 66 participants, 59 participants with unilateral branch retinal vein occlusion, 5 participants with unilateral central retinal vein occlusion, 1 participant with bilateral branch retinal vein occlusion, and 1 participant with branch retinal vein occlusion in one eye and central retinal vein occlusion in the other eye. Mean degree of peripapillary fundus tessellation progression were significantly higher in the whole retinal vein occlusion group (0.33±0.39, P<0.001), central retinal vein occlusion group (0.71±0.8, P=0.025) and branch retinal vein occlusion group (0.29±0.34, P=0.006) than the control group (0.20±0.26). After adjustment for age, prevalence of tilted disc, change of best corrected visual acuity, axial length, progression of peripapillary fundus tessellation was associated with the presence of retinal vein occlusion (P=0.004; regression coefficient B, 0.094; 95%CI, 0.029, 0.158; standardized coefficient B, 0.056). As a corollary, after adjusting for smoking duration, systolic blood pressure, anterior corneal curvature, prevalence of RVO was associated with more peripapillary fundus tessellation progression (P<0.001; regression coefficient B: 1.257; OR: 3.517; 95%CI: 1.777, 6.958). Peripapillary fundus tessellation progresses faster in individuals with retinal vein occlusion. This may reflect the thinning and hypoperfusion of choroid in patients with retinal vein occlusion.

En Face Optical Coherence Tomography Analysis to Assess the Spectrum of Perivenular Ischemia and Paracentral Acute Middle Maculopathy in Retinal Vein Occlusion

To assess the spectrum of perivenular ischemia in eyes with retinal vascular obstruction (typically central or hemicentral retinal vein obstruction) using en face optical coherence tomography (OCT). Retrospective observational case series. Eyes with recent retinal vascular occlusion illustrating paracentral acute middle maculopathy (PAMM) in a perivenular fern-like pattern with en face OCT were evaluated in this study. Multimodal retinal imaging including en face OCT segmentation of the inner nuclear layer was performed in all patients. Color fundus photography and fluorescein angiography (FA) images were used to create a vascular overlay of the retinal veins vs the retinal arteries to map the distribution of PAMM with en face OCT analysis. Multimodal retinal imaging was performed in 11 eyes with acute retinal vascular obstruction. While 7 eyes demonstrated obvious findings of retinal vein obstruction (5 with central and 2 with hemicentral retinalvein occlusion), 4 eyes were unremarkable at presentation. En face OCT analysis demonstrated a spectrum of perivenular PAMM illustrating a fern-like pattern with sparing of the periarteriolar area in all cases. En face OCT may illustrate a remarkable perivenular pattern of PAMM in eyes with retinal vascular obstruction even in the absence of significant funduscopic findings. Perivenular PAMM with en face OCT demonstrates a wide spectrum of variation with narrow fern-like perivenular lesions at the mildest end and more diffuse lesions with only periarterial sparing at the most severe end of the spectrum. Arterial hypoperfusion secondary to outflow obstruction from a central retinal vein obstruction appears to be the most common cause of this presentation, although primary arterial hypoperfusion may also be an etiology.

Prothrombotic Fibrin Clot Phenotype in Patients with Deep Vein Thrombosis and Pulmonary Embolism: A New Risk Factor for Recurrence.

Prothrombotic fibrin clot phenotype, involving faster formation of dense meshwork composed of thinner and highly branched fibers that are relatively resistant to plasmin-induced lysis, has been reported in patients with not only myocardial infarction or stroke, but also venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT), and/or pulmonary embolism (PE). Prothrombotic fibrin clot phenotype, in particular prolonged clot lysis time, is considered a novel risk factor for VTE as well as venous thrombosis at unusual location, for example, cerebral sinus venous thrombosis, retinal vein obstruction, and Budd-Chiari syndrome. Growing evidence from observational studies indicates that abnormal fibrin clot properties can predict recurrent DVT and PE and they are involved in serious complications of VTE, for example, thromboembolic pulmonary hypertension and postthrombotic syndrome. The purpose of this article is to review our current understanding of the role of fibrin clot structure and function in venous thrombosis with emphasis on clinical issues ranging from prognosis to therapy.

A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

Purpose: To report a case of fragmentation and anterior migration occurred after dexamethasone intravitreal implant (Ozurdex, Allergan, Irvine, CA, USA) injection in a branch retinal vein occlusion patient. Case summary: A 66-year-old male was referred for blurred vision. He received cataract surgery in 1986 and was diagnosed with central retinal vein obstruction in 2011 in the right eye. For treatment of macular edema, dexamethasone intravitreal implant was performed in the right eye. One week after implantation, a fragment of the dexamethasone implant migrated to the anterior chamber with corneal edema and surgical removal was performed immediately. One day after removal, the remaining fragmented implant migrated to the anterior chamber and corneal edema still existed. The fragmented implant was removed with anterior chamber irrigation. After removal, corneal edema improved and visual acuity was recovered. Conclusions: Anterior migrated dexamethasone implant could induce corneal complications, such as corneal edema and corneal decompensation and might lower the corneal endothelial cell even if immediately removed. We report a case of corneal edema, which was induced by anterior migration of a fragmented dexamethasone implant and recovered with immediate surgical removal. J Korean Ophthalmol Soc 2016;57(4):667-671

Genetic polymorphisms and their association with central retinal vein occlusion combined with cilioretinal artery occlusion

Combined cilioretinal artery and retinal vein occlusions are infrequently documented retinal vascular disorders. The role of genetic polymorphisms has been investigated. A 45-year-old woman presented with decreased visual acuity in her right eye. Fluorescein angiography demonstrated a cilioretinal artery occlusion associated with central retinal vein obstruction. Results of testing for the factor V Leiden were negative. However, the patient was heterozygous for the prothrombin G20210A mutation and the two polymorphisms (C667T and A1298C) of the methylenetetrahydrofolate reductase (MTHFR) gene. Specific genetic factors can be associated with retinal vascular occlusions.

Responce to intravitreal Bevacizumab for macular edema following central retinal vein occlusion in patients with pseudoexfoliation syndrome

AbstractPurpose To evaluate efficacy of intravitreal 1.25mg Bevacizumab in patients with pseudoexfoliation sindrome (PEX) and macular edema (ME) secondary to central or branch retinal vein occlusion.Methods A retrospective study was performed on 168 patients with central retinal vein occlusion (CRVO) and branch retinal vein obstruction (BRVO) with significant decreased visual acuity (VA) due to ME. To evaluate the role of 1.25mg bevacizumab in patients with PEX, were created two groups: the first group – 21 patients with CRVO or BRVO and clinical diagnosis of PEX (mean age 74.5 [range 63 ‐ 87]) and the second group – 21 patients with CRVO or BRVO with no clinical signs of PEX (mean age 72.7 [range 60 ‐85]). All patients were analyzed for the best corected VA and optical coherence tomography changes of the central macular thickness.Results A clinical diagnosis of PEX was present in 21 of 168 patients (12.5%), 17 (81.0%) of them had a CRVO and 4 (19.1%) – BRVO. The average of initial VA in the first group was 0.16 (SD±0.19), in the second group – 0.18 (SD±0.19). In the second group the VA after intravitreal injection of bevacizumab was significantly better (0.49 (SD±0.33)) compared to the first group (0.29 (SD±0.26)) (Mann‐Whitney test, p=0.043). Mean central retinal thickness decreased from 696.9µm (SD±261.9) to 261.0µm (SD±154.2) in the first group and 636.5µm (SD±236.9) to 254.5µm (SD±167.2) in the second group.Conclusion Pseudoexfoliation syndrome is significantly more common in eyes with central retinal vein occlusion compared to branch retinal vein occlusion. Pseudoexfoliation syndrome could be counted as one of the factors damaging functioning of the neurosensory retina.

Clinical Course after Intravitreal Bevacizumab Injection in Ischemic Central Retinal Vein Obstruction

Clinical Course after Intravitreal Bevacizumab Injection in Ischemic Central Retinal Vein Obstruction