Type Of Central Retinal Vein Occlusion Research Articles

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.

Central and Hemicentral Retinal Vein Occlusion: Role of Anti–Platelet Aggregation Agents and Anticoagulants

To investigate systematically the role of anti-platelet-aggregating drugs or anticoagulants in central retinal vein occlusion (CRVO) and hemi-CRVO. Cohort study. Six hundred eighty-six consecutive patients with CRVO (567 patients, 585 eyes) and nonischemic hemi-CRVO (119 patients, 122 eyes). At first visit, all patients had a detailed ophthalmic and medical history (including the use of anti-platelet aggregating drugs or anticoagulants), and comprehensive ophthalmic and retinal evaluation. Visual evaluation was carried out by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. At the initial visit, CRVO and hemi-CRVO were classified as nonischemic and ischemic. Visual acuity, visual fields, and severity of retinal hemorrhages. All 3 types of CRVO, showed a significantly greater severity of retinal hemorrhages among aspirin users than nonusers (P<0.001). Initial visual acuity and visual fields were significantly worse in aspirin users than nonusers in nonischemic CRVO and hemi-CRVO, but did not differ for ischemic CRVO. Among patients with nonischemic CRVO who initially had 20/60 or better visual acuity, there was a significant association of aspirin use with visual acuity deterioration. The odds ratio of visual acuity deterioration, adjusting for age, diabetes, ischemic heart disease, and hypertension, for aspirin users relative to nonusers was 2.24 (95% confidence interval [CI], 1.14-4.41; P = 0.020). Of those whose macular edema resolved, overall cumulative visual acuity outcome also suggested a higher percentage with deterioration among aspirin users, odds ratio for deterioration of 3.62 (95% CI, 0.97-13.54; P = 0.05) for aspirin users relative to nonusers. For the nonischemic CRVO patients with 20/70 or worse visual acuity at the initial visit, after resolution of macular edema, improvement in visual acuity was less likely in the aspirin users than in nonusers (odds ratio, 0.18; 95% CI, 0.04-0.72; P = 0.016). Findings of this study indicate that, for patients with CRVO and hemi-CRVO, the use of aspirin, other anti-platelet aggregating agents, or anticoagulants was associated with a worse visual outcome and no apparent benefit. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Natural History of Visual Outcome in Central Retinal Vein Occlusion

To investigate systematically the natural history of visual outcome in central retinal vein occlusion (CRVO). Cohort study. Six hundred sixty-seven consecutive patients (30 patients had both eyes involved resulting in 697 eyes) with CRVO first seen in the authors' clinic from 1973 through 2000. At the first visit, all patients underwent a detailed ophthalmic and medical history and a comprehensive ophthalmic evaluation. Visual evaluation was carried out by recording visual acuity, using the Snellen visual acuity chart, and assessing visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. Central retinal vein occlusion was classified into nonischemic (588 eyes) and ischemic (109 eyes) types at the initial visit based on functional and morphologic criteria. Visual acuity and visual fields. Of the eyes first seen within 3 months, visual acuity was 20/100 or better in 78% with nonischemic CRVO and in only 1% with ischemic CRVO (P < 0.0001), and visual field defects were minimal or mild in 91% and 8%, respectively (P < 0.0001). Final visual acuity, on resolution of macular edema, was 20/100 or better in 83% with nonischemic CRVO and in only 12% with ischemic CRVO (P < 0.0001), and visual field defects were minimal or mild in 95% and 18%, respectively (P < 0.0001). On resolution of macular edema, in eyes with initial visual acuity of 20/70 or worse, visual acuity improved in 59% with nonischemic CRVO, with no significant (P = 0.55) improvement in ischemic CRVO. Similarly, on resolution of macular edema, in eyes with moderate to severe initial visual field defect, improvement was seen in 86% of nonischemic CRVO eyes, but no significant (P = 0.83) improvement was seen in eyes with ischemic CRVO. In nonischemic CRVO, development of foveal pigmentary degeneration, epiretinal membrane, or both, was the main cause of poor final visual acuity. This shows that initial presentation and the final visual outcome in the 2 types of CRVO are entirely different. A clear differentiation of CRVO into nonischemic and ischemic types, based primarily on functional criteria, is crucial and fundamental in determining visual outcome. Visual outcome is good in nonischemic CRVO and poor in ischemic CRVO.

Bilateral Combined Cilioretinal Artery and Central Retinal Vein Occlusion

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

This Issue of Acta

This Issue of Acta

Von Willebrand factor, endothelial damage and ocular disease

Plasma von Willebrand factor (vWF), a marker for vascular damage, was measured in patients with giant cell arteritis (GCA), central retinal vein occlusion (CRVO), and active intraocular inflammation (AII), vWF was highest in GCA (median 3.52 kIU/L) relative to age matched controls (1.08 kIU/L, p<0.0001), with elevated levels in 75% of patients, the highest values found at disease presentation. Longitudinal measurements showed prolonged elevation of vWF, and increased levels were also found in 50% of patients with clinically inactive disease. In CRVO, raised levels were found in 53% of patients (median 2.32 kIU/L, p = 0.0002), but could not differentiate between an ischaemic and non-ischaemic sub-group. There was no statistical difference between those patients with and without systemic disease. Although vWF was raised in 34% of patients with AII (median 1.26 kIU/L, p = 0.0114), it was not different in uveitis (median 1.26 kIU/L), as compared to retinal vasculitis (median 1.58 kIU/L) or in those patients with and without systemic disease. vWF did not correlate with C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) in any of the groups studied. It appears a sensitive test for detecting vascular damage in GCA and may have a role in monitoring the disease where either a prolonged elevation or alteration of vWF levels may be of importance, particularly if ESR and CRP levels are normal. vWF measurement may be limited to more widespread vascular disease, such as in GCA as it was unable to differentiate between different types of CRVO or AII.

Occlusion d'une artère ciliorétinienne associée à une occlusion de la Veine centrale de la rétine

Cilioretinal artery occlusion (CLRAO) may be occasionally associated with central retinal vein occlusion (CRVO). This combined retinal vascular pathology is described in 5 patients. In this clinical setting the vulnerability of cilioretinal vessels can be explained by the difference in regulatory mechanisms between choroidal and retinal blood flow. The type of CRVO may predict whether the CLRAO is primary or secondary to the CRVO.

Relative Afferent Pupillary Defect in Central Retinal Vein Occlusion

In a prospective study, 120 patients with unilateral central retinal vein occlusion (CRVO) were investigated to determine the role of the relative afferent pupillary defect (RAPID) in differentiating ischemic from nonischemic CRVO. In 87 patients with nonischemic CRVO, 90% had a RAPID 0.3 log units or less and none had a RAPID larger than 0.9 log units. In contrast, in 33 patients with ischemic CRVO 91 % had a RAPID of 1.2 log units or more, and none had a RAPID smaller than 0.6 log units. Thus, this simple, quick, and inexpensive test has proved to be a highly sensitive and reliable indicator in the differential diagnosis of the two types of CRVO.

Classification of Central Retinal Vein Occlusion

Our prospective clinical study of 360 eyes with central retinal vein occlusion (CRVO) and our experimental studies on CRVO in 54 eyes of rhesus monkeys have shown that CRVO consists of the following two distinct entities: (1) Nonischemic CRVO in which there is essentially a stasis of retinal venous circulation; we call it venous stasis retinopathy (VSR). (2) Ischemic CRVO: We call this hemorrhagic retinopathy (HR). Our prospective clinical studies have revealed that it is absolutely essential to differentiate CRVO into VSR and HR because of their very different prognoses and management. VSR is a benign and self-limited condition, while HR is a severe, potentially blinding disorder. Lumping the two types of CRVO together as one disease has caused much confusion concerning the prognosis and management of CRVO. The basis of such a classification and differential diagnosis of VSR and HR is discussed at length.