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Retinal vein occlusion is a common cause of visual loss. The clinical features, pathogenesis, aetiology and management of this condition are presented and discussed. It is an advantage to involve both the physician and the ophthalmologist in the management of the condition.
Retinal vein occlusion (RVO) represents one of the most frequent vascular disorders of the posterior pole. RVO treatment is disappointing because a great number of patients remains with a reduced visual acuity; the visual acuity is the functional test which shows the treatment efficacity. The study group of patients was treated with sulodexid, a therapeutic agent with thrombolytic and fibrinolytic action; sulodexid was associated with laser photocoagulation where it was required. Study's results point out efficiency only for those cases treated precociously between 48 to 72 hours from the outset.
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Retinal vein occlusion (RVO) not infrequently occurs in diabetic patients. Although the aetiology is unclear, it could relate to the other microvascular complications of diabetes. In the non-diabetic, both the central (CRVO) and branch (BRVO) forms are commonly associated with hypertension and hyperlipidaemia. We have therefore studied fifty type II diabetic patients with RVO compared to a carefully matched diabetic control group (n = 50) to elucidate underlying medical conditions and hence the aetiology of RVO in diabetic patients. The two groups were well matched. Diabetics with RVO showed a strikingly high prevalence of hypertension compared to the controls (72% versus 32%: p < 0.001) and a trend to increased hyperlipidaemia (54% versus 36%). Diabetic microvascular complications were more common in the control group (diabetic retinopathy and proteinuria). No significant differences were observed in mean HbA1 or weight, but current smoking habits and blood pressure levels were increased in the diabetics with RVO. 80% of diabetic patients with the BRVO form, were hypertensive. We conclude that the main underlying medical conditions for RVO in diabetics are hypertension and hyperlipidaemia, and these may be important in the aetiology as in the non-diabetic. RVO is more common in type II rather than type I diabetes, and does not associate with the presence of diabetic microvascular complications. Clinical assessment for hypertension and hyperlipidaemia is therefore important in diabetic patients with RVO, especially if recurrence of the condition and further visual loss is to be prevented.
Retinal vein occlusion (RVO) is most commonly seen in middle-aged or older patients and is associated with underlying cardiovascular risk factors. It is much less common in younger patients. Use of the oral contraceptive pill (OCP) is known to be a risk factor for cardiovascular and cerebrovascular disease. There have previously been a few isolated case reports of patients sustaining an RVO whilst taking the OCP. The aim of this study was to investigate patients sustaining an RVO whilst taking the OCP or hormone replacement therapy (HRT). From a large series of 588 patients, we found 11 with an RVO associated with sex hormone preparations. Of these, 6 had taken the OCP and 5 were HRT users. From this large group there were only 9 female patients aged under 35 years who sustained an RVO. Of these, 6 were associated with use of the OCP. All patients were investigated for recognised medical risk factors for RVO. None of these factors were identified in the patients who had used the OCP. Of the patients taking HRT, 4 of the 5 had other potential risk factors. From our large series, the prevalence of RVO in female patients under 35 years taking the OCP was 66%. There is a 30% uptake of the OCP in the general population. These data support the view that RVO is a contraindication to the use of the OCP. Additionally, it would appear (albeit from limited data) that patients who sustain RVO may continue with their HRT, as HRT is not a major single risk factor for RVO.
Retinal vein occlusion (RVO) is associated with hyperhomocysteinaemia and the antiphospholipid syndrome-disorders known to contribute to both arterial and venous thrombosis. In both of these conditions and RVO, platelet activation occurs. Aspirin, not warfarin, is the most effective antithrombotic agent in RVO and, taken together, these observations suggest an important role for platelets in this common ocular thrombotic condition. Platelet glycoprotein Ia/IIa (GpIa/IIa) is an adhesion molecule mediating platelet-collagen interactions and is key to the initiation of thrombosis. Recently, the cellular density of this molecule was shown to be determined by two silent, linked polymorphisms (C807T/G873A) within the GpIa/IIa gene. There is evidence that some of the resulting genotypes are associated with thrombo-embolic disease. This study therefore aimed to establish the prevalence of the GpIa/IIa polymorphisms and the three commonest hereditary thrombophilic disorders (prothrombin gene G20210A (PT) mutation, Factor V Leiden (FVL), and the thermolabile methylene tetrahydrofolate reductase C677T (MTHFR) mutation) in patients with RVO and normal controls. The GpIa/IIa polymorphisms and thrombophilic abnormalities were all identified using the polymerase chain reaction.Our results show that the frequency of the GpIa/IIa polymorphisms was similar in our normal control population to previously published series. Patients with RVO, however, had only a 10% (4/40) frequency of the lowest risk subtype (CC/GG) compared to 37.5% (15/40) in the control group-P 0.0039. The incidence of the PT, FVL, and MTHFR thrombophilic mutations was not different between the two groups, but interestingly none of the 7/40 RVO cases with a PT, FVL, or MTHFR mutation had the low-risk GpIa/IIa genotype while all but one of the controls did-P<0.05. Thus, 17.5% of RVO patients harboured more than one prothrombotic abnormality. The principal difference between the RVO and control group was the very high incidence of the intermediate-risk GpIa/IIa subtype (CT/GA)-82.5 vs 50%, P&<0.05. These results suggest a major role for GpIa/IIa polymorphisms in the pathogenesis of RVO.
Retinal vein occlusion (RVO) is the second commonest vascular disease of the eye, second only to Diabetic Retinopathy. The association of the retinal vein occlusion with other systemic disease likes hypertension, diabetes mellitus and others has been well documented. With the increase in persons being affected from these disorders, patients with retinal vein obstruction are also increasing. Hence, a study was designed to evaluate all cases of RVO to find out its association with systemic disorders. A total of 100 patients (106 eyes) were enrolled in the study. Out of which, 66 cases reported to have Brach Retinal Vein Occlusion (BRVO) and rest 34 cases with Central Retinal Vein Occlusion (CRVO). Among the associated systemic diseases, hypertension and diabetes mellitus accounted for 84% cases. Isolated hypertension (54%) was most commonly seen followed by diabetes mellitus (8%). The prevalence of BRVO was almost twice as compared to CRVO. The high association of various systemic disorder especially Hypertension and diabetes further supports the need of early and periodic eye examination for those suffering from these disorders.
Central retinal vein occlusion is a common retinal disease with usually severe complications. At present no safe treatment exists promoting the recovery of lost vision. Several surgical approaches to modify the natural course of the disease have been proposed in recent years. These options include laser-induced chorioretinal venous anastomosis, the injection of tissue plasminogen activator into a retinal vein, optic nerve decompression, and vitrectomy for macular edema. Even though all the proposed treatments have not yet been supported by randomized clinical trials, these techniques can be considered as innovative in an area where no effective treatment is available. Larger clinical trials are required to assess both the effectiveness and complication rate of surgical treatments designed to reverse the natural evolution of central retinal vein occlusion.
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Hemicentral retinal vein occlusion (HRVO) is an anatomic variant of central retinal vein occlusion (CRVO) and thus different from branch retinal vein occlusion (BRVO). Therefore, the risk factors for HRVO should be similar to those of CRVO and different from those of BRVO. To test this, the authors compared 15 demographic and clinical variables of 28 HRVO patients with those of 117 CRVO and 214 BRVO patients. Mean age of onset and sex ratio were not significantly different among the groups. Elevated erythrocyte sedimentation rate (ESR) (P = 0.019) and elevated intraocular pressure (IOP) (P = 0.025) were significantly more prevalent in the HRVO than the BRVO group. In addition, when the authors compared CRVO with BRVO, elevated ESR (P = 0.003), elevated IOP (P = 0.015), and positive purified protein derivative (PPD) (P = 0.003) were significantly more prevalent in the CRVO than the BRVO group, whereas hypertension (P = 0.03) and hyperopia (P = 0.008) were significantly more prevalent in the BRVO group. However, of the variables tested between HRVO and CRVO patients, no significant differences were found.
Central retinal vein occlusion is a common cause of permanent visual loss. Work up and laboratory evaluation of patients requires the clinician to rule out hypertension, diabetes, hyperlipidemia, and glaucoma. Patients without an identifiable risk factor are often subject to extensive testing for primary and secondary thrombophilias. The purpose this paper is to review the literature to determine which of these tests is associated with central retinal vein occlusion. Antiphospholipid antibodies and elevated plasma homocysteine levels appear to be the tests associated most commonly in patients with central retinal vein occlusion in most controlled studies. Primary thrombophilias are found rarely when screening patients with central retinal vein occlusion. Extensive testing for thrombophilias is not warranted in the vast majority of patients with central retinal vein occlusion. Older patients with any of the common vascular risk factors do not require thrombophilic screening. By carefully selecting the patients who are evaluated for thrombophilias, the likelihood of finding true-positive tests is increased.
The Retinal Thickness Analyzer is a laser slit biomicroscopy imaging device that produces accurate measurements of retinal thickness and displays the images in a two-dimensional pattern, superimposed on a fundus image. This article reports a patient with decreased vision following branch retinal vein occlusion in whom the Retinal Thickness Analyzer was used to establish the diagnosis of a macular lamellar hole that was not apparent clinically.
OBJECTIVE: To investigate the clinical features of central retinal vein occlusion (CRVO) complicating exudative retinal detachment (ERD). METHODS: General health, vision, intraocular pressure, appearance of the fundus and fundus fluorescein angiography (FFA) and the results of ultrasound examination in cases with CRVO complicating ERD were analyzed. RESULTS: Eight patients were male and 7 patients were female. Age of those patients ranged from 18 to 42 years, averaged 25 years. Five cases combined with neovascular glaucoma. Initial vision ranged from 0.05 to light perception. There were notably edema and hemorrhage in the macular region. Extensive exudative appeared at the edge of edema and detachment region. The extent of retinal detachment was 2/12 - 5/12 quadrant at sitting position. No collateral vessels were found on the optic disk. FFA showed extensive blockage by the hemorrhages or capillary nonperfusion. CONCLUSIONS: ERD is a rare and severe complication of CRVO, which usually develops in young patients and combines with neovascular glaucoma. The appearance in fundus and FFA shows a characteristic features.
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The laser flare cell meter (LFCM) was used to evaluate alterations of the blood-aqueous barrier in eyes with retinal vein occlusion (RVO). In 42 eyes of 42 patients with RVO (30 branch vein occlusions, 12 central vein occlusions) aqueous flare and aqueous cells were determined and retinal fluorescein angiography was performed. Flare and cell values were compared with 59 normal age and sex-matched control eyes and correlated with fluorescein angiographic findings. Both aqueous flare (12.321 (SD 6.717) photon counts/ms) and aqueous cells (mean 3.37 cells/0.075 x 10(6)/l) were significantly increased in eyes with RVO in comparison with the normal control group (flare 4.288 (SD 1.144) photon counts/ms, cells 0.54 cells/0.075 x 10(6)/l, p < 0.0001 and p < 0.005). Flare values in eyes with central RVO (19.517 (SD 7.762) photon counts/ms) were significantly higher than in eyes with branch RVO (9.443 (SD 3.307) photon counts/ms, p < 0.0001). Significant correlations were found between flare values and area of RVO (r = 0.70, p < 0.0001) and between flare values and area of retinal non-perfusion (r = 0.76, p < 0.0001). There were also significant correlations between flare values and number of cotton wool spots (r = 0.54, p < 0.0002) and between cell counts and degree of cystoid macular oedema (r = 0.46, p < 0.006). Our findings show that aqueous protein concentration, as indicated by flare, and aqueous cells are increased in RVO and that changes of aqueous flare correlate with fluorescein angiographic findings that reflect the severity of RVO. Measurements with LFCM may be useful non-invasively to quantify changes of the ocular barrier functions in RVO.
BACKGROUND: Retinal neovascularization (RNV) has never been described in cases of macular branch retinal vein occlusion (MBRVO), due to the limited amount of ischemia in this form of retinal vein occlusion. Ischemic areas as wide as 5-10 disc diameters were required by previous studies to count as ischemic cases of central or major branch retinal vein occlusion. CASE REPORT: A 56-year-old woman who had been suffering from MBRVO for 3 years presented at the posterior pole a zone of non-perfusion, extending over 7.5 disc areas, and three small tufts of RNV. RNV regressed after two subsequent laser treatments of the ischemia. Retrohyaloid hemorrhage was observed 2 months after the first treatment. CONCLUSION: Since the average diameter of the non-perfused area was about 2.75 disc diameters, this case demonstrates that small RNVs can appear in less extensive areas of ischemia than is generally believed.
Exudative retinal detachment (ERD) is an uncommon complication of branch retinal vein occlusion (BRVO). The ERD pathogenesis has been mainly related to the haemodynamic overload and to an impairment in the function of the retinal pigment epithelium. Data relative to 98 cases of BRVO without ERD were compared with the correspondent data of 10 cases of BRVO with ERD. Venous leakage showed a substantial equivalency between the two groups, while evaluation of retinal venous collaterals demonstrated a lower amount in the BRVO cases with ERD, with a statistically significant difference. Moreover, considering the various ERD localizations, we suggest that the ERD pathogenesis is mainly ascribable to the scant development of retinal venous collaterals but that an important role may also be played by the retinal pigment epithelium impairment consequent to the retinal ischaemia.
Central retinal vein occlusion is associated with systemic conditions, such as arterial hypertension, diabetes, hypercholesterolemia, but also with certain hypercoagulability states (thrombophilia). Growing evidence indicates, that the presence of antiphospholipid antibodies and elevated plasma homocysteine levels predispose to central retinal vein occlusion. In younger patients, factor V Leiden (Arg506Gln) could increase the risk of this disease. Other probable causes of thrombophilia related to retinal vein occlusion include increased levels of plasminogen activator inhibitor 1 and lipoprotein (a), which impair fibrinolysis.