Intravitreal triamcinolone for ischemic branch retinal vein occlusion with serous retinal detachment.
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Aged, 80 and over↗
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[Erythrocyte aggregation and retinal vein occlusion. Preliminary data for a randomized study on the efficacy of anti-erythrocyte aggregation (troxerutin) in retinal vein occlusion].
Erythrocyte aggregation (EAg) is one of the principal determinants of blood viscosity at low shearing rates (slow flow). The retinal venous circulation, characterised by a slow circulatory rate and a high resistance to flow, creates a favourable environment for the formation of erythrocyte aggregates. EAg and other laboratory parameters (haematocrit, fibrinogen, plasma proteins, clotting) were measured in 64 patients presenting with retinal vein occlusion (RVO) and 64 controls matched for age, sex, risk factors (HT, diabetes, smoking) and concomitant vascular disease. Statistical analysis of the results demonstrated a significant difference between the RVO group and the control group for fibrinogen (p = 0.03) and erythrocyte aggregation (p = 0.00003 for the aggregation index at 10 sec and p = 0.0002 for the threshold of partial dissociation). The rise in the fibrinogen level alone cannot explain the increased erythrocyte aggregation. These results demonstrate that the increased EAg largely explains the hyperviscosity reported by other authors and suggest that it plays an important role in the pathogenesis of RVO.
Adult↗
Retinal vessel responses to systemic autonomic stimulation in fellow eyes of patients with retinal vein occlusion.
The retinal vessel calibre responses to systemic autonomic stimulation were studied in fellow eyes of 11 patients with central retinal vein occlusion (CRVO) and 10 patients with branch retinal vein occlusion (BRVO), using sustained isometric muscle contraction as the stimulus. These vessel responses were compared to those of a control group of 11 subjects of similar ages. The changes in retinal vessel calibre were measured using the Quantimet Image Analyser. There was no significant difference in mean arteriolar constriction during isometric muscle contraction (mean +/- SEM) between the CRVO group (6.0 +/- 1.34%) and the BRVO group (5.4 +/- 0.31%), (p greater than 0.05), and between either of these groups compared with the control group (7.4 +/- 1.20%), (p greater than 0.50). Similarly there was no significant difference in mean venule responses between the groups (CRVO 4.9 +/- 0.48%; BRVO 4.6 +/- 0.63%; control subjects 3.8 +/- 0.90%; p greater than 0.05). The diastolic blood pressure responses were similarly not significantly different between the 3 groups (CRVO 22.3 +/- 1.27, range + 17 to 29 mmHg; BRVO 25.8 +/- 2.9 mmHg, range 18 to 45 mmHg; control subjects 21.3 +/- 1.7 mmHg, range 16 to 35 mmHg), (p greater than 0.10). The implications of the results are discussed.
Adult↗
Bilateral simultaneous retinal vein occlusion.
Central retinal vein occlusion (CVO) is a common retinal vascular disorder with potentially blinding complications. However, a simultaneous bilateral affection is not a common entity. One such patient is described here.
Adult↗
[A case of central retinal vein occlusion followed by branch retinal artery occlusion].
BACKGROUND: The influence of retinal artery circulation on central retinal vein occlusion (CRVO) is not well known. CASE: A 73-year-old man with hypertension complained of transient visual loss in his left eye. At initial examination, ophthalmoscopy of his left eye showed mild dilatation and tortuosity of the retinal vein and a few dot hemorrhages. Fluorescein angiography disclosed normal arm-to-retina circulation time and no leakage of dye, but delayed retinal circulation time. These findings indicated venous stasis retinopathy of CRVO. In spite of intravenous infusion of prostaglandin E1 and vasodilative treatment, four days after initial examination, the patient's left eyeground showed complication of branch retinal artery occlusion (BRAO). A fibrinolytic agent was given intravenously, but four weeks later, his left eyeground developed typical hemorrhagic retinopathy. The hemodynamics of retrobulbar arterial circulation were investigated by color Doppler imaging. CONCLUSION: We report a case of venous stasis retinopathy of CRVO associated with BRAO, that developed hemorrhagic retinopathy despite treatment with prostaglandin E1 and other vasodilative agents. We think that arterial insufficiency might be responsible for the conversion from venous stasis retinopathy to hemorrhagic retinopathy of CRVO.
Aged↗
[Two cases of frosted retinal angiitis with central retinal vein occlusion].
BACKGROUND: Frosted retinal angiitis usually occurs in children, and has a good prognosis. We report two cases of unilateral frosted retinal angiitis in adults. They resulted in visual degradation because of associated central retinal vein occlusion and neovascular glaucoma. CASES: Case 1 was a 36-year-old female. Almost all retinal veins and some retinal arteries had vasculitis in her right eye, and the veins were slightly dilated and sheathed. Case 2 was a 23-year-old female. Angle hypopyon was observed in her left eye. Retinal veins were dilated, meandered, and sheathed. Retinal hemorrhages were also observed. In both cases, systemic steroid therapy gradually improved the retinal vasculitis, but central retinal vein occlusions gradually developed, and in spite of systemic administration of urokinase and panretinal photocoagulation, neovascular glaucoma developed, and visual acuity became degraded in both cases. CONCLUSION: Two cases of frosted retinal angiitis complicated by retinal vein occlusion were reported. Careful observation of retinal blood flow is necessary in frosted retinal angiitis in adults.
Adult↗
The management of central retinal vein occlusion.
Central retinal vein occlusion is the result of outflow obstruction and is associated with a variety of medical conditions, mainly affecting the vascular system. Treatment of the coexistent medical conditions has no beneficial effect on visual outcome. Outflow obstruction has been treated by fibrinolytic agents and anticoagulants, hemodilution, and photocoagulation. None of these treatments were of value in improving or maintaining vision. Photocoagulation prevents neovascular complications in ischemic central retinal vein occlusion.
Adult↗
[Expression of basic fibroblast growth factor and fibroblast growth factor receptor 1 in the experimental retinal vein occlusion model].
Retinal ischemia promotes retinal neovascularization. Vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) are important growth factors for neovascularization. We did experimental retinal vein occlusion (RVO) and examined the expression of basic FGF and FGF receptor 1(one of the basic FGF receptors) by in situ hybridization. We used adult pigmented rats (Brown-Norway strain). Dye laser photocoagulation (577 nm) was applied to the retinal arteries and veins within two disc diameters of the optic nerve head to injure the retinal vessels. After one week, laser photocoagulation was applied to only the retinal veins to occlude them (RVO model). As a control, laser photocoagulation was applied to the posterior retina avoiding the retinal vessels. After treatment, the eyes were removed and 10 microns thick cryostat-cut chorioretinal section were used for in situ hybridization with probes as mentioned above. In the RVO model, expression of messenger RNA of basic FGF (b-FGF) and FGF receptor 1 increased in the inner nuclear layer and the inner segment of the photoreceptors, and appeared in the retinal vessel wall in the early stage. This shows that b-FGF and FGF receptor 1 increased in the ischemic retina, and were produced on the retinal vessel wall. This suggests that b-FGF may be involved in protection, regeneration, and proliferation of the retinal vascular endothelial cells in retinal circulatory disturbance.
Animals↗
Activated protein C resistance in young adults with central retinal vein occlusion.
BACKGROUND: Central retinal vein occlusion is a disease that is most common in old people. While the disease in old people often is associated with atherosclerosis, hypertension, diabetes, or glaucoma, this is much less evident in young people. However, a new defect in the anticoagulant system has recently been discovered, activated protein C resistance. This hereditary defect may well be associated with central retinal vein occlusion, and so this factor was analysed in patients younger than 50 years with a history of central retinal vein occlusion. METHODS: Blood samples were obtained from 31 patients younger than 50 years with a history of central retinal vein occlusion, and analysed for activated protein C resistance with standard clinical laboratory methods. RESULTS: In this material 26% of all the patients and 36% of the patients younger than 45 years were resistant to activated protein C. The normal incidence of activated protein C resistance is 2-7%. CONCLUSION: Activated protein C resistance seems to be the most common known cause of central retinal vein occlusion in young people.
Adult↗
Quantitative assessment of macular edema with retinal vein occlusion.
PURPOSE: To evaluate the retinal thickness analyzer, a new image analyzer involving laser-slit biomicroscopy, for quantitative assessment of retinal thickness in patients with macular edema secondary to retinal vein occlusion. METHODS: Fifty-eight patients (central retinal vein occlusion, 22 eyes; branch retinal vein occlusion, 36 eyes) with a clinical diagnosis of macular edema associated with retinal vein occlusion were evaluated. Retinal thickness analysis was performed with the retinal thickness analyzer. A green helium-neon laser slit directed into the eye was scanned to generate optical cross-sections of the retina. Images were analyzed by an automated software algorithm, and a detailed map of the retinal thickness was obtained. RESULTS: Laser-slit images obtained with the retinal thickness analyzer in patients with macular edema associated with retinal vein occlusion disclosed intraretinal changes such as retinal edema, cystoid spaces, and hemorrhages. Linear regression analysis showed a significant relationship between the macular thickness in the central fovea and corrected visual acuity reported on a logMAR scale (P = .002, adjusted R2 = 0.40 in central retinal vein occlusion; P = .002, adjusted R2 = 0.34 in branch retinal vein occlusion). CONCLUSION: We confirmed the capability of the retinal thickness analyzer to provide rapid and precise evaluation of macular thickening in patients with retinal vein occlusion.
Adult↗
Optociliary veins and visual prognosis after central retinal vein occlusion.
The effect of acquired optociliary veins on visual acuity after ischemic central retinal vein occlusion in patients 45 years of age or older was assessed retrospectively. Fundus photographs and medical records of 21 patients, 45 years of age or older, with photographically documented central retinal vein occlusion and at least six-months follow-up were analyzed. Eleven of 21 patients developed acquired optociliary veins. Patients with acquired optociliary veins were more likely to experience stable or improved visual acuity (nine of 11 patients) than were patients without them (four of ten patients) over a mean follow-up period of 30 months (P = .049).
Age Factors↗
Activated protein C resistance and anticoagulant proteins in young adults with central retinal vein occlusion.
BACKGROUND: Central retinal vein occlusion is a disease that is most common in old people, and often associated with atherosclerosis, hypertension, diabetes or glaucoma. Since these diseases are much less evident in young people, we wanted to investigate the prevalence of disorders in the most common anticoagulant proteins in a group of young patients with central retinal vein occlusion. METHODS: 37 consecutive patients younger than 50 years and with a history of central retinal vein occlusion, were analysed for deficiencies of natural inhibitors of coagulation (protein C, S, and antithrombin III), plasminogen, resistance to activated protein C, and the presence of anticardiolipin or lupus anticoagulants. RESULTS: Anticoagulant protein deficiencies were found in 4 patients (11%) and activated protein C resistance in 7 patients (19%). Anticardiolipin or lupus anticoagulants were not found in the patients. CONCLUSION: Activated protein C resistance and anticoagulant protein deficiencies seem to be important factors to the etiology to central retinal vein occlusion in young patients.
Activated Protein C Resistance↗
Correlation between higher blood flow velocity in the central retinal vein than in the central retinal artery and severity of nonproliferative diabetic retinopathy.
PURPOSE: To assess the correlation between a higher blood flow velocity in the central retinal vein (CRV) than in the central retinal artery (CRA) and the severity of nonproliferative diabetic retinopathy (non-PDR). METHODS: We evaluated both eyes of 20 non-PDR patients with higher peak systolic velocity (PSV) in the CRV than in the CRA unilaterally as determined by color Doppler imaging (CDI). The eyes with higher PSV in the CRV were placed in group D2-H, and the fellow eyes were placed in group D2-L. The stage of non-PDR was determined by the guidelines of the Early Treatment Diabetic Retinopathy Study. Normal subjects and non-PDR patients without higher PSV in the CRV were evaluated as CDI controls. RESULTS: Advanced non-PDR (P=0.001) and cystoid macular edema (P=0.02) were statistically more frequent in group D2-H. The velocities in the ophthalmic artery and the short posterior ciliary artery were not statistically different among all groups. The velocities in the CRA were similar in all non-PDR groups and significantly lower than in the normal subjects (P<0.05). The velocities in the CRV were significantly higher only in group D2-H (P<0.001). CONCLUSION: Higher PSV in the CRV than in the CRA was significantly correlated with the severity of non-PDR, especially in the presence of cystoid macular edema.
Aged↗
The formation and involution of optociliary veins during the course of central retinal vein occlusion.
BACKGROUND: Formation of collateral pathways by veins on the optic nerve head is sometimes observed during the resolution of a central retinal vein occlusion (CRVO). However, no cases have been reported in which the formation and involution of these collateral pathways were documented during the resolution of a CRVO. CASE: A 56-year-old man with a nonischemic CRVO was followed over a 10-year period by ophthalmoscopy, fluorescein angiography (FA), and indocyanine green angiography (IA). OBSERVATIONS: Initial examination revealed only mild arteriosclerosis and the absence of optociliary veins (OCV) in the right eye. Approximately 9 years later, the patient returned with a nonischemic CRVO, and FA demonstrated a prolongation of the retinal circulation time to 12.1 seconds (normal < 11.0 seconds). Monitoring of this patient while undergoing treatment disclosed the development of OCV on the optic nerve head and gradual decrease in the retinal hemorrhage. FA showed that the retinal circulation time was shortening and recovering to normal. IA verified an outflow through the OCV into choroidal veins. Later, ophthalmoscopy showed a narrowing of the diameter of the OCV. CONCLUSIONS: We suggest that the OCV developed to drain blood from the retinal veins into the vortex veins through choroidal veins to compensate for the slowing of retinal blood outflow. The reperfusion of the central retinal vein was accompanied by the narrowing of the OCV.
Blood Flow Velocity↗
Central retinal vein occlusion in juvenile diabetes; case report with consideration of the pathogenic relationship between diabetic retinopathy and retinal vein occlusion.
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Cardiovascular System↗
Branch retinal vein occlusion in the right eye and retinal hemorrhage in the left in a patient with classical Tsutsugamushi disease.
PURPOSE: To report branch retinal vein occlusion and retinal hemorrhages associated with tsutsugamushi disease. METHODS: Case report of a 60-year-old woman who complained of fever, chills, headache, lymphadenopathy, and blurred vision in the right eye following an insect bite to the lower right forehead. RESULTS: Serological findings showed elevated titers for the strains of Rickettsia tsutsugamushi. Ophthalmologic examination disclosed bilateral conjunctival injection, flame-shaped hemorrhage in her right fundus, and scattered hemorrhage in her left fundus. Fluorescein angiography demonstrated dye leakage and dilation of capillaries. CONCLUSIONS: Branch retinal vein occlusion associated with classical tsutsugamushi disease, as demonstrated in our patient, may be rare.
Antibodies, Bacterial↗
[A case of central retinal vein occlusion accompanied by central retinal artery occlusion].
A 81-year-old woman developed central retinal vein occlusion (CRVO) in her left eye subsequent to central retinal artery occlusion (CRAO). She noticed sudden visual loss in the left eye. At initial examination, her left visual acuity was 0.03, and only a small visual field was preserved at temporal area. The left fundus showed findings of mild non-ischemic CRVO. In addition white clouded retina was recognized at the left posterior pole which indicated CRAO. FAG showed remarkably prolonged arterial circulation, but no retinal capillary obliteration. Then retinal hemorrhage increased rapidly and her left eye developed hemorrhagic retinopathy. Two weeks after initial examination, FAG showed extensive retinal capillary obliteration. In this case it was supposed that central retinal artery occlusion due to arteriosclerosis produced ischemic capillaropathy and venous thrombosis, after which restoration of arterial circulation caused hemorrhagic retinopathy.
Aged↗
[The formation and involution of the optociliary vein during the course of central retinal vein occlusion].
BACKGROUND: Formation of collateral pathways by veins on the optic nerve head is sometimes observed during the resolution of a central retinal vein occlusion (CRVO). However, no cases have been reported which documented the formation and involution of these collateral pathways during the resolution of a CRVO. CASE: A 56-year-old man with a non-ischemic CRVO was followed over a 10-year period by ophthalmoscopy, fluorescein angiography (FA), and indocyanine green angiography (IA). Initial examination revealed only mild arteriosclerosis and absence of the optociliary vein (OCV) in the right eye. Approximately 9 years later, the patient returned with non-ishemic CRVO, and FA demonstrated a prolongation of the retinal circulation time to 12.1 seconds (normal < 11.0 seconds). Monitoring of this patient during treatment disclosed development of an OCV on the optic nerve head and gradual decrease in the retinal hemorrhage. In FA, the retinal circulation time was shortened and returned to normal. IA verified an outflow through the OCV into choroidal veins. Later, ophthalmoscopy showed a narrowing of the diameter of the OCV. CONCLUSION: We suggest that the OCV developed to drain blood from retinal veins to the vortex veins through choroidal veins to compensate for the slowing of retinal blood outflow. The reperfusion of the central retinal vein was accompanied by the narrowing of the OCV.
Collateral Circulation↗