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PubMed2005

[Measurement of macular edema in retinal vein occlusion using optical coherence tomography and its visual prognosis].

OBJECTIVE: To examine the type of macular edema in patients with retinal vein occlusion by using optical coherence tomography (OCT). To compare the sensitivity and specificity between OCT and fundus fluorescein angiography (FFA). To investigate the visual prognosis and risk factors in patients with cystoid macular edema (CME). METHODS: Ninety-one eyes of 90 patients with various types of retinal vein occlusion were examined by OCT and FFA. There were 54 cases male and 36 cases female. The age of these patients ranged from 20 to 74 years old and averaged (57.8 +/- 13.8) years old. Right eye was affected in 45 cases, and left eye in 46 cases (both eye in 1 case). Central retinal vein, hemicentral retinal vein and branch retinal vein were affected in 54, 9 and 28 eyes, respectively. The average follow-up period was 6.10 months. The sensitivity and specificity of OCT and FFA were measured. The visual prognosis and risk factors were analyzed. Macular central retinal thickness of 54 opposite normal eye was measured for comparison. RESULTS: (1) The classification of macular edema by OCT was cystoid macular edema in 71 eyes (78.0%); subretinal fluid in 14 eyes and laminar macular hole in 1 eye. The minimal and maximal height of intraretinal cystoid space was 94 microm and 1317 microm, respectively and averaged (668.18 +/- 245.58) microm. The minimal and maximal height of macular central retinal thickness of 54 opposite normal eye was 110 microm and 236 microm, respectively and averaged (154.09 +/- 21.85) microm. The maximal height of subretinal fluid space was 1377 microm or even beyond the detective limit of OCT. (2) The sensitivity of OCT for detection of CME was 98.6% and the specificity was 100%. The sensitivity of FFA was 86.1% and the specificity was 100.0%. (3) The visual prognosis of 61 eyes with CME follow-up over 3 months: The difference between the initial and final VA in branch retinal vein occlusion was statistically significant (P < 0.01), while no difference between initial and final VA in central and hemicentral retinal vein occlusion (P > 0.05). The factors affected visual prognosis of CME included the duration, the presence of hemorrhage in cystoid space and the severity of occlusion, etc. In CME under 3 months, the visual prognosis after therapy is better than that of before the therapy (P < 0.01); while in eyes with duration more than 3 months, no difference of vision could be detected before and after the therapy (P > 0.05). CONCLUSIONS: OCT is a safe, high-resolution, non-invasive, reliable and reproducible new examine method for detecting CME. The visual prognosis of CME is poor. It is possible that the visual prognosis can be improved by early detecting CME using OCT.

Adult↗
PubMed2003

Retinochoroidal collateral veins protect against anterior segment neovascularization after central retinal vein occlusion.

OBJECTIVE: To test the hypothesis that retinochoroidal collateral veins (RCVs), or alternatively, retinociliary or optociliary shunts/collaterals/veins or opticociliary anastomoses, act protectively against the development of anterior segment neovascularization (ASN) following central retinal vein occlusion (CRVO). DESIGN: Case-control retrospective medical record review of patients with CRVO. PATIENTS: We identified 107 patients with CRVO, of whom 34 had developed ASN, by reviewing their medical records. After applying exclusion criteria, a case group and an age-, sex-, and visual acuity-matched control group were selected. We analyzed these groups for the presence or absence of RCVs and noted the time course involved in their development. MAIN OUTCOME MEASURES: Anterior segment neovascularization (including neovascularization of the iris and/or anterior chamber angle), neovascular glaucoma, and RCV development. RESULTS: Only 1 (5.4%) of 19 individuals who developed ASN did so in the presence of RCVs. In contrast, 11 (57.9%) of 19 individuals in the control group developed RCVs. Statistical analysis revealed that patients who developed ASN were roughly 25 times less likely to have had RCVs than individuals who never developed ASN (odds ratio = 24.74; P =.001). CONCLUSION: Retinochoroidal collateral veins are negatively associated with ASN post-CRVO and may function in a protective manner against such an outcome.

Aged↗
PubMed1997

Branch retinal vein occlusion. Axial length and other risk factors.

OBJECTIVE: To determine the association between axial length, as a measurement of hyperopia, and branch retinal vein occlusion and to determine the clinical characteristics and other risk factors of patients with branch retinal vein occlusion. METHODS: A case-control study was performed using 36 patients with branch retinal vein occlusion and 36 age- and sex-matched control patients selected from a list of subjects who had undergone cataract extraction. RESULTS: There was essentially no difference in axial length between patients the disorder and control patients (23.55 mm versus 23.62 mm; P = 0.79). Although the intraocular pressure (IOP) among control eyes was somewhat higher than that in branch retinal vein occlusion eyes, the difference was not statistically significant (P = 0.32). Systemic hypertension was more common in patients with branch retinal vein occlusion (53%) than in control patients (42%) but the difference was not statistically significant (P = 0.35). Chronic open-angle glaucoma was present in 14% of patients with branch retinal vein occlusion and 22% of control patients (P = 0.37), but this difference was not statistically significant. Diabetes mellitus was two times more common in controls (28%) than in patients with branch retinal vein occlusion (14%). This difference, however, also did not reach statistical significance (P = 0.13). CONCLUSIONS: Hyperopia as measured by axial length is not a risk factor for branch retinal vein occlusion. This study provides evidence that hypertension is a risk factor for branch retinal vein occlusion and that chronic open-angle glaucoma and diabetes mellitus are not risk factors for branch retinal vein occlusion.

Adult↗
PubMed1992

Seasonal variations in the onset of retinal vein occlusion.

Seasonal variation in the development of retinal vein occlusion in 1003 consecutive patients with various types of retinal vein occlusion was studied prospectively from 1973 to 1990. No seasonal variation in the onset of any type or combination of types of retinal vein occlusion was found. This refutes previous reports of such seasonal variation, which were based on small retrospective series.

Adult↗
PubMed1994

Disk hemorrhages and retinal vein occlusions in glaucoma.

There are several reasons to consider disk hemorrhages, branch retinal vein occlusions and central retinal vein occlusion as manifestations of the same vascular disease, the only difference among them being the size of the vessel affected. There is a close association of these vascular events with open angle glaucoma, and all of them increase with increasing follow-up time. The morphological changes described in the retinal veins in glaucoma and in central vein occlusions are endothelial proliferations causing progressive increase of flow resistance. Similar changes most probably also cause branch vein occlusions and disk hemorrhages. This vascular condition which obstructs the vessels with hindrance of the blood flow and impaired nutrition of neuronal tissue might be the primary cause of glaucoma.

Glaucoma, Open-Angle↗
PubMedDate not supplied

Neovascular glaucoma associated with cilioretinal artery occlusion combined with perfused central retinal vein occlusion.

BACKGROUND: Cilioretinal artery occlusion rarely results in neovascular glaucoma, especially in cases of extensive cilioretinal infarction and combined retinal vascular occlusion. CASE: A 62-year-old man with diabetes mellitus and essential hypertension showed a visual acuity of counting fingers, retinal whitening temporal to the optic disc with mild dilation and tortuosity of the retinal veins, and retinal hemorrhages in four quadrants of his right eye. Fluorescein angiography demonstrated a delayed filling of the central retinal vein and cilioretinal artery. OBSERVATIONS: Two months later, neovascular glaucoma developed and retinal ablation was performed using an argon laser. Trabeculectomy was also performed due to the intractability of the glaucoma, and central artery occlusion was found. On magnetic resonance angiography, the right distal common carotid artery was irregularly narrowed and the right ophthalmic artery was almost entirely occluded. CONCLUSIONS: In cases of cilioretinal artery occlusion and perfused central retinal vein occlusion with multiple risk factors, close follow-up is advised.

Ciliary Arteries↗
PubMed1994

Correlation of electroretinographic and fluorescein angiographic findings in unilateral central retinal vein obstruction.

BACKGROUND: In central retinal vein obstruction (CRVO), electroretinogram (ERG) abnormalities and extensive retinal capillary dropout (CD) in the fluorescein angiogram (FA) are good indicators of retinal ischemia. We retrospectively studied patients with unilateral CRVO and compared the ERG and FA results. METHODS: Single white flash ERG, photopic ERG, scotopic ERG and flicker ERG were recorded in 30 cases of unilateral CRVO. We analyzed the correlation between the ERG results and the presence/absence of extensive CD. RESULTS: The ERG b/a-wave amplitude ratios, photopic and scotopic b-wave amplitudes, and flicker amplitudes were significantly smaller (P < 0.05) in eyes with extensive CD (n = 12, 40%), than in eyes without (n = 18, 60%). When the photopic or scotopic b-wave amplitudes were normal or supernormal, extensive CD on FA was absent in all eyes. When the b/a-wave ratios were > or = 1.0 or when the b-wave amplitudes with white flash or flicker amplitudes were normal or supernormal, extensive CD was present in less than 32% of eyes. CONCLUSION: These results suggest that the ERG results, especially the b/a-wave amplitude ratio, are significantly correlated with the presence/absence of CD on FA in CRVO.

Adult↗
PubMed1996

Vitreous Hemorrhage complicating laser-induced chorioretinal anastomosis for central retinal vein occlusion.

PURPOSE: To report a severe complication of laser chorioretinal anastomosis for central retinal vein occlusion. METHOD: Case report. RESULTS: In the right eye of a 62-year-old woman with nonischemic central retinal vein occlusion, retinal neovascularization at the laser chorioretinal anastomosis site caused dense secondary vitreous hemorrhage. Vitreous hemorrhage prevented laser panretinal photocoagulation for subsequent iris neovascularization, necessitating vitrectomy surgery to clear the hemorrhage and allow the treatment. CONCLUSION: Laser chorioretinal anastomosis can result in severe vitreous hemorrhage and complicate efforts to manage later sequelae of central retinal vein occlusion.

Anastomosis, Surgical↗
PubMed1994

A randomized, double-masked study on the treatment of retinal vein occlusion with troxerutin.

Hemorheologic factors probably play a role in the pathogenesis and prognosis of retinal vein occlusion. Accordingly, we designed a prospective, randomized, double-masked study to evaluate the effect of troxerutin, a rheologic drug, on retinal vein occlusion. Fifty-three patients were included, 27 with central retinal vein occlusion and 26 with branch retinal vein occlusion. They were randomly assigned for treatment with either troxerutin or a placebo. All subjects were similar in age, gender, associated diseases, hemorheologic values, and clinical severity of the retinal vein occlusion. At the end of follow-up, members of the troxerutin-treated group, as compared with the placebo group, showed significant improvement in visual acuity (P = .03), macular threshold (P = .01), retinal circulation times (P = .04), and macular edema (P = .05). Furthermore, they had diminished progression of ischemia (P = .05) and decreased red blood cell aggregability (P = .006) when compared with the controls. These encouraging preliminary results obtained with a rheologic treatment attest to the pathogenic role of blood viscosity in retinal vein occlusion and suggest that a large-scale randomized study should be conducted.

Adult↗
PubMed1989

Treatment of branch retinal vein occlusion with argon laser photocoagulation.

Although temporal branch retinal vein occlusion has, on the whole, a good prognosis, in about 40% of the patients the outcoming vision is markedly changed. The authors used argon laser to treat 15 patients suffering from temporal branch retinal vein occlusion. They analyze their experiences and the results of the treatment of chronic macular edema and neovascularizations with argon laser photocoagulation. In 5 of 7 patients with chronic macular edema, they achieved resorption of the edema within 2 months after photocoagulation. They elaborated their own modification of the laser barrage according to L'Esperance. In more than half the patients, treated for chronic macular edema, the achieved visual acuity was 6/6-6/9, the worst vision was 6/18. In none of the patients a decrease in visual acuity occurred. In the management of neovascularizations of the retina and the disc of the optic nerve, argon laser photocoagulation resulted in involution of the neovascularizations in all 3 patients, vitreous hemorrhage did not occur in any of the eyes. Although the group of the treated patients is only small, the authors consider the treatment of the temporal branch retinal vein occlusion with argon laser photocoagulation to be beneficial.

Argon↗
PubMed1996

The venous closing pressure in central retinal vein obstruction.

OBJECTIVE: To assess the rate of change in the central retinal venous closing pressure in central retinal vein obstruction over time, and its relationship to visual acuity improvement and the development of rubeosis iridis. METHODS: Fifty patients presenting with central retinal vein obstruction of less than three months' duration, between the ages of 40 and 80 years, were reviewed prospectively. The central retinal venous closing pressure was measured by digital ocular compression. Patients were discharged from the study after the six-month visit. RESULTS: All patients had elevated venous closing pressure at presentation, whereas at six months only 24 patients had persistent elevation. Of 16 patients with lowering of the venous closing pressure within four months of onset of central retinal vein obstruction, 11 (69%) had two or more lines of visual acuity improvement. Only two of 10 patients (20%) developing lowering of the venous closing pressure thereafter had visual improvement. No patient developed rubeosis iridis after the venous closing pressure lowered. CONCLUSION: The central retinal venous closing pressure is raised in central retinal vein obstruction to about central retinal arterial diastolic pressure, and is its pathognomonic sign. This sign is easily elicited via digital pressure on the eyelid, and has prognostic significance for visual acuity improvement and the development of rubeosis iridis.

Adult↗
PubMed2005

Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the Atherosclerosis Risk in Communities & Cardiovascular Health studies.

OBJECTIVE: To examine the associations of retinal vein occlusion and arteriolar emboli with cardiovascular disease. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Pooled from the Atherosclerosis Risk in Communities Study (n = 12,642; mean age, 60 years) and the Cardiovascular Health Study (n = 2824; mean age, 79 years). METHODS: Retinal vein occlusion and arteriolar emboli were identified from a single nonmydriatic retinal photograph using a standardized protocol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including standardized carotid ultrasonography. MAIN OUTCOME MEASURES: Retinal vein occlusion and arteriolar emboli. RESULTS: Prevalences of retinal vein occlusion and arteriolar emboli were 0.3% (n = 39 cases) and 0.2% (n = 34 cases), respectively. After adjusting for age, retinal vein occlusion was associated with hypertension (odds ratio [OR], 2.96; 95% confidence interval [CI], 1.43-6.14), systolic blood pressure (BP) (OR, 4.12; 95% CI, 1.40-12.16; highest quartile vs. lowest), diastolic BP (OR, 2.64; 95% CI, 1.07-6.46; highest quartile vs. lowest), carotid artery plaque (OR, 5.62; 95% CI, 2.60-12.16), body mass index (OR, 3.88; 95% CI, 1.23-12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95% CI, 1.08-10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95% CI, 2.00-8.36), and focal arteriolar narrowing (OR, 5.17; 95% CI, 2.59-10.29). After adjusting for age, retinal arteriolar emboli were associated with hypertension (OR, 3.14; 95% CI, 1.44-6.84), systolic BP (OR, 3.46; 95% CI, 1.13-10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33; 95% CI, 1.01-5.42), carotid artery plaque (OR, 4.62; 95% CI, 1.85-11.57), plasma lipoprotein (a) (OR, 3.69; 95% CI, 1.20-11.41; highest quartile vs. lowest), plasma fibrinogen (OR, 3.09; 95% CI, 0.98-9.76; highest quartile vs. lowest), and current cigarette smoking (OR, 3.08; 95% CI, 1.47-6.47). Approximately a quarter of participants with retinal vein occlusion and arteriolar emboli had evidence of carotid artery plaque as defined from ultrasound. CONCLUSIONS: Retinal vein occlusion and retinal arteriolar emboli are associated with carotid artery disease, hypertension, and other cardiovascular risk factors.

Aged↗
PubMed1998

Fluorescein angiography versus ERG for predicting the prognosis in central retinal vein occlusion.

PURPOSE: It is not easy to predict which patients with a central retinal vein occlusion will develop rubeosis and which will not. We have compared two methods for doing so, fluorescein angiography and full-field electroretinogram (ERG). Our aim was to improve our possibilities for predicting rubeosis in patients with central vein occlusion. METHODS: 32 patients with a central retinal vein occlusion with a duration of less than 14 days were included in the study. Fluorescein angiography and ERG were performed in all patients. The fluorescein angiograms were studied by two independent examiners in a masked mode. The patients were then followed for at least one year. RESULTS: Development of rubeosis in patients with central retinal vein occlusion could be predicted by fluorescein angiography in 82% of the patients and with ERG in 94% of the patients. The non-ischemic central retinal vein occlusions were identified in 62% by fluorescein angiography and in 100% with ERG. Fluorescein angiography misjudged 9 patients 28%, whereas ERG only misjudged 1 patient, 3%. CONCLUSION: ERG seems to be a better method for predicting the prognosis in central retinal vein occlusion than fluorescein angiography.

Adult↗
PubMedDate not supplied

Treatment of retinal vein thrombosis with pentoxifylline: a controlled, randomized trial.

The aim of this study was to evaluate PXF (pentoxifylline; 1600 mg daily vs placebo) in patients with retinal vein thrombosis (RVT) in a 4-week trial, evaluating clinical outcome and retinal flow. Inclusion criteria were sudden loss of vision (SLV); retinal vein thrombosis (RVT); decrease in retinal vein flow; asymmetry between retinal veins (>40%) documented by duplex scanning (retinal vein thrombosis flow = RVTF). All 18 included patients completed the study. The groups were comparable. No side effect was observed. An improvement in arterial flow (p<0.05) and a decrease in analogue score (p<0.05) were observed in both groups (due to the spontaneous evolution with partial thrombus lysis in 4 weeks). The increase in arterial flow (PSF and EDF) were greater (p<0.05) in the PXF group. The RVFV increase was better in the PXF group (350% increase vs 200% increase in the placebo group; p<0.05). There was a significant difference in the analogue score decrease (4 vs 7) in the PXF group (p<0.05). In conclusion, PXF improved retinal flow after RVT better than placebo. It should be considered as an important treatment option.

Adult↗
PubMed1988

Surgical decompression of branch retinal vein occlusions.

Many patients with branch retinal vein occlusions can develop significant long-term diminution of vision due to such complications as macular edema, retinal neovascularization, and vitreous hemorrhage. One of us (S.C.) developed a new surgical procedure that involves sectioning or decompression of the common sheath connecting the artery and vein at the crossing where a branch retinal vein occlusion occurs. The patient whose case we report had a visual acuity improvement from 20/200-2 to 20/25+1 eight months after surgery.

Female↗
PubMed1990

Haemorheological changes in patients with retinal vein occlusion after isovolaemic haemodilution.

In 83 patients with central retinal vein occlusion and branch vein occlusion we measured the haematocrit (HCT), plasma viscosity (PV), red cell aggregation (RCA), red cell filterability (RCF) and apparent whole blood viscosity (WBV). A control group (n = 41) was matched for sex, age, and cardiovascular risk factors. Measurements were performed before and after treatment with isovolaemic haemodilution (IHD). We found no significant differences between patients with retinal vein occlusion (RVO) and control subjects in haematocrit, plasma viscosity, red cell aggregation, and red cell filterability and no increased whole blood viscosity in the patient group. Patients with ischaemic retinal vein occlusion and non-ischaemic retinal vein occlusion did not show different haemorheological parameters either. After treatment with haemodilution, only the haematocrit and whole blood viscosity were significantly decreased, and there were no changes in plasma viscosity, red cell aggregation or red cell filterability.

Adult↗
PubMed1996

[Role of the vitreous in central retinal vein occlusion].

To investigate the role of the vitreous in eyes with central retinal vein occlusion, especially in relation to neovascularization and macular edema, we conducted a retrospective chart review of the vitreous condition of 150 patients (150 eyes) with central retinal vein occlusion. Based on fluorescein angiography findings and color photographs, eyes with central retinal vein occlusion were classified as ischemic or nonischemic. In ischemic cases, retinal or optic disc neovascularization, or both, developed in eight (57%) of 14 eyes without complete posterior vitreous detachment at the final examination. The prevalence of neovascularization was significantly higher than in eyes with complete posterior vitreous detachment (0%, 0/43) at the final examination (p < 0.01). In nonischemic cases, the prevalence of no posterior vitreous detachment or partial posterior vitreous detachment with vitreomacular adhesion was significantly higher in eyes with macular edema (76%, 28/37) than in eyes without it (23%, 13/56) at the final examination (p < 0.01). Complete posterior vitreous detachment may protect against retinal or optic disc neovascularization in eyes with severe central retinal vein occlusion. Vitreomacular adhesion may cause persistent macular edema in eyes with mild central retinal vein occlusion.

Adult↗
PubMedDate not supplied

Axial length and hyperopia in eyes with retinal vein occlusions.

We performed a prospective study in order to elucidate the predisposing role of axial length and hyperopia in retinal vein occlusions. The study group comprised 39 patients with unilateral central retinal vein occlusion (CRVO), 50 patients with unilateral branch retinal vein occlusion (BRVO), 13 patients with unilateral hemispheric retinal vein occlusion (HRVO) and 45 control eyes. The axial length of affected eyes was compared to fellow eyes and control eyes in each subgroup of patients with retinal vein occlusion. No statistical difference was noted for any of the subgroups (p > 0.05). Hyperopia was detected in 12 of 39 eyes (31%) with CRVO, 14 of 50 eyes (28%) with BRVO, 4 of 13 eyes (31%) with HRVO and 15 of 45 eyes (33%) in the control group. No statistically significant difference was discovered (p > 0.05). In the light of our study, we believe that axial length and hyperopia may not be risk factors in retinal vein occlusions, in contrast to common belief.

Adult↗