Colour Doppler assessment of blood flow in eyes with central retinal vein occlusion

PURPOSE: To assess the blood flow changes in eyes with central retinal vein occlusion (CRVO) and compare these values with values of fellow eyes and eyes of normal subjects. METHODS: 25 eyes of 25 consecutive newly diagnosed patients with CRVO comprised the study group. Their fellow eyes and those of 25 healthy subjects were the control group. All patients underwent a complete ophthalmological examination. Eyes with CRVO were classified into two groups as non-ischaemic and ischaemic by fundus fluorescein angiography. Colour Doppler imaging was performed with a Toshiba Sonolayer SSH-140A and 7.5-MHz linear array probe. Maximum systolic velocity (V(max)), end-diastolic velocity (V(min)) and resistive index (R(i)) values were noted for each of the central retinal artery (CRA), central retinal vein (CRV) and ophthalmic artery (OA). These parameters were compared with those of the fellow eyes and both eyes of the control group. RESULTS: Mean ages were 63.55 and 61.45 years in the CRVO and control groups, respectively. Age and sex distributions were statistically identical in both groups. When we compared the eyes with CRVO to the control group, no statistically significant difference existed between the two groups with regard to the V(min) and R(i )values of the CRA and CRV. However, V(max ) values of the CRA and CRV were significantly lower in CRVO eyes when compared to the control group. The CRVO group and control group had similar V(max), V(min ) and R(i) values for the OA. Only the V(max) was significantly lower in the CRV in eyes with CRVO when compared to the unaffected fellow eyes. No statistically significant difference could be detected between any of the parameters of CRA, CRV and OA of the ischaemic and non-ischaemic CRVO groups. CONCLUSIONS: More data on broader series need to be obtained in order to decide on the practical use of colour Doppler imaging in the differentiation of ischaemic eyes from non-ischaemic eyes in CRVO.     

视网膜静脉阻塞激光治疗后玻璃体出血的临床分析

目的：了解视网膜静脉阻塞(RVO)激光治疗后发生玻璃体出血的原因。方法：回顾分析2年来门诊11例(11眼，CRVO：2眼；BRVO：9眼)激光后的视网膜静脉阻塞发生玻璃体出血的病例。结果：11例RVO中：少量玻璃体出血5例；中-多量玻璃体出血6例，其中2例作玻璃体切除术，其余激光治疗后出血停止而治愈。由初次激光治疗到玻璃体出血时间6月-11年，再次激光或／和手术后视力均有改善。结论：不规范或不完全的视网膜光凝是导致RVO激光治疗发生玻璃体出血的主要原因，规范的视网膜光凝、定期随诊和眼底荧光造影是保证疗效的关键。     

The natural course of central retinal vein occlusion

We reviewed the records of 160 patients who had central retinal vein occlusion between 1980 and 1985. Of 168 eyes, 107 (64%) were classified as nonischemic types and 61 (36%) were classified as ischemic types. Of 107 nonischemic eyes, ten (9%) converted to the ischemic variant. Of 107 nonischemic eyes, 33 (31%) lost three or more lines of visual acuity irrespective of initial visual acuity. A final visual acuity less than or equal to 20/200 was recorded in 57 of 61 (93%) of ischemic eyes and 53 of 107 (50%) of nonischemic eyes.     

年轻视网膜中央静脉阻塞患者的临床进程

目的描述55岁以下的视网膜中央静脉阻塞(CR-VO)患者的临床进程。设计和方法回顾性非比较性的连续病例分析。复习了67例患者的人口统计学、影像、临床和视力数据。对其中随访6个月以上(平均29.2个月)的病例资料进行了统计学分析。主要结果测定最佳矫正视力和眼内新生血管形成的发病率。结果在连续的67例(男性55%,平均年龄45岁)患者中,视力平均为20/50。其中45例(67%)患者被查出至少有1种全身性疾病。在57例随访6个月以上的患者中,最终视力20/40(含)以上的占42%,20/50-20/100的占18%,20/200(含)以下的占40%.在CRVO发病的3-6个月内,绝大部分患者出现了视力减退。在发病的12个月以后,出现视力提高的极少见。就诊视力在20/40(含)以上的22例患者中,36%的患者在最近的1次检查中视力下降到了20/400甚至更低。就诊视力在20/200-20/400的10例患者中,8例视力提高到20/60甚至更高。就诊视力在数指或者更差的6例患者中,没有1例视力得到改善。在CRVO发病的1-9个月内,10例(18%)患者被诊断为眼内新生血管形成。其中前节新生血管形成的患者有6例(11%),包括3例(5%)新生血管性青光眼。新生血管形成的发生与患者的性别、年龄、有无伴随疾病、症状的持续时间和就诊视力均没有明显关系。结论年轻患者的CRVO有着多变的临床过程     

"二步法"激光诱导脉络膜视网膜静脉吻合术治疗兔视网膜中央静脉阻塞的视觉电生理变化

目的评价“二步法”激光诱导脉络膜视网膜静脉吻合术(laser-induced chori-oretinal venous anastomosis,LCRVA)治疗实验性视网膜中央静脉阻塞(central retinal veinocclusion,CRVO)的有效性。方法青紫蓝兔30只,8只(16眼)设为正常对照组,其余22只(44眼)采用光动力学方法建立双眼的CRVO模型。CRVO模型成功后,对双眼CRVO兔(15只),随机选1眼先后用倍频Nd:YAG激光器和Nd:YAG激光器分别在选定部位击破Bruch膜及相邻的静脉壁,以建立视网膜静脉与脉络膜血管之间的吻合通道;对侧眼作为CRVO对照眼;4只单眼CRVO兔中,2只为LCRVA治疗组,另2只为CRVO对照组。于术前1d,术后4h、1d、3d、1周、2周、3周、4周、8周、12周和16周各时间点,分别进行ERG检测。结果34眼(77.3%,15只兔双眼,4只兔单眼)一次性建立了CRVO模型。对其中的17眼行LCRVA,每眼击射2个点。经眼底荧光素血管造影检查证实,在8眼(47.0%)中的11个点(32.4%)存在功能性吻合。CRVO对照组较正常对照组在各时间点主要表现为ERG b波潜伏期延长,振幅下降。经LCRVA治疗后2~3周,b波振幅呈恢复趋势,与CRVO对照组有显著性差异(P<0.05)。OPs波振幅与ERG b波呈现相似变化。ERGa波变化不明显。结论兔CRVO眼的视网膜功能明显受损,LCRVA可一定程度减轻CRVO对视功能的损害。     

The natural course of central retinal vein occlusion.

Thirty-five patients with central retinal vein occlusion had an extensive medical and laboratory evaluation to identify possible etiologic factors. We describe the natural course of the two forms of retinal venous occlusive disease, hemorrhagic retinopathy and venous stasis retinopathy, by observing a group of 25 untreated patients from one to eight years. Systemic vascular disease was most commonly associated with retinal venous occlusive disease. The visual prognosis is favorable in venous stasis retinopathy and extremely poor in hemorrhagic retinopathy. However, two of ten patients with venous stasis retinopathy developed hemorrhagic retinopathy with poor visual outcome.     

Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase

We investigated prospectively in 128 patients (140 eyes) the role of six routine clinical tests in the differentiation of ischemic central retinal vein occlusion (CRVO) from non-ischemic CRVO during its early acute phase. There were fourfunctional tests [visual acuity, visual fields, relative afferent pupillary defect (RAPID), electroretinography (ERG)] and twomorphologic tests (ophthalmoscopy and fluorescein fundus angiography). We found that none of the six tests had 100% sensitivity and specificity in such a differentiation during the early, acute phase, so that no one test can be considered a gold standard; however, combined information from all six is almost always reliable. Overall, the four functional tests proved far superior to the two morphologic tests in differentiating ischemic from non-ischemic CRVO: RAPID was most reliable in uniocular CRVO (with a normal fellow eye), followed closely by ERG in all cases; combined information from RAPID and ERG differentiated 97% of cases; perimetry was the next most reliable, followed by visual acuity. The two morphologic tests performed worst; fluorescein angiography provided either no information at all on retinal capillary nonperfusion (in at least one-third of the eyes during the early, acute phase) because of multiple limitations, or sometimes provided misleading information. Ophthalmoscopic appearance is the least reliable, most misleading parameter.A preliminary summary of this was presented at the Macula Society Meeting, Cannes, France (June, 1987) and at the XVIth Meeting of the Club Jules Gonin, Bruges, Belgium, 4–8 September 1988. This investigation was supported by grant EY-1151 from the National Institutes of Health and, in part, by unrestricted grants from Research to Prevent Blindness, Inc., and from Alcon Research Institute     

Macular oedema in central retinal vein occlusion treated with intravitreal triamcinolone

PURPOSE: To investigate the efficacy of intravitreal triamcinolone as treatment for macular oedema in central retinal vein occlusion (CRVO). METHODS: We conducted a retrospective comparative case series of nine patients with macular oedema associated with CRVO (six non-ischaemic and three ischaemic) treated with an intravitreal injection of 4 mg triamcinolone acetonide, compared with 10 control (observation) patients (six non-ischaemic and four ischaemic). Examination included visual acuity (VA) tests and complete ophthalmic examinations at baseline, 1, 2 and 6 months postoperatively. RESULTS: The mean baseline VA was 20/161 for CRVO treatment group patients and 20/75 for observation group patients (p = 0.15). No significant difference in VA between CRVO treatment group patients (20/99) and controls (20/282) was observed at the final 6-month visit (p = 0.33). Subgroup analysis of the non-ischaemic CRVO treatment patients compared with the non-ischaemic controls also showed no significant difference at the 6-month visit (20/59 and 20/100, respectively; p = 0.20). At 6 months, five of the six non-ischaemic treated patients had VA >or= 20/100, compared with five of the six non-ischaemic control patients. All patients tolerated the procedure well, but there was a significant increase in intraocular pressure by the 2-month visit (p = 0.015). CONCLUSIONS: Intravitreal injection of triamcinolone may not be effective for treatment of macular oedema in all CRVO patients or all non-ischaemic CRVO patients. A trend towards VA improvement was noted but was not statistically significant. Although our treatment was not hindered by severe complications, there was a significant increase in IOP in the 2 months following treatment.     

Impending central retinal vein occlusion associated with increased platelet aggregability.

A case is presented of an impending central retinal vein occlusion, venous stasis retinopathy, seen in an otherwise healthy 57-year-old woman. The patient demonstrated hyperactive platelets when tested for primary and secondary aggregation. Coagulation tests and platelet count were normal. It is proposed that such an abnormality in platelet function, when present, can be an important factor in the pathogenesis of impending central retinal venous occlusion. Antiplatelet therapy may be used in the management of this hemodynamic alteration.     

Subhyaloid hemorrhage in association with an atypical central vein occlusion

BACKGROUND: Subhyaloid macular bleeding is a rather rare complication caused by central or branch retinal vein occlusions, by vascular malformations, Terson's syndrome, trauma or valsalva's manoeuver. We report on a young and otherwise healthy patient with a large subhyaloid macular hemorrhage associated with an atypical central vein occlusion. HISTORY AND SIGNS: A 25-year old female was evaluated for an acute and dramatic drop of visual acuity of the right eye. The ophthalmological findings included an extensive subhyoidal macular bleeding, congested, tortuous retinal veins and some flame-shaped preretinal haemorrhages along a couple of veins. Furthermore, a slight edema in the area of an inferiorly of the macular region localized cilioretinal artery was visible. The general history of the patient was unremarkable with the exception of smoking. Anamnestically, Valsalva's manoeuver could not be excluded by the patient. CONCLUSION: Atypical central vein occlusions can be the rare cause of a subhyaloid macular hemorrhage. A Valsalva's manoeuver could have caused in our patient the subhyaloid macular and the preretinal bleedings. The temporarily raised venous pressure could have been responsible for the central vein occlusion, secondarily causing the occlusion of a cilioretinal paramacular artery.     

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.     

视网膜中央静脉阻塞的彩色超声多普勒检查

采用彩色超声多普勒成象技术对１０例视网膜中央静脉阻塞患者进行视多膜中央动、静脉的血流测定，并选择１０例性别、年龄相当的正常健康人进行对照。结果显示：患眼的视网中央动脉收缩期峰值血流速度（ＰＳＶ）和加速度（Ａ），平均视网膜中央静脉以速（ＣＲＶ）较对侧健肯和正常对照明显降低，而且ＣＲＶ较ＰＳＶ降低明显，提示ＣＲＶ的测量可能在鉴别缺血型与非缺血型视网膜中央静脉阻塞以及预测新生血管并发症的产生方面有一定意     

Capillary blood flow in acute branch retinal vein occlusion

PURPOSE: To study retinal capillary blood flow during the acute stage of induced branch retinal vein occlusion (BRVO) in the feline retina and the effect of systemic blood pressure during this event. METHODS: Known fractions of the animal blood cells were labeled by a fluorescent marker and tracked by an electro-optical device as they flowed within the retinal microcirculation. Branch retinal vein occlusion was induced by photocoagulation of a large vein at the optic disk rim. The findings were video recorded and analyzed by computerized image processing. RESULTS: Reversed capillary blood cell flow from the blocked vein was noted immediately following occlusion of the vein. Two patterns of reversed capillary flow were identified: one from the blocked vein to a terminal arteriole and the other from a blocked vein to another vein via a junction with a terminal arteriole. Increased systemic blood pressure decreased the reversed flow in both flow patterns. CONCLUSIONS: 1) Flow deviation to nearby retinal arterioles or veins (shunting) through the normal capillary system is an immediate hemodynamic event following acute BRVO. 2) The reversed capillary flow is affected by the systemic blood pressure.