Central retinal vein occlusion in a young adult

This report describes a case of central retinal vein occlusion (CRVO) which was classified as papillophlebitis in a young female adult. In this age group, CRVO is relatively rare and tends to be mild in both its short-term and long-term visual consequences. The patient in this case showed a concurrent episode of bilateral intra-ocular pressure (IOP) elevation and the presence of cilio-retinal arteries in the affected eye. Despite extremely poor vision at presentation and the poor prognostic sign of cilio-retinal arteries, the patient made an excellent visual recovery with only mild paracentral field damage. (Clin Exp Optom 1995; 78: 2: 60–64)     

Central retinal vein occlusion in young people

In a study performed on 20 subjects with central retinal vein occlusion (CRVO) aged 40 years or less we found the ischemic form in 20%. Disc edema was a common finding at the onset, while macular edema was less frequently seen. Systemic or ocular disorders that could be related with the development of the CRVO were often found; a patient was affected with myasthenia gravis and another with Sturge-Weber syndrome: these two diseases were not previously reported in association with CRVO. In only two of the 11 patients followed-up the visual acuity improved. The visual prognosis in CRVO of young people is often poor; the more frequent cause of the reduced visual acuity is chronic cystoid macular edema.     

Central retinal vein occlusion in young adults

Central retinal vein occlusion (CRVO) is usually seen in older adults and is often associated with systemic vascular disease. CRVO can be seen in young adults, and although it is occasionally associated with a systemic disease, in the majority of cases it occurs in an otherwise healthy patient with no known systemic disease or ocular problem. Inflammation of the central retinal vein has been proposed as a cause of the occlusion in young adults and for that reason it has been called papillophlebitis. The appearance of unilateral optic disc edema, dilatation, and tortuosity of the major retinal veins with a variable amount of retinal hemorrhage in young, healthy adults with complaints of blurred vision or photopsias has been called, in addition to papillophlebitis, benign retinal vasculitis, optic disc vasculitis, nonischemic CRVO, big blind spot syndrome, and presumed phlebitis of the optic disc. An approach to the diagnostic evaluation of the young adult with CRVO is presented. Although most eyes recover vision to better than 20/40, about one-fifth have significant visual loss, and many suffer ocular sequelae. Many treatment modalities have been tried for this entity, but no conclusive evidence exists that any treatment alters its natural history.     

Central retinal vein occlusion in a patient treated with antiandrogenic drug

Central retinal vein occlusion (CRVO) is usually seen in older adults and is often associated with systemic vascular disease, this is much less evident in young people. A case report of a 28-year-old woman presented a central retinal vein occlusion in her left eye. This young woman was treated with antiandrogenic drug. Investigations revealed an abnormality of the hemostatic system. The central retinal vein occlusion was resolved and the fundus assumed a normal appearance one-month after the primary episode. Retinal vascular occlusions with antiandrogenic drug may be due to three mechanisms: increased platelet cell aggregation, alteration of fibrinolytic system and vascular endothelium hyperplasia.     

Central retinal vein occlusion in a patient with thrombotic thrombocytopenic purpura

PURPOSE: To describe the occurrence of central retinal vein occlusion in a patient with thrombotic thrombocytopenic purpura. METHODS: Case report. RESULTS: A 52-year-old woman developed central retinal vein occlusion in the acute phase of thrombotic thrombocytopenic purpura, followed by iris neovascularization only 1 month after the onset of central retinal vein occlusion. Color Doppler imaging of the affected eye showed an increased resistive index of the central retinal artery and reduced blood flow velocity of the central retinal vein compared to the fellow eye. CONCLUSION: We describe a rare association between central retinal vein occlusion and thrombotic thrombocytopenic purpura with rapid evolution of iris neovascularization. Our case demonstrates that close ophthalmologic attention is important in thrombotic thrombocytopenic purpura.     

Central retinal artery occlusion after radial optic neurotomy in a patient with central retinal vein occlusion

PURPOSE: To describe a patient with a central retinal vein occlusion (CRVO) who developed central retinal artery occlusion after radial optic neurotomy. DESIGN: Interventional case report. METHODS: A 70-year-old woman with CRVO underwent a radial optic neurotomy on her right eye. Her preoperative visual acuity in the affected eye was 20/400. RESULTS: Radial optic neurotomy was performed after phacoemulsification and aspiration for a cataract with intraocular lens implantation. At the insertion of a CRVO knife, pulsating bleeding occurred from the cup of the optic disk; the bleeding was stopped within 2 minutes by elevating the intraocular pressure to 80 mm Hg. On the following day, the patient noticed that she had lost light perception. Fluorescein angiography showed a marked delay of arterial filling, indicating a central retinal artery occlusion. Retinal circulation returned to normal 2 months later; however, her vision was still no light perception. CONCLUSIONS: Ophthalmologists should be aware that severe complications such as central retinal artery occlusion can be associated with radial optic neurotomy, which is an unproven surgical procedure with a questionable pathophysiologic mechanism.     

Central retinal vein occlusion in young adults (papillophlebitis).

We performed a retrospective study of 103 cases of central retinal vein occlusion (CRVO) in young, nondiabetic adults that were followed for at least six months. Of these patients, 64% were men and 36% were women. While visual acuity was usually good, 33 eyes (32%) had a final visual acuity of 20/200 or worse, including 6 eyes (6%) with a final visual acuity of no light perception. Ocular complications included chronic cystoid macular edema, macular pigmentary changes (37%), sheathing of retinal vessels (22%), venous collaterals of the disc (33%), macular hole formation (1%), neovascularization of the disc (1%), retina (1%), and iris (19%), neovascular glaucoma (8%), and vitreous hemorrhage (7%).     

Central retinal vein occlusion associated with cilioretinal artery occlusion

PURPOSE: To describe the clinical characteristics and pathogenesis of central retinal vein occlusion (CRVO) associated with cilioretinal artery occlusion (CLRAO). METHODS: The study included 38 patients (38 eyes) who had CRVO associated with CLRAO and were seen in our clinic from 1974 to 1999. At their first visit to our clinic, all patients provided a detailed ophthalmic and medical history and underwent comprehensive ophthalmic evaluation, color fundus photography, and fluorescein fundus angiography. At each follow-up visit, the same ophthalmic evaluations were performed, except for fluorescein fundus angiography. RESULTS: Of 38 eyes, 30 had nonischemic CRVO, 5 had ischemic CRVO, and 3 had nonischemic hemi-CRVO. Patients with nonischemic CRVO were significantly younger (mean age +/- SD: 45.3 +/- 16.0 years) than those with ischemic CRVO (72.3 +/- 9.2 years; P = 0.001) and those with nonischemic hemi-CRVO (64.7 +/- 7.5 years; P = 0.018). At least one third of the patients gave a definite history of episode(s) of transient visual blurring before the onset of constant blurred vision. Initially, the ophthalmoscopic and fluorescein angiographic findings were similar to those seen in CRVO and hemi-CRVO, except that all these eyes had retinal infarct in the distribution of the cilioretinal artery; its size and site varied widely. Fluorescein angiography typically showed only transient hemodynamic block and not the typical CLRAO. During follow-up, visual acuity improved markedly in nonischemic CRVO (P < 0.001) and nonischemic hemi-CRVO but deteriorated in ischemic CRVO. Retinopathy resolved spontaneously in 22 eyes with nonischemic CRVO (mean duration +/- SD: 42.0 +/- 101.0 months), in 2 eyes with ischemic CRVO (15.4 +/- 4.5 months), and in 1 eye with nonischemic hemi-CRVO. Retinociliary collaterals developed in 30% of eyes with nonischemic CRVO, in 40% of eyes with ischemic CRVO, and in 66% of eyes with nonischemic hemi-CRVO. CONCLUSION: CRVO associated with CLRAO constitutes a distinct clinical entity. The pathogenesis of CLRAO in CRVO is due to transient hemodynamic blockage of the cilioretinal artery caused by a sudden sharp rise in intraluminal pressure in the retinal capillary bed (due to CRVO) above the level of that in the cilioretinal artery.     

Central retinal vein occlusion: a review

Central retinal vein occlusion remains a common cause of unilateral visual loss. Until recently, our treatment options for this condition were limited only to laser photocoagulation for the devastating end sequelae of anterior segment neovascularization. Over the last 2 years, a number of randomized controlled trials have given us significant new treatment options to address not only visual loss from macular oedema but also the ability to create a bypass around the obstruction in the central retinal vein and to address the raised venous hydrostatic pressure. In the future, it is likely that combination approaches to the management of central retinal vein occlusion will develop using specific agents and techniques to address the components of macular oedema, retinal ischaemia and raised venous hydrostatic pressure, all of which combine to produce the clinical picture and the reduction in vision seen in this condition.     

Central retinal vein occlusion combined with cilioretinal artery occlusion

A healthy 65-year-old man with sudden profound visual loss in his right eye presented with clinical signs of central retinal venous occlusion and retinal whitening, indicative of a cilioretinal arterial obstruction. He had been diagnosed with cilioretinal artery occlusion at a private ophthalmology clinic three days before being referred to our department. On fluorescein angiogram of the affected eye, the proximal portion of the retinal arteries filled with dye 27.3 seconds after injection, indicating a delay in retinal arterial filling. Moreover, the cilioretinal artery did not fill at that phase, but went on to fill 45.1 seconds after injection. Over 63.4 seconds after the filling of the retinal arteries, the laminar flow of the retinal venous vessels appeared. This was not until 90.7 seconds after injection. This patient was elderly, had no systemic diseases, and showed non-ischemic CRVO, prolonged retinal arterial filling on fluorescein angiography, and poor prognosis in visual acuity. His clinical course seemed to favor the pathogenetic hypothesis of a primary arterial affection.     

Recurrent central retinal vein occlusion in a young thrombophilic patient with factor V Leiden mutation

PURPOSE: To investigate the cause of recurrent central retinal vein occlusion in a 26-year-old white woman. METHODS: Case report. Complete blood analyses were done, including HLA tissue typing, immunoserologic and coagulation tests, with cardiovascular and capillaroscopy investigations. Factor V:R506Q and prothrombin 20210 GIA mutations were checked by polymerase chain reaction and restriction enzyme analysis. RESULTS: DNA analysis showed the patient to be heterozygous for factor V:R506Q mutation. During a follow-up of 18-months, after starting anticoagulant therapy, the patient had not suffered from any other ocular or systemic occlusive vascular accident. CONCLUSIONS: The R506Q factor V gene mutation may be associated with recurrent central retinal vein occlusions. Genetic investigation should be promptly recommended in thrombotic patients to establish a specific preventive treatment.     

Central retinal vein occlusion in a patient with familial antithrombin III deficiency: case report

A 60-year old man with familial antithrombin III deficiency, a primary cause of hypercoagulation, developed central retinal vein occlusion. Familial antithrombin III deficiency is inherited as an autosomal dominant condition. It is characterized by recurrent episodes of thromboembolism. The occurrence of central retinal vein occlusion in a person with familial deficiency of antithrombin III suggests the possibility of a casual relationship.     

Central retinal vein occlusion case-control study

PURPOSE: To investigate risk factors for central retinal vein occlusion (CRVO). DESIGN: Retrospective case-control study. METHODS: Consecutive patients with CRVO examined from July 1, 2005 through July 31, 2006 were compared with an historical gender- and age-matched control group of patients with ocular problems other than vascular occlusive disease from the same referral practice. Risk factors for CRVO were evaluated. RESULTS: The 144 patients in the CRVO group, 87 males and 57 females, had a mean age of 69.6 years (+/-13.6 years). CRVO was associated with hypertension (P < .001), diabetes mellitus (P = .047), glaucoma (P < .001), atrial fibrillation (P = .036), angiotensin-converting enzyme inhibitor use (P = .022), aspirin use (P < .001), and warfarin use (P = .011) by univariate analyses. Postmenopausal estrogen use was more common among women in the control group (P = .029). Multivariate logistic regression found the independent predictors for CRVO to be: glaucoma (adjusted odds ratio [OR], 4.75; P < .001), aspirin use (adjusted OR, 2.66; P = .001), and warfarin use (adjusted OR, 3.34; P = .005). CONCLUSIONS: We found many of the same risk factors previously identified for CRVO by other studies, but we identified both aspirin and warfarin use to be independent risk factors for CRVO. Although these findings suggest the vasculopathic and prothrombotic risks in some patients may not be addressed adequately by antithrombotic therapy, they also suggest that the pathogenesis of CRVO may be more complicated than just the development of a primary thrombus within the vein.     

Cilioretinal artery occlusion in young adults with central retinal vein occlusion

Ten patients, all younger than 50 years of age, had a temporal cilioretinal artery occlusion associated with a nonischemic central retinal vein occlusion. On fluorescein angiography, the cilioretinal artery eventually filled in all but one eye. The cilioretinal artery showed pulsations on fluorescein angiography in five eyes. The central retinal vein occlusion eventually resolved and the fundus assumed a normal appearance in all nine of the followed cases. Eight of nine eyes that underwent follow-up examination had final visual acuity of 20/30 or better. The occlusion of the central retinal vein produces an elevation of intraluminal capillary pressure because the central retinal artery continues to pump blood into the retina. Because the perfusion pressure of the cilioretinal artery is lower than the central retinal artery, it becomes relatively occluded. The prognosis for these patients is generally good unless the entire parafoveal capillary net is affected by the cilioretinal artery that is occluded.