Diurnal intraocular pressure in young adults with central retinal vein occlusion

In the older population, there is a well-known relationship between central retinal vein occlusion (CRVO) and glaucoma and ocular hypertension. In young adults, CRVO is a rare occurrence, the cause of which is not well understood. Seven patients under the age of 36 years with CRVO and no associated systemic disease underwent modified diurnal intraocular pressure (IOP) measurements (8:00 AM to 11:00 PM). Abnormal IOPs were found in the affected and/or the unaffected fellow eyes. To the authors' knowledge, this is the first report implicating abnormal IOP as an etiologic factor in the development of CRVO in young adults. Only with diurnal IOP measurements were the elevated swings and peak IOPs detected. This finding suggests that abnormal IOP may be an important factor in the development of CRVO in young adults.     

Prevalent misconceptions about acute retinal vascular occlusive disorders

Acute retinal vascular occlusive disorders collectively constitute one of the major causes of blindness or seriously impaired vision, and yet there is marked controversy on their pathogeneses, clinical features and particularly their management. This is because the subject is plagued by multiple misconceptions. These include that: (i) various acute retinal vascular occlusions represent a single disease; (ii) estimation of visual acuity alone provides all the information necessary to evaluate visual function; (iii) retinal venous occlusions are a single clinical entity; (iv) retinal vein occlusion is essentially a disease of the elderly and is not seen in the young; (v) central retinal vein occlusion (CRVO) is one disease; (vi) fluorescein fundus angiography is the best test to differentiate ischemic from nonischemic CRVO; (vii) the site of occlusion in CRVO is invariably at the lamina cribrosa; (viii) clinical picture of CRVO is often due to compression or strangulation of the central retinal vein (CRV) in the lamina cribrosa and not its occlusion; (ix) an eye can develop both CRVO and central retinal artery occlusion (CRAO) simultaneously; (x) every eye with CRVO is at risk of developing neovascular glaucoma; (xi) lowering intraocular pressure (IOP) helps to improve retinal circulation in an eye with CRVO; (xii) every patient with retinal vein occlusion should have complete hematologic and coagulation evaluation; (xiii) the natural history of CRVO does not usually involve spontaneous visual improvement; (xiv) management of CRVO is similar to that of venous thrombosis anywhere else in the body, i.e. with aspirin and/or anti-coagulants; (xv) fibrinolytic agents can dissolve an organized thrombus in the CRV; (xvi) it is beneficial to lower blood pressure in patients with CRVO; (xvii) panretinal photocoagulation used in ischemic retinal venous occlusive disorders has no deleterious side-effects; (xviii) glaucoma or ocular hypertension can cause branch retinal vein occlusion; (xix) branch retinal vein occlusion can cause neovascular glaucoma; (xx) in eyes with CRAO, the artery is usually not completely occluded; (xxi) CRAO is always either embolic or thrombotic in origin; (xxii) amaurosis fugax is always due to retinal ischemia secondary to transient retinal arterial embolism; (xxiii) asymptomatic plaque(s) in retinal arteries do not require a detailed evaluation; (xxiv) retinal function can improve even when acute retinal ischemia due to CRAO has lasted for 20h or more; (xxv) CRAO, like ischemic CRVO, can result in development of ocular neovascularization; (xxvi) panretinal photocoagulation is needed for "disc neovascularization" in CRAO; (xxvii) fibrinolytic agents are the treatment of choice in CRAO; (xxviii) there is no chance of an eye with retinal arterial occlusion having spontaneous visual improvement; (xxix) absence of any abnormality on Doppler evaluation of the carotid artery or echography of the heart always rules out those sites as the source of embolism; and (xxx) absence of an embolus in the retinal artery means the occlusion was not caused by an embolus. The major cause of all these misconceptions is the lack of a proper understanding of basic scientific facts related to the various diseases. The objective of this paper is to discuss these misconceptions, based on these scientific facts, to clarify the understanding of these blinding disorders, and to place their management on a rational, scientific basis.     

眼压和眼轴长与视网膜静脉阻塞的关系

目的探讨眼压和眼轴长与视网膜静脉阻塞（RVO）的关系。方法应用CanonTX-F型眼压计对56例RVO患者的眼压进行测量,并用A超对其眼轴进行测量,对照组为年龄、性别相匹配的98例白内障摘除患者。结果视网膜中央静脉阻塞（CRVO）阻塞眼眼压显著低于对测眼及正常对照眼（P〈0.01）;视网膜分支静脉阻塞（BRVO）阻塞眼眼压与对测眼及正常对照眼比较差异无显著性（P〉0.05）。CRVO阻塞眼眼轴长与对照眼比较差异有显著性（P〈0.01）;BRVO阻塞眼眼轴长与对照眼比较差异无显著性（P〉0.05）。结论眼轴长偏短是CR-VO的危险因素,CRVO可引起眼压降低;眼轴长偏短不是BRVO的危险因素,BRVO不能引起眼压降低。     

Ocular hypertension in patients with central/hemicentral retinal vein occlusions: cumulative prevalence and management

AIM: To prospectively evaluate the cumulative prevalence and the management of ocular hypertension (OH) in patients with unilateral acute central/hemicentral retinal vein occlusions (C/HCRVOs) over the course of 3y. METHODS: The study included 57 patients with unilateral acute C/HCRVOs. All patients underwent a comprehensive ophthalmological examination of both eyes. OH associated with C/HCRVO in patients showing a score >5% for the risk of conversion to primary open angle glaucoma (POAG) was treated with OH medication. The treatment aimed for a decrease in intraocular pressure (IOP) to <21 mm Hg with a >22% reduction from the initial values. The cumulative prevalence of OH and the effectiveness of treatment assessed by the cumulative prevalence of conversion from OH to POAG, were estimated. RESULTS: Fifteen patients had OH associated with C/HCRVOs, the cumulative prevalence of OH was 29.4% (95% confidence interval, 16.9-41.9). The mean value of the risk score of OH conversion to POAG for the 5 subsequent years was 11.7%±5.4%. The IOP significantly decreased from 25.67±2.16 mm Hg to 18.73±2.96 mm Hg. None of the OH patients converted to POAG during the follow-up period. CONCLUSION: The increased cumulative prevalence of OH in C/HCRVO patients indicates that OH is a risk factor for the appearance of venous occlusion. Patients with OH associated with C/HCRVO must be considered to be at high risk for conversion to POAG. Treatment with OH medications prevented conversion to POAG during the 3-year follow-up.     

Central retinal vein occlusion in pseudoexfoliation of the lens capsule

In surveying an extensive group of patients with unilateral pseudoexfoliation of the lens capsule certain interesting points emerged, particularly on the incidence of central retinal vein occlusion in this condition,and perhaps in glaucoma also. A total of 284 patients with unilateral pseudo-exfoliation of the lens capsule were examined clinically after an ophthalmic and general history were taken. Mean intraocular pressure (IOP) was 30.9 mmHg in the affected eye and 18.1 mmHg in the unaffected eye. Central retinal vein occlusion occurred in 10 affected eyes but no unaffected eyes and always in affected eyes with a rise in IOP. Average IOP in the affected eye with central retinal vein occlusion was 37.5 mmHg (range 26-54 mmHg);in the unaffected fellow eye it was 18.0 mmHg (range 11-28 mmHg). Although the process involved in producing pseudo-exfoliation of the lens capsule may contribute to the precipitation of central retinal vein occlusion, these findings suggest the rise in IOP is the more important cause. This may also be so in other forms of glaucoma.     

并发视网膜中央动静脉阻塞的特殊PORN1例

目的:报道1例艾滋病患者特殊的进行性外层视网膜坏死(PORN),同时合并视网膜中央动脉及静脉阻塞。方法:病例报告。结果:患者表现为进行性外层视网膜坏死,视神经亦受累,合并视网膜中央动静脉阻塞,与带状疱疹性视网膜病变的最初表现一样。积极的治疗包括玻璃体腔和特异性系统抗带状疱疹病毒治疗,以及强化的抗逆转录病毒治疗(HAART)。视网膜坏死静止,对侧眼未受累,而患眼的视力极差。结论:首次报道了1例并发视网膜中央动静脉阻塞的特殊PORN,积极的局部联合系统治疗使得局部病情控制,并预防了对侧眼发病。     

Optic disc size in central retinal vein occlusion

Predisposing factors in central retinal vein occlusion (CRVO) have included various systemic disorders and glaucoma. Recent reports have suggested a possible relation between specific anatomic configurations of the optic nerve head and the development of anterior ischemic optic neuropathy. The authors analyzed several optic disc parameters in 57 ocular normotensive patients with unilateral CRVO and in 27 control subjects. There was no significant difference in the horizontal disc diameter and cup-to-disc ratio between eyes with unilateral CRVO, fellow eyes with CRVO, and control eyes. The current data suggest that there is no relation between optic disc size and CRVO.     

眼压和轴长在视网膜中央静脉阻塞中的意义

目的　探讨眼压和轴长在视网膜中央静脉阻塞中的意义。方法　应用TX- 10眼压计对4 6例(46只眼) CRVO患者的眼压进行测量。并使用A型超声仪对其中16例CRVO眼轴进行测量,对照组与病例组年龄和性别相配,例数相等。结果　36例CRVO阻塞眼眼压较对侧眼有不同程度降低。CRVO阻塞眼眼压显著低于对侧眼及正常对照眼(P <0 .0 1)。CRVO阻塞眼轴长显著短于对侧眼及正常对照眼(P <0 .0 1)。结论　CRVO可引起眼压降低,短眼轴是CRVO的危险因素。     

Photocoagulation for retinal vein occlusion

The role of photocoagulation in retinal vein occlusion (RVO) has been studied since 1974. The most serious complications of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) are: (i) visual deterioration, most commonly due to macular edema, and (ii) the development of ocular neovascularization (NV), particularly neovascular glaucoma (NVG), with hazardous consequences for vision and even the eye itself.Before discussing the role of photocoagulation in the management of NV and macular edema in RVO, it is crucial to gain a basic scientific understanding of the following relevant issues: classification of RVO, ocular NV in RVO, and the natural history of macular edema and visual outcome of RVO. These topics are discussed.In CRVO, ocular NV is a complication of ischemic CRVO but not of nonischemic CRVO. Photocoagulation has been advocated to prevent and/or treat the development of ocular NV and NVG. Since NVG is the most dreaded, intractable and blinding complication of ischemic CRVO, the role of photocoagulation and its management are discussed. Findings of three randomized, prospective clinical trials dealing with photocoagulation in ischemic CRVO are discussed.The role of photocoagulation in the management of ocular NV and macular edema in BRVO, and three randomized, prospective clinical trials dealing with those are discussed.Recent advent of intravitreal anti-VEGF and corticosteroid therapies has drastically changed the role of photocoagulation in the management of macular edema and NV in CRVO and BRVO. This is discussed in detail.     

Autophagy dysregulation mediates the damage of high glucose to retinal pigment epithelium cells

Intraocular pressure (IOP) modifications in patients with acute central/hemicentral retinal vein occlusions (RVOs) consist in IOP reductions and increases. The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor, that increases gradually until 3mo after the venous occlusion onset, and then finally disappears after month 4th. The IOP increases lead to the ocular hypertension and glaucoma. The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups: 1) the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis; 2) the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance (ocular hypertension, primary angle-closure, primary angle-closure glaucoma, and open angle glaucomas); and 3) the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations, lacking a causal connection between the 2 conditions.     

The fellow eye in retinal vein occlusive disease

Bilateral occurrence of retinal vein occlusive disease is relatively uncommon. In this retrospective review of 157 patients with retinal vein occlusion, 74 had unilateral major trunk occlusion (MTO), i.e., either central (CRVO) or hemicentral (hemi-CRVO) retinal vein occlusion, 12 had MTO in both eyes, and two had MTO in one eye and branch retinal vein occlusion (BRVO) in the other. In 69 patients there was unilateral BRVO. Thus, 8.9% of the patients had bilateral retinal vein occlusive disease of any type. Of the 88 patients with MTO in at least one eye, 13.6% had MTO disease in the fellow eye as well and only 2.3% had BRVO in the fellow eye. Major trunk occlusion in one eye thus appears to be a greater risk factor than BRVO for the bilateral occurrence of retinal vein occlusive disease. Another factor predisposing to bilateral occurrence in the group of patients with MTO was the coexistence of diabetic retinopathy (P less than 0.05).     

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

AIM: To explore levels and determinants of awareness and knowledge about glaucoma among patients. METHODS: This was a cross-sectional study that included adult patients from October to the end of December 2018. A semi-structured questionnaire was designed by the researchers to measure the levels of awareness and knowledge about 18 basic information about glaucoma. The sheet was divided into 4 domains: types of glaucoma; risk factors; clinical features; and management. A knowledge score (KS, range= 0-18) was calculated, with higher scores indicating higher levels. RESULTS: A total of 383 patients responded to the questionnaire, 61.9% males, mean±SD age was 38.5±12.94 years old, and 61.6% had a university degree or higher. Of them, 6.3% and 23.2% reported personal and family history of glaucoma, respectively. The most frequently reported source of information about glaucoma was another person with glaucoma (28.2%), followed by physicians (24.8%) and TV (19.6%). Knowledge by item ranged from 3.1% to 82.5% correctness rate, while KS showed mean=5.91 and median=5; and reliability testing of the knowledge scale showed Cronbach’s alpha=0.782. Higher KS were found among respondents with higher educational level (P =0.036), diabetes history (P=0.025), and personal (P<0.001) and family (P<0.001) history of glaucoma. CONCLUSION: This study reveals low awareness and knowledge levels about glaucoma among the attendees of a local eye care hospital, where several misconceptions about disease risk factors, clinical features, and management are identified.     

A review on vasohibin and ocular neovascularization

AIM: To evaluate and compare the incidences of ocular hypertension and severe intraocular pressure (IOP) elevation after posterior subtenon injection of triamcinolone acetonide (PSTA) for various diseases.METHODS: Totally 179 eyes that had received PSTA for diabetic macular edema, pseudophakic cystoid macular edema, branch retinal vein occlusion, central retinal vein occlusion (CRVO), choroidal neovascularization or noninfectious uveitis were retrospectively enrolled. The primary outcomes included ocular hypertension defined as an IOP >21 mm Hg, and severe IOP elevation defined as a rise of 10 mm Hg or more in IOP compared with baseline. Cox regression models were used to analyze the hazard ratios (HRs) among different diseases.RESULTS: After PSTA, the mean IOPs from month 1 to month 6 all significantly increased (P<0.05). Ocular hypertension occurred in 30.7% of eyes (median time: 8wk), and severe IOP elevation occurred in 16.2% of eyes (median time: 9wk). Patients receiving PSTA for CRVO or uveitis had a significantly higher risk for ocular hypertension (HR=3.049, P=0.004 for CRVO; HR=5.464, P=0.019 for uveitis) and severe IOP elevation (HR=2.913, P=0.034 for CRVO; HR=7.650, P=0.009 for uveitis). CONCLUSION: IOP significantly increased within 6mo after PSTA, with the onset of ocular hypertension happening mostly at 2 to 3mo. Patients of CRVO or noninfectious uveitis had a higher risk of ocular hypertension or severe IOP elevation after PSTA and should be monitored for IOP more carefully.     

Ocular surface temperature in central retinal vein occlusion: preliminary data

PURPOSE: To compare ocular surface temperature (OST) measures in patients with central retinal vein occlusion (CRVO) and controls. METHODS: Thirty-six patients with unilateral CRVO and 54 healthy volunteers were included in the study. OST was evaluated by infrared thermography. RESULTS: In CRVO eyes and in fellow, nonaffected eyes, OST values were lower than in controls (p<0.05). Ischemic CRVO eyes showed lower temperatures than nonischemic ones. CONCLUSIONS: Infrared thermography may be helpful in the management of patients with CRVO.     

Retinectomy for treatment of intractable glaucoma: long term results

AIM: To report long term efficacy and complications of retinectomy as an intraocular pressure lowering procedure for intractable glaucoma. METHODS: This was a consecutive interventional case series. In 44 consecutive eyes (39 patients, 22 men and 17 women) retinectomy was performed to lower the intraocular pressure (IOP) in patients with uncontrolled IOP (>35 mm Hg for more than 4 months) despite conventional filtering surgery and drug treatment. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by an intraocular gas tamponade of 20% C(3)F(8). Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (three eyes), secondary glaucoma due to aphakia (13 eyes), severe ocular trauma (seven eyes), uveitis (seven eyes), and glaucoma in Ehlers-Danlos syndrome (two). RESULTS: All patients underwent successful surgical retinectomy. All patients were followed for 5 years. Mean postoperative IOP after 4 years was 15.7 (SD 9.4) mm Hg, representing a decrease of IOP by 61% compared to the preoperative level (41.2 (9.4) mm Hg). In 52.3% of eyes long term regulation of IOP could be achieved without complications. Retinectomy was least effective in neovascular glaucoma because of central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed a tendency towards low IOP levels with subsequent phthisis bulbi. The initial visual acuity of all patients was lower than 20/50 (mean 1.8 (0.8) logMAR) in the treated eye. Final visual acuity was 2.3 (0.6) logMAR. 21 out of 44 cases developed retinal complications (retinal detachment or proliferative vitreoretinopathy (PVR)) after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for PVR. Nine eyes developed phthisis, seven of which were enucleated during the follow up. CONCLUSIONS: Long term results after retinectomy demonstrate its efficacy in otherwise intractable glaucoma. Efficacy and safety of retinectomy are dependent on the underlying disease.     

Intensive immunosuppression treatment for central retinal vein occlusion in a young adult: A case report

Purpose: To describe a case of severe central retinal vein occlusion (CRVO) in a young patient, in whom intensive immunosuppressive therapy improved the clinical outcome. Case report: A 35-yearold men presented with a first episode of CRVO in his right eye in 1990. Despite corticosteroids and laser treatment, rubeotic glaucoma developed and the eye had to be enucleated. Seven years later, CRVO developed in the fellow eye, with venous tortuosity and haemorrhages. An extensive systemic workup was unremarkable. Corticosteroids failed to control the clinical situation. Cells were seen in the anterior vitreous. Visual acuity decreased to 2/60. Cyclosporine and azathioprine were added, but did not prevent recurrences. Campath-1H treatment was then started and visual acuity improved to 6/36. In November 2000, visual acuity was 6/24 and haemorrhages had cleared. Discussion: Many authors have proposed a role for inflammation in the pathophysiology of CRVO in young patients. However, there is no general agreement on corticosteroid use in these patients. Our case illustrates that, in some settings, high-dose corticosteroids and intensive immunosuppression might be used successfully to preserve vision.     

Pseudoexfoliation and glaucoma in eyes with retinal vein occlusion

Purpose: To evaluate pseudoexfoliation (PE) and pre-existent glaucoma in eyes with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Methods: Consecutive eyes with a diagnosis of BRVO (73 eyes of 70 patients) and CRVO (53 eyes of 49 patients) examined between July and December 1998 comprised the study eyes. Age-matched control group consisted of 384 eyes of 192 outpatients. The prevalence of PE and glaucoma were determined and appropriate statistical tests were performed. Results: PE was present in six of 73 eyes with BRVO (8.2%), 11 of 53 eyes with CRVO (20.8%) and 20 of 384 control eyes (5.2%). Two of 73 eyes with BRVO (2.7%) and 10 of 53 eyes with CRVO (18.9%) had glaucoma. Compared with the control eyes, PE was significantly more common in eyes with CRVO and coexistent glaucoma was significantly more common both in eyes with CRVO and in eyes with BRVO. Conclusion: While glaucoma seems to be a risk factor both for BRVO and CRVO, PE is a likely risk factor for CRVO.     

眼球轴长与视网膜中央静脉阻塞关系的探讨

目的探讨眼球轴长与视网膜中央静脉阻塞(centralreinalveinocclusion,CRVO)的相关关系.方法采用A超测量30例CRVO患者及120例年龄匹配的正常人及白内障摘除患者眼球轴长.结果CRVO组患眼平均轴长(22.54±0.74)mm,对侧眼平均轴长(22.95±0.92)mm;经统计学处理,差异无显著性(t=2.94,P>0.05).对照组右眼平均轴长(23.45±0.66)mm,左眼平均轴长(23.56±0.95)mm,左右眼比较差异无显著性(t=1.96,P>0.05).CRVO组患眼与对照组轴长比较,差异有显著性(t=4.09,P<     

Ahmed青光眼阀植入联合视网膜光凝或冷凝治疗新生血管性青光眼

目的:探讨Ahmed青光眼阀植入联合视网膜光凝或冷凝术对新生血管性青光眼治疗的临床效果。方法:选取4a来住院的新生血管性青光眼56例58眼,其中视网膜中央静脉阻塞25例25眼,糖尿病性视网膜病变21例23眼,视网膜血管炎5例5眼,颈动脉狭窄4例4眼,视网膜分支静脉阻塞1例1眼,平均年龄50.6岁,均行Ahmed青光眼阀植入联合视网膜光凝或冷凝治疗,其中47眼于手术前后行全视网膜光凝,11眼于手术中联合周边视网膜冷凝术,平均随访18.0±6.2mo,观察手术前后视力和眼压的变化以及术后并发症的情况,结果进行统计学分析。结果:视力:术后43眼有不同程度地提高,15眼无变化,无视力下降者。眼压:随访6mo时眼压由术前49.56±8.25mmHg降至17.86±5.25mmHg,总成功率为85%;随访12mo时,眼压由术前50.25±7.18mmHg降至18.80±6.81mmHg,总成功率为78%;24mo以上随访19眼,眼压由术前51.05±8.10mmHg降至20.12±7.01mmHg,总成功率为74%,手术前后眼压比较差异有非常显著性。并发症主要有前房出血、前房延缓形成、引流管内口堵塞、引流盘纤维包裹,经术后处理均得到了恢复。结论:Ahmed青光眼阀植入联合视网膜光凝或冷凝是治疗新生血管性青光眼安全有效的方法之一。     

Medical conditions underlying retinal vein occlusion in patients with glaucoma or ocular hypertension.

Forty-three patients with glaucoma and 24 patients with ocular hypertension presenting with a retinal vein occlusion were medically assessed. The prevalence of systemic hypertension was 60.5% in those with glaucoma and 66.6% with ocular hypertension. The prevalence of hyperlipidaemia was 38.1% in those with glaucoma and 37.5% in those with ocular hypertension. These findings were compared with those from a carefully age-sex matched group of patients presenting with a retinal vein occlusion without evidence of glaucoma or ocular hypertension. There were no statistical differences between any of the groups (52.2% had systemic hypertension and 28.8% had hyperlipidaemia). There was also a strikingly high prevalence of systemic hypertension (89%) and hyperlipidaemia (55.5%) in nine of the patients who had evidence of a recurrent retinal vein occlusion associated with glaucoma, and these prevalence rates were strikingly similar to the rates in patients with recurrence but without glaucoma. The data suggest that glaucoma or ocular hypertension has a less prominent aetiological role in the development of a retinal vein occlusion than underlying medical causes and that full medical assessment is worthwhile.