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

Abstract

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 four functional tests [visual acuity, visual fields, relative afferent pupillary defect (RAPD), electroretinography (ERG)] and two morphologic 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:RAPD was most reliable in uniocular CRVO (with a normal fellow eye), followed closely by ERG in all cases; combined information from RAPD 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.

Definition and Classification of Retinal Vein Occlusion

“…BRVO is more common than CRVO. In BRVO, a branch of the retinal venous system is occluded, while in CRVO, the occlusion is located in the central retinal vein [11][12][13][14][15][16] . BRVO is divided further into major BRVO and macular BRVO.…”

The 30‐Hz flicker cone ERG for monitoring the early course of central retinal vein occlusion

“…In these studies patients with a few days up to many months duration of their central retinal vein occlusion have been examined (Vannas 1960;Sabates et al 1983;Kaye & Harding 1988;Severns & Johnson 1993;Johnson et al 1988;Johnson & McPhee 1993;Hayreh et al 1989Hayreh et al , 1990Karpe 1945;Morrell et al 1991;Breton et al 1989;Williamson et al 1997;Larsson et al 1998). We have earlier reported on a group of patients with central retinal vein occlusion, who had their first ERG examination done within 2 weeks after the onset of their symptoms.…”

Clinico-epidemiological characteristics of central retinal vein occlusion in a tertiary level eye care center of Nepal

“…All patients included in the study were classified with regard to their ischemic status into two groups, ischemic CRVO ( Figure 1) and non-ischemic CRVO (Figure 2). To differentiate ischemic and non-ischemic CRVO functional tests (visual acuity, relative afferent pupillary defect) and morphological tests (ophthalmoscopy, fundus fluorescein angiography) were used (Hayreh et al, 1990). A detailed history was recorded which included visual loss and past history with relevance to systemic diseases like diabetes, hypertension and hyperlipidemia.…”