Glaucoma as a prognostic factor of central retinal vein occlusion: visual and anatomical outcomes and occurrence of ischaemic central retinal vein occlusion

Abstract

Purpose To compare the functional and anatomical outcomes of central retinal vein occlusion (CRVO) according to the presence of glaucoma before the onset of CRVO, and to assess whether pre‐existing glaucoma affects the prognosis of CRVO in terms of development and conversion to ischaemic CRVO. Methods In this retrospective cohort study, patients with treatment‐naïve CRVO were enrolled between December 2009 and February 2019. The patients were classified into two groups according to the presence of pre‐existing primary open‐angle glaucoma at CRVO diagnosis. We reviewed medical records regarding basic demographics, ocular characteristics and treatments. The effects of pre‐existing glaucoma on the occurrence of ischaemic CRVO were also investigated using Cox proportional hazard models. Results Of 166 eyes from 166 patients, 26 (15.7%) had pre‐existing glaucoma. The pre‐existing glaucoma group revealed significantly older (69.4 ± 13.3 versus 56.5 ± 15.9) and lower BCVA at baseline (1.06 ± 0.75 versus 0.64 ± 0.58, logMAR) and final visits (1.56 ± 1.35 versus 0.64 ± 0.48, logMAR) (all p < 0.05) than non‐glaucomatous group. In terms of perfusion status of CRVO, the glaucoma group showed higher incidence of ischaemic CRVO (30.8% versus 5.3%, p = 0.052) at initial and last visits as well as more disorganization of retinal inner layers (DRIL) at 3 months (76.0% versus 49.6%, p = 0.015). Pre‐existing glaucoma (hazard ratio (HR) = 2.141, p = 0.014), lower vision at baseline (HR = 2.071, p = 0.001) and DRIL at 3 months (HR = 2.905, p = 0.011) were significant risk factors for the occurrence of ischaemic CRVO. Conclusion In patients with CRVO, pre‐existing glaucoma was associated with poorer visual and anatomical outcomes, and played as a significant risk factor for the development and conversion to ischaemic CRVO with lower vision and presence of DRIL at early phase of CRVO.

Causal Association between Glaucoma and Risk of Retinal Vascular Occlusion: A Mendelian Randomization Study

“…The physical obstruction of the retinal venous system is generally induced by thrombosis, deformation of the vein wall, and external biomechanical compression secondary to glaucoma 32 . Mechanically, it is postulated that the elevated intraocular pressure compresses the lamina cribrosa and optic disc, thereby leading to the stretching and weakening of the vessel wall, which further predisposes the retinal vein to occlusion 33 . Meanwhile, the direct biomechanical insult of intraocular pressure obstructs the retinal vein drainage and induces venous stasis, consequently exacerbating the intimal proliferation in the vein 34 .…”

Biomechanical homeostasis in ocular diseases: A mini-review

“…The physical obstruction of the retinal venous system is generally induced by thrombosis, deformation of the vein wall, and external biomechanical compression secondary to glaucoma ( 68 ). Mechanically, it is postulated that the elevated IOP compresses the LC and optic disc, thereby leading to the stretching and weakening of the vessel wall, which further predisposes the retinal vein to occlusion ( 69 ). An excessive dropout of parapapillary choroidal microvasculature is also observed in RVO patients ( 70 ).…”