Natural History of Visual Outcome in Central Retinal Vein Occlusion

Abstract

Objective-To investigate systematically the natural history of visual outcome in central retinal vein occlusion (CRVO). Design-Cohort study.Participants-667 consecutive CRVO patients (697 eyes) with CRVO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. CRVO was classified into nonischemic (588 eyes) and ischemic (109 eyes) at initial visit, based on functional and morphological criteria. Main Outcome Measures-Visual acuity and visual fields.Results-Of the eyes first seen within 3 months of onset, visual acuity was 20/100 or better in 78% in non-ischemic CRVO and only 1% in ischemic CRVO (p<0.0001), and visual field defects were minimal or mild in 91% and 8% respectively (p<0.0001). Final visual acuity, on resolution of macular edema, was 20/100 or better in 83% in non-ischemic CRVO and only 12% in ischemic CRVO (p<0.0001), and visual field defects minimal or mild in 95% and 18% respectively (p<0.0001). On resolution of macular edema, in eyes with initial visual acuity 20/70 or worse, visual acuity improved in 59% of the non-ischemic CRVO, with no significant (p=0.55) improvement in ischemic CRVO. Similarly, on resolution of macular edema, in eyes with moderate to severe initial visual field defect, improvement was seen in 86% of non-ischemic CRVO eyes but no significant (p=0.83) improvement in ischemic CRVO. In non-ischemic CRVO, development of foveal pigmentary degeneration and/or epiretinal membrane was the main cause of poor final visual acuity. This shows that initial presentation and the final visual outcome in the two types of CRVO are totally different.Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947 sohan-hayreh@uiowa.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2012 January 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-A clear differentiation of CRVO into non-ischemic and ischemic types, based primarily on functional criteria, is crucial and fundamental in determining visual outcome. Visual outcome is good in non-ischemic CRVO and poor in ischemic CRVO Unders...

Influence of diabetes and diabetes type on anatomic and visual outcomes following central rein vein occlusion

“…However, Hayreh et al suggested that CVs formation may be associated with a delay in resolution of macular edema and worse prognosis. 9 Recent data from the SCORE study may indicate that the development of venous collaterals does not demonstrate an independent association with visual acuity in eyes with CRVO. 36 Although limited to only 15 instances of CV formation, our data did not demonstrate a significant difference in the incidence of collateral formation following CRVO in patients with or without DM.…”

“…8 The ischemic CRVO generally presents with poorer visual acuity at baseline, worse visual prognosis and higher risk of developing neovascularization as compared with the nonischemic group. 8,9 Visual decline in patients with CRVO may occur from ischemic injury to the retina, macular edema, vitreous hemorrhage, retinal neovascularization, and/or neovascular glaucoma. 10 There is an associated vision-related decline in quality of life.…”

Central retinal vein occlusion: modifying current treatment protocols

“…The ischemic subtype of CRVO accounts for about 20% of cases and is associated with worse initial presenting visual acuity (VA) and poor visual prognosis even after edema resolution. 6 A cohort study showed that presenting VA in ischemic CRVO patients was (6/30) or better in only 1% of ischemic CRVO patients compared with 78% of non-ischemic patients. 6 Furthermore, final VA after resolution was better than 6/30 in only 12% of ischemic CRVO patients compared with 83% in non-ischemic patients.…”

“…6 A cohort study showed that presenting VA in ischemic CRVO patients was (6/30) or better in only 1% of ischemic CRVO patients compared with 78% of non-ischemic patients. 6 Furthermore, final VA after resolution was better than 6/30 in only 12% of ischemic CRVO patients compared with 83% in non-ischemic patients. Stratifying patients early based on the perfusion state and the initial presenting visual acuity is useful in predicting outcomes.…”

“…Stratifying patients early based on the perfusion state and the initial presenting visual acuity is useful in predicting outcomes. 6,7 Current treatment modalities…”