Pattern of Vascular Nonperfusion in Retinal Venous Occlusions Occurring Within the Optic Nerve With and Without Optic Nerve Head Swelling

Abstract

To investigate the significance of optic nerve head swelling (ONHS) in relation to the pattern of vascular nonperfusion, visual acuity (VA), and demographic profile in retinal venous occlusions (RVOs) occurring within the optic nerve. Methods: Cases of RVO occurring within the optic nerve were divided on the basis of the presence (105 cases) or absence (163 cases) of ONHS. This division was performed by examining the color stereo fundus photographs in conditions masked from other clinical parameters. Duration of symptoms before assessment, age, and sex distributions were compared. The vein involved was identified, and the occlusion was confirmed to have occurred within the optic nerve by observing that the vein pierced the lamina cribrosa as a dilated vein. Fluorescein angiographs were examined, and the extent of vascular nonperfusion in the macula and peripheral retina was quantified from grade 1 to grade 4. The extent of break in the perifoveal capillary arcade was graded as 0, less than or equal to 90°, and greater than 90°. Bestcorrected VA was assessed using the Snellen chart. Results: The 2 groups were comparable in terms of the duration of the symptoms before examination. The mean age was significantly younger in the group with ONHS (58.3 vs 65.1 years, PϽ.001). Age distribution by sex From the Eye and Vision Research Institute

Is optic nerve head swelling of prognostic value in central retinal vein occlusion?

“…This is a possible bias in our study, where the patients with ONHS were examined earlier after the onset of CRVO than the patients without ONHS. This is one possible explanation for the diametrically different results of our study and the earlier reports indicating the presence of ONHS in CRVO associated with less severe vascular non-perfusion and better visual acuity [3]. Another explanation could be that ONHS is not a predictor of the prognosis in CRVO, but just an unrelated associated clinical finding [10,16].…”

“…In this study we have shown that fluorescein angiography, the cone b-wave implicit time in the 30-Hz flicker ERG and initial visual acuity are of prognostic value in CRVO, but we were unable to confirm the previous finding that ONHS is a sign of good prognosis in CRVO [3]. ONHS is a dynamic change and usually resolves with time [9].…”

Is optic nerve head swelling of prognostic value in central retinal vein occlusion?

“…This is a possible bias in our study, where the patients with ONHS were examined earlier after the onset of CRVO than the patients without ONHS. This is one possible explanation for the diametrically different results of our study and the earlier reports indicating the presence of ONHS in CRVO associated with less severe vascular non-perfusion and better visual acuity [3]. Another explanation could be that ONHS is not a predictor of the prognosis in CRVO, but just an unrelated associated clinical finding [10,16].…”

“…In this study we have shown that fluorescein angiography, the cone b-wave implicit time in the 30-Hz flicker ERG and initial visual acuity are of prognostic value in CRVO, but we were unable to confirm the previous finding that ONHS is a sign of good prognosis in CRVO [3]. ONHS is a dynamic change and usually resolves with time [9].…”

An overview of peripapillary hyperreflective ovoid mass-like structures

“…Retinal vascular occlusions may also result in axoplasmic stasis due to retinal and optic nerve head edema. This hypothesis is supported by the finding that PHOMS were found in 13% of patients with retinal vascular occlusions in the study by Dai et al [31,41]. PHOMS have also been reported in inflammatory conditions of both the optic nerve (optic neuritis) and retina (white dot syndromes) [25].…”

Functional benefits of a chorioretinal anastomosis at 2 years in eyes with a central retinal vein occlusion treated with ranibizumab compared with ranibizumab monotherapy

“…As there remains considerable controversy concerning the nature and location of the obstruction to venous outflow, direct resolution of this appears currently impractical 18 19. The only option to address the elevated CVP would be to bypass the site of the obstruction and this is achievable as an outpatient procedure with the L-CRA, where an obstructed retinal vein is anastomosed with an unobstructed choroidal vein 7–9.…”

Is optic nerve head swelling of prognostic value in central retinal vein occlusion?

“…This is a possible bias in our study, where the patients with ONHS were examined earlier after the onset of CRVO than the patients without ONHS. This is one possible explanation for the diametrically different results of our study and the earlier reports indicating the presence of ONHS in CRVO associated with less severe vascular non-perfusion and better visual acuity [3]. Another explanation could be that ONHS is not a predictor of the prognosis in CRVO, but just an unrelated associated clinical finding [10,16].…”

“…In this study we have shown that fluorescein angiography, the cone b-wave implicit time in the 30-Hz flicker ERG and initial visual acuity are of prognostic value in CRVO, but we were unable to confirm the previous finding that ONHS is a sign of good prognosis in CRVO [3]. ONHS is a dynamic change and usually resolves with time [9].…”

An overview of peripapillary hyperreflective ovoid mass-like structures

“…Retinal vascular occlusions may also result in axoplasmic stasis due to retinal and optic nerve head edema. This hypothesis is supported by the finding that PHOMS were found in 13% of patients with retinal vascular occlusions in the study by Dai et al [31,41]. PHOMS have also been reported in inflammatory conditions of both the optic nerve (optic neuritis) and retina (white dot syndromes) [25].…”

Functional benefits of a chorioretinal anastomosis at 2 years in eyes with a central retinal vein occlusion treated with ranibizumab compared with ranibizumab monotherapy

“…As there remains considerable controversy concerning the nature and location of the obstruction to venous outflow, direct resolution of this appears currently impractical 18 19. The only option to address the elevated CVP would be to bypass the site of the obstruction and this is achievable as an outpatient procedure with the L-CRA, where an obstructed retinal vein is anastomosed with an unobstructed choroidal vein 7–9.…”

Is optic nerve head swelling of prognostic value in central retinal vein occlusion?

“…This is a possible bias in our study, where the patients with ONHS were examined earlier after the onset of CRVO than the patients without ONHS. This is one possible explanation for the diametrically different results of our study and the earlier reports indicating the presence of ONHS in CRVO associated with less severe vascular non-perfusion and better visual acuity [3]. Another explanation could be that ONHS is not a predictor of the prognosis in CRVO, but just an unrelated associated clinical finding [10,16].…”

“…In this study we have shown that fluorescein angiography, the cone b-wave implicit time in the 30-Hz flicker ERG and initial visual acuity are of prognostic value in CRVO, but we were unable to confirm the previous finding that ONHS is a sign of good prognosis in CRVO [3]. ONHS is a dynamic change and usually resolves with time [9].…”

An overview of peripapillary hyperreflective ovoid mass-like structures

“…Retinal vascular occlusions may also result in axoplasmic stasis due to retinal and optic nerve head edema. This hypothesis is supported by the finding that PHOMS were found in 13% of patients with retinal vascular occlusions in the study by Dai et al [31,41]. PHOMS have also been reported in inflammatory conditions of both the optic nerve (optic neuritis) and retina (white dot syndromes) [25].…”

Functional benefits of a chorioretinal anastomosis at 2 years in eyes with a central retinal vein occlusion treated with ranibizumab compared with ranibizumab monotherapy

“…As there remains considerable controversy concerning the nature and location of the obstruction to venous outflow, direct resolution of this appears currently impractical 18 19. The only option to address the elevated CVP would be to bypass the site of the obstruction and this is achievable as an outpatient procedure with the L-CRA, where an obstructed retinal vein is anastomosed with an unobstructed choroidal vein 7–9.…”