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Natural History and Clinical Management of Central Retinal Vein Occlusion

Natural History and Clinical Management of Central Retinal Vein Occlusion Abstract Objective: To provide clinical management guidelines for eyes with central retinal vein occlusion. Design: Prospective cohort study with randomized clinical trials of specific subgroups of patients. Three-year follow-up every 4 months. Setting: Nine ophthalmology practices. Patients: Seven hundred twenty-five patients with central vein occlusion. Main Outcome Measures: Iris neovascularization (INV), neovascular glaucoma, and visual acuity. Results: Visual acuity outcome was largely dependent on initial acuity. Sixty-five percent of patients with initially good visual acuity (20/40 or better) maintained visual acuity in the same range at the end of the study. Patients with intermediate initial acuity (20/50-20/200) showed a variable outcome: 19% improved to better than 20/50, 44% stayed in the intermediate group, and 37% had final visual acuity worse than 20/200. Patients who had poor visual acuity at the first visit (<20/200) had an 80% chance of having a visual acuity less than 20/200 at final visit, whether perfused or nonperfused initially. In the first 4 months of follow-up, 81 (15%) of the 547 eyes with perfusion converted to ischemia. During the next 32 months of follow-up, an additional 19% of eyes were found to have converted to ischemia for a total of 34% after 3 years. The development of nonperfusion or ischemia was most rapid in the first 4 months and progressed continuously throughout the entire duration of follow-up. Iris neovascularization of at least 2-clock hours, and/or angle neovascularization (ANV) developed in 117 (16%) of the 714 eyes. Sixty-one of the 117 eyes that had INV/ANV were initially categorized as nonperfused or indeterminate; 56 of the 117 eyes were initially categorized as perfused. When INV/ANV occurred, it was treated promptly with panretinal photocoagulation. The strongest predictors of INV/ANV were visual acuity (P<.001) and the amount of nonperfusion seen by fluorescein angiogram (P<.001). For eyes initially categorized as nonperfused or indeterminate, 35% (61/176) developed INV/ANV, compared with 10% (56/538) for eyes initially categorized as perfused. Other risk factors were venous tortuosity (P=.02), extensive retinal hemorrhage (P=.07), and duration less than 1 month (P=.08). Neovascular glaucoma that was unsuccessfully managed with medical treatment developed in only 10 eyes. No eye was enucleated. Conclusions: Visual acuity at baseline is a strong predictor of visual acuity at 3 years for eyes with good vision and eyes with poor vision, but a poor predictor for intermediate acuities. Visual acuity is also a strong predictor for the development of INV/ANV, as is nonperfusion. During the course of follow-up, one third of the eyes with perfusion converted to eyes with ischemia. Clinical management guidelines, developed from these and previously reported Central Vein Occlusion Study data, are presented. References 1. Central Vein Occlusion Study Group. Central Vein Occlusion Study of photocoagulation therapy: manual of operations . Online J Curr Clin Trials . 1993. 2. Central Vein Occlusion Study Group. Central Vein Occlusion Study of photocoagulation therapy: design and baseline . Online J Curr Clin Trials . 1993. 3. The Central Vein Occlusion Study Group. Baseline and early natural history report: the Central Vein Occlusion Study . Arch Ophthalmol . 1993;111:1087-1095.Crossref 4. The Central Vein Occlusion Study Group. A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion: the Central Vein Occlusion Study Group N report . Ophthalmology . 1995;102:1434-1444.Crossref 5. The Central Vein Occlusion Study Group. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion: the Central Vein Occlusion Study Group M report . Ophthalmology . 1995;102:1425-1433.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Natural History and Clinical Management of Central Retinal Vein Occlusion

Archives of Ophthalmology , Volume 115 (4) – Apr 1, 1997

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References (5)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150488006
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To provide clinical management guidelines for eyes with central retinal vein occlusion. Design: Prospective cohort study with randomized clinical trials of specific subgroups of patients. Three-year follow-up every 4 months. Setting: Nine ophthalmology practices. Patients: Seven hundred twenty-five patients with central vein occlusion. Main Outcome Measures: Iris neovascularization (INV), neovascular glaucoma, and visual acuity. Results: Visual acuity outcome was largely dependent on initial acuity. Sixty-five percent of patients with initially good visual acuity (20/40 or better) maintained visual acuity in the same range at the end of the study. Patients with intermediate initial acuity (20/50-20/200) showed a variable outcome: 19% improved to better than 20/50, 44% stayed in the intermediate group, and 37% had final visual acuity worse than 20/200. Patients who had poor visual acuity at the first visit (<20/200) had an 80% chance of having a visual acuity less than 20/200 at final visit, whether perfused or nonperfused initially. In the first 4 months of follow-up, 81 (15%) of the 547 eyes with perfusion converted to ischemia. During the next 32 months of follow-up, an additional 19% of eyes were found to have converted to ischemia for a total of 34% after 3 years. The development of nonperfusion or ischemia was most rapid in the first 4 months and progressed continuously throughout the entire duration of follow-up. Iris neovascularization of at least 2-clock hours, and/or angle neovascularization (ANV) developed in 117 (16%) of the 714 eyes. Sixty-one of the 117 eyes that had INV/ANV were initially categorized as nonperfused or indeterminate; 56 of the 117 eyes were initially categorized as perfused. When INV/ANV occurred, it was treated promptly with panretinal photocoagulation. The strongest predictors of INV/ANV were visual acuity (P<.001) and the amount of nonperfusion seen by fluorescein angiogram (P<.001). For eyes initially categorized as nonperfused or indeterminate, 35% (61/176) developed INV/ANV, compared with 10% (56/538) for eyes initially categorized as perfused. Other risk factors were venous tortuosity (P=.02), extensive retinal hemorrhage (P=.07), and duration less than 1 month (P=.08). Neovascular glaucoma that was unsuccessfully managed with medical treatment developed in only 10 eyes. No eye was enucleated. Conclusions: Visual acuity at baseline is a strong predictor of visual acuity at 3 years for eyes with good vision and eyes with poor vision, but a poor predictor for intermediate acuities. Visual acuity is also a strong predictor for the development of INV/ANV, as is nonperfusion. During the course of follow-up, one third of the eyes with perfusion converted to eyes with ischemia. Clinical management guidelines, developed from these and previously reported Central Vein Occlusion Study data, are presented. References 1. Central Vein Occlusion Study Group. Central Vein Occlusion Study of photocoagulation therapy: manual of operations . Online J Curr Clin Trials . 1993. 2. Central Vein Occlusion Study Group. Central Vein Occlusion Study of photocoagulation therapy: design and baseline . Online J Curr Clin Trials . 1993. 3. The Central Vein Occlusion Study Group. Baseline and early natural history report: the Central Vein Occlusion Study . Arch Ophthalmol . 1993;111:1087-1095.Crossref 4. The Central Vein Occlusion Study Group. A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion: the Central Vein Occlusion Study Group N report . Ophthalmology . 1995;102:1434-1444.Crossref 5. The Central Vein Occlusion Study Group. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion: the Central Vein Occlusion Study Group M report . Ophthalmology . 1995;102:1425-1433.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Apr 1, 1997

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