Atlas of Ophthalmology

Conversion of Nonischemic to Ischemic Hemicentral Retinal Vein Occlusion (Fluorescein fundus angiography, Colour photography)

Retina -> Vascular Diseases (see also: Systemic Immunologic Diseases) -> Retinal Vein Occlusion
Patient: 79 years of age, female, BCVA 0.16 at OD, 0.3 at OS, IOP 21/24 mmHg under Xalatan. General Medical History: empty. Ocular Medical History: Primary open angle glaucoma. Main Complaint: Deterioration of vision at OS Methods: Colour photography, Fluorescein fundus angiography. Findings: Fluorescein fundus angiography in 2012 (first visit): No focal capillary nonperfusion areas. Fluorescein fundus angiography in 2013 (second visit): Presence of multiple isolated focal capillary nonperfusion areas. Colour photography in 2013 (second visit): Multiple retinal hemorrhages, no retinal microinfarcts, glaucomatous optic nerve atrophy. Discussion Differentiating ischemic CRVO from nonischemic CRVO is crucial. Fluorescein fundus angiography during the early acute phase of CRVO provided reliable information about retinal capillary nonperfusion in approximately 60% of cases. Visual outcome is good in nonischemic CRVO and poor in ischemic CRVO. Hayreh (1) suggested, that a clear differentiation of CRVO into nonischemic and ischemic types, based primarily on functional criteria, is fundamental in determining visual outcome. He reported that visual acuity was 20/100 or better in 78% with nonischemic CRVO and in only 1% with ischemic CRVO. Final visual acuity was 20/100 or better in 83% with nonischemic CRVO and in only 12% with ischemic CRVO. Of 100% eyes with nonischemic CRVO, about 10% converted to the ischemic type. Hayreh reported, that there was a higher prevalence of history of cerebrovascular disease in those that converted from nonischemic to ischemic CRVO. Most CRVO eyes start as nonischemic and some convert later to ischemic CRVO. Literature: (1) Hayreh SS, Podhajsky PA, Zimmerman MB. Natural history of visual outcome in central retinal vein occlusion. Ophthalmology. 2011 Jan;118(1):119-133.e1-2. doi: 10.1016/j.ophtha.2010.04.019. Epub 2010 Aug 17.

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