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Nonischemic Central Retinal Vein Occlusion

Nonischemic Central Retinal Vein Occlusion

 

Case 2:
Resolving Central Retinal Vein Occlusion

Inability to focus and blurred vision in the right eye of recent onset prompted a 71-year-old woman to seek medical attention. Her vision had deteriorated progressively over 2 weeks; now her visual acuity measured 20/100 in the right eye and 20/25 in the left eye. There was no afferent pupillary defect, and the intraocular pressure was normal in both eyes.

The patient was taking hydrochlorothiazide, 5 mg/d, for longstanding hypertension and aspirin-meprobamate, 200 mg/d, for arthritis and headaches. Her blood pressure was 128/70 mm Hg, and auscultation revealed no carotid bruits. The patient's complete blood cell count; erythrocyte sedimentation rate; and C-reactive protein, blood glucose, and lipid levels were all normal. A carotid duplex ultrasonogram showed no hemodynamically significant stenosis and essentially normal velocities of blood flow.

A slit-lamp examination revealed mild nuclear sclerotic cataracts in both eyes. A dilated funduscopic examination disclosed a moderately congested optic nerve with dilated and tortuous retinal vessels (A). Scattered throughout the fundus were dot, blot, and flame-shaped hemorrhages. A few yellowish white cotton-wool spots were also seen. A fluorescein angiogram confirmed a nonischemic central retinal vein occlusion (CRVO).

The patient returned 5 weeks later. The vision in the right eye had improved to 20/40. A dilated funduscopic examination found resolving optic disc congestion, less dilation and tortuosity of the retinal blood vessels, and resolving retinal hemorrhages and cotton-wool spots (B).

Spontaneous improvement can occur in CRVO, especially if the condition remains nonischemic (ie, if neovascularization of the iris or retina does not occur). All patients with ischemic CRVO and those at high risk for conversion to ischemic status (ie, who show capillary nonperfusion on fluorescein angiographic examination) should be followed up monthly for 6 months. Up to 30% of eyes with nonischemic CRVO will become ischemic in 3 years.1

If fluorescein angiography is not available, a relative afferent pupillary defect test may provide additional diagnostic and prognostic information and help determine the risk of ischemia and neovascularization.2 If an afferent pupillary defect develops, ischemia of the retina will likely ensue.

References

REFERENCES:
1. Greenberg PB, Gupta G. Current management of retinal vein occlusion. Retinal Physiol. 2005;2:18-23.
2. Hayreh SS, Klugman MR, Beri M, et al. Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase. Graefes Arch Clin Exp Ophthalmol. 1990;228:201-217.
 
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